GW1--05637_Well Construction - GW1_20240916

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WELL CONSTRUCTION•RECO ' (GW-11 For Internal Use Only:' ,
'1.Well Coatraet•r I.fo. ':' i'' ."'": : - .. , . ! ., , .
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_ - .. .. .. •I�.WATER 2ANi8
' _ _Wen Codno[aeNaa PROM TOYDLle7m!IIOre ' - - .
. NC wen OodMo�C.ati6catOIMomhc% ' ' IS.OUTER CASING(for aala-aced weW OR LINER(tra• ticable
- s-n c'- ' J3 ro th-�v$ •PROM •ro: DIRMa1Lt v:� MATm!! ,
Cast Name .
. • `' Ii INNER CASING OR TUBING(eediamd dried-bap)
• 2.Wd1 CeaatracUoaPermlt*: G k..11 .J - I.
' .Toe!, ,• •DIAMmR - 'martins : MATIRItL'
, - •Thinpwnda(Le UIC Comm,.Starr.rattan co,lire.)• -—I-I, n• `,' m • syit, .. .-Th,n,- ..-pvf...e
- 3.Well Use(cheek well lire):
. - ' : Water Slimily Well:. - •
• PROM , .TO.4....1. DIAMirilt .SLOT6l7Z T1 OTU/3•• MAIL
• ' OAgticultwnl MunicipallPublic. '.
°Geothermal(Heetieg/C,00lmg Supply) daihal.Water Supply(!inale) n. ft •.
OlndrutrialiComatexcial. al'Water Supply(gland) is.GROUT .
. Olrtit 4o(r • OWdls>100.000 OPD PROM TO -• rdCLQetrbalBOD a�AM
Noe-WaterSapply.Well R' Lit'
. •, OMasiMrinB - °Rex o cry • It. It. a
Iajeetloa Well: l ei 1 ,:j
°Aquifer Recharge .. OGro dwiterRemediation
IL SARD/GRAVELPAC Ktif apallnHe) •
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OAquiferSforageandRecovery, OSalnutyBerrier - PROM - • To •r • MAMMALsnQracarlQtrMtrBol
°Aquifer Test °StormweterDrainage : , . _.f .I. tt. .
OEapenmeatelTechndogy • OSubaidmceCOntrol" . ' (t:, II .r It
°Geothermal(Closed lop) °Tracer . . '20.DRILLING LOG(attach additional siee&ifaeewa,J) •a ['Other 'ra ' I -
OGeathemd(BeabngloolmgRe(um) (e:gdamunder/21Remarks) PROM• TO R DLSC I IION(eateriaeias,nphadep,aa(,da
A DateWell(s)Completed: D' 7'21 MUMS• •, . , , tt ) tt .. i ,pA
' , ' " 5a.WellLowtioa. "` • • • • • • • . ' t ' 9R7 " LA S 7o .
'TAW
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�e rl el'D` 1z C c�1.� in - }'1 G r
FaalityN?waer Nma l • • - Facility BlS(if appYoablo) , tw • r-. ',.h. +j+
. + `• der Y. ( I h4LI . -•R' It. k 1me,.sA��.. ^v 4.w
A csa..eazip , >c tt. S EP-1."n 2024. '
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2LI1ZMARI{.9�
", Comity • ' : Pam!IdeatificationNo.(PIN) • I Um ,
• .. ,W'I X•J'.L
56.Latitude and longitude hi degreei/miautes/seconds or decimal degrees:
- , (fwelfieldarel ita%ceg), •• - • ztCer a_
' , • .3h' 1 ' .gig • • •N• �o / l` X
6.Is(are)the wel(s):' !eminent. or °Temporary ,•
I I_�O l S bofCa"147el,Cedrador • D,m--�
itok s hr ltiwebyeerroyriret►hawrlrOjr.nrMae)ovmarardat.marl ;
_7.Is tils a repair to as eslalLg well:.- -OYea or )No• _ • . ISAA'GtC 02C:0100 or1JAJVCAC 07C.o700.WdlCpn rn cttcnJtandordr;ndtt
ff this Is o ripc raft1 oat brown roll cor inaallon Ay(asroNow aplaln the na0awofthe. V/rk recoldlm boar provided to the Lion oiwrq:':.
rdpaA iarderl7l nanerkr:datorr°roil the baekofrhl:fonrt "
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23.Site'diagramr or additional well detain •
` S.For Gcoprobe/DPT or C1osed-Loop Geothermal Wells baying the sane Yoe may use:the back of this page to p ovde addthcnal well eoastnuctiue construction,only 1 OW-1 is needed. Indicate TOTAL NUMBER of wells . . (add'9eb Over'm Rlriarb Boz)-You may also attach additional pages ifnecc•
•drilled:_ I•:;
24.SUBMITTAL INS1'1tUC11ONS
Total well depth below laird .surface: dWh I
Farnmktpla nen:l4t all eirpenfdif!rr+rt f pie-3@700'arrd7®Io(r) ( ) Submit'this G within 30 nays of wel completion per(he followia
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10 Stetle water level below top ak.es dla: • lam) 24a. For All Well Original form to Division of Water Resiiur a
{fwMdrlerdl t:®boor enrbii soli,+- //�� Infaimatim Procrsting Unit,1617 WC,Raleigh,NC 17699-1617 �1
11 Borehole diameter: ., 1dm For Iajecttou*ells:Copy toLDWR,U r ',
12.Well constriction Method: O'1 a-Y(.t ._ . Program,1636 MSC.1Weigh,NC 27699-1636 ideation-
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Ce a• :!ot•rx eabla,d�ect paat4 ato) • - . li r 24e.For Water Supper and Ope'ri-Lo•p Geo(beriwl Ketone Walls:Copy'
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FOR WATER SUPPLY WS .�ty:�aanmental heailth department of the county whets installed
LLS ONLY: .
13a Yield m 24d.For Water Wells Prodida¢.tun 100,060 GPD:Copy to DWIt;CCM
(gym) a.5 Method Of tub' i r PermitPmgn n,!1611 MSC,.Ralergb,NC276i9S-1611 • -
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136.Didafectioa type.' 1 ' 1 l/ '' e. ' . . .
Amoat+l: