GW1--05716_Well Construction - GW1_20240920

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•' . WELL CONSTRUCTION RECO (G?W 1 For Internal pie Only: .
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IS.OIITER CA3IIH(i(far..i j sited wsJfr OR L[IYZR Of a i'inble)
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V' a J • U.INNER GSING ORTUHII7G(Lisliaad drier Ind 2.Wall Coeutrredoa Permit tL: ,• .J (/:/ PROM ' To,., n„urn�. t MAT�,�r,
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3.WellUse(check well use): •. . , f P ! /� �hr!h P
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Water Slimily Well:. , 17.SCItE1<N i .
• OAgncultunl O enieipal/Pu6ile snots TO I DL MalTat swans TDzaarsss KATO
OGeothetmd(Rceting&oolmg Supply) ' entiat Water S i it. >e 1, • ,
Wily(single) ft• ,ft.. la
OInduslrial/Comme oW idealist Wier Supply(ahated),
O►� OWdls>100•110110PD PROM . TO MA DIPL►c1'MattrMxpnoD&AM
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Non-WaterSrpply,Well: ' _ 'u�.•i
OMcwto.ins OR 'v. Z3' n /;�7/P �(fiI
• • Injection Well: y f!6YPs J�L1.,•,
OAquifirRecharEe • i rt. � it. i / �,'�
°Groundwater Remediation •
OAquiferStotaae and RecOYery OSalmityBrria �09MAt<DlGRAVSLPACKOfa•plln6la)
OAgniferTest OSto.mwater TO •��� 1aat.►CaMSNrMelaon
Dninsge , tt •:!; ft.
OBxpcnmental Technology • - OS
ubaidenoe• OGeothaimd(Qaaed Loop) OTsacer Control rt. :I!, IL
OGeot6e.ma1 Itl.DRILZ,IIIG LOG(atfaei additional Amu if aaxory)
Ilia ou1�&Rebttn) OOtha(aiplain under ll21Remab) IRON , TO,• D=Sam!floN(aMr.laLaa,w.IFeelc.• ft.'
� t.e+e,psis ores..
. 4 Date Wells)Completed f•-1(p -,Z
wee ID,r tc R
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•, . FaalitylOineerNees . • ' heility!Miff 1,0=610 a R,
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SCemtJ _ Priest ldmd(tat, .. (PRO
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(irviell La ihiar a • ade'hsat l lautesfseeonds or decimal de6reer f, ry
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f.b(are)the weil(s): ferieaDeat •r' ;OTet; Orary •
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. 7.L file a re 'tr to an .�2�Q7 _ �ii •iYeLCaoteadar " '; Debi��
lJrblyd. rA d�Gweil: °Yes -or N. i-• By'fining this lamahersby cat*dmrise*W)was(were)cooruatd4oOeop i .I awbairnxellcreoryaerket I3.t14C.tC07C bwHO Pvvi hI mO1C.07001 •. Cjr, • • j se•.- trdtl' s
. , repair arder VI remark sealwn or m tles beck,c �br rha not oar ifrlis ' .eJ�ielr rsoorJ/we beinP�l la de wsl o.mr
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B.For• • • •WDP7t'•r Closed-Loop .• ' , 23.Site diagram or'addlilo..l well details: .
eousbeensbvetieq;only.1(�W 1 is needP Geothermal Weds having tiro attire., " • You may melee hock of tins
Indicate TOTA1.NU1�BR of wells' . (add'Sce Ovei'to page to aketprovide additional well opt
ed
]tlinarlct Boxj.Yea may also attach bucfioa it
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1 p•des ifneex�
f.fi6)il well depth belsw land 2t SUBMITTAL INS'IRUCITUNS - • •
surface:_ �.
F`araerdH le
`p r " &oh`v rist(`empie-3 or ind;woo, (R) Submit Wla G7r Mfhun 30 da• ys'of well e•mpletioa per the fol swisg
Ill$t�fie inter level hciotr.to o ,1
wrrtade nt erl f mks*, +/; /�' zv (lL) .24s. Fir AK Origin_a1 form to Duran"of.Wa1 - • L
11 Boreholedlanteter Vr !�'- .j RO ns 161Tb13 ��• ' MSC, NC 27699-1617
'246..For L cur dies Copy to Ij -
.•,12.Well cousiruetton method 1 Progrem,163ti MSC., 'U bJection Control(n
(u 0 1 a Y(.) •_ �, tih.NC 27ti99-iti36
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cab.dieeet ,�`) 2�e•For Water S. I and O eu-),.a G��
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FOR WATER Sl)PPLYt3e euTaanm � e.mal Relwn WciL:Copy to
. . . . WILLS ONLY: cotaty
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13i.Yield(EPm) i 1' poor W IYe1Us Srodidu ., • .
Method of teak Raleigh, 100 0 -3-9 M :Copy to D
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