GW1--05814_Well Construction - GW1_20240926

WELL CONSTRUCTION RECORD IGW-1) rtit intcinal I Ix•Only:
1.Well('nNrsctor Infotmatton: -
Nick Young 14.WATER ZONER
WellumnctorName FROM .- I0 i,r_M•RlFIIfTN-_-- _
4605-A ti aGo n. zi
ti rt.
NC Well C rnrtraaot CMtticato Numb
IN.W. Poole Well and Pump Co. s,011rptC-To -TDIAMEIFR lla1U HICK Watt 0(
ISl.O AM DIAee aed THICKNESS MArclili%
Compam Name Q 1 ti Cl f., f Col0 In. a`t t' G 10.i V
A c� 16.INNER CASIRYO OR'WRING((geothermal cl.ed-Nap) ,__.
2.Well Construction Permit k: it d FROM 10 DIAMI1FR _THICKNESS I MATERIAL .
n. R. in
l is nil applicable wed!mnrtrvcnnn permits(se.I;IC.County,State,Variance.etc)
n. n. in
3.Well Use(check well use): _
Water Supply Well: 17,SC1tY,EN
FROM TO DIAMETER SLOT SIZE THICKNESS NIA IFRIAI,
Digriailhiral °Municipal Public n. n. In
DO thmnal(ldcating'Cooling Supply) ts in.Water Supply(single) n, n, i ~
e
Dlndustrial Commercial ❑Residential Water Supply(shared) IB.CRONY
❑lmgation ❑Wads'•100.000 GPI) FROM TO MATFRIAI. _FMPIACEMTNT ME moo K A worst
Non-Water Supply Well: 0 n- a 0 a Pd fl"-i= ,( ter
O\lonitonng ❑Recovery ft_ I --Y`
Infection Well: n. ,--
0.4quitix Recharge ❑Groundwater Remediatien
19.SAND/GRAVEI.PACK (applicable)
°Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MAI IRIAI. EMPIACEMENT METHOD
0 Aquifer Test ❑Stet na ater Drainage n. n.
°Experimental Technology °Subsidence Control n. R
❑Gcothamal(Closes loop) OTraca 20.DRILLING LOG(attach additional sheets If necessary)
OGexllarnal(llcatine Cooling Return) OOtlner(explain under 821 Remarks) FROM I ro DESCRIPTION r,turbans.r.1Vrerktype,pew lea rte..)
O a oL a "Top.SoN\
a Date wdl(a)Completed: tWl dLI Well lD# (2. ft 61.0 ft.
Clta.,l .:,.: - :!II ',J 1
5a.Well Location: 80 R 3is- ti ,5\o,k a e(
3ere.rv..) CAS CI ft. a SEP 2 O 2044
Facility/Owner Naloc Facilely mat Of applicable) A. rt.
13.1 CAra,a,a.‘ c ivy Gt.30 ta Se\ri..k.r c ft rt. ►rr.:.:^-4.L' y." .-y lira,
Penseal Address,City and zip n. 1 n. Diu.•••'`0'31
3a�� �� 21.REMARKS I
_ T Parcel Li,,,.:-.",,n No(PIN) Used steel hardened drive shoe
5b.Latitude and longitude in deg rees/n*suteslsecondc or declnnl degrees:
-
(dwell field,ooc la long n sufficient) 22.('crtincatlon:
35.5261 2-4.L, N -1R, 16131.2"L ,V aj4C7 - / a�
G.Wale)the'trellis): t'Permanent or °Temporary Stgnat e.,tr tt ell Coin Date
signing this form 1 hereby cr Atho�tie wells)was(werel constructed in nnrrdt•a a..a;r
7.Is this a repair to an existing well: OYes or allo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a cops
((:his a a repair,fill out known well construction iafonnaaom and=plain the nature of the of rhs rrrord has burn wnvided to the well owner.
repair under#21 remarks season or on the back of this form 23.Site diagram or additional well details:
You For GeoprobeJDPT or Closed-Loop(;eothernal Wells having the sane may use the back of this page to provide additional nett conshrictiom info
construction,only I GW-1 is muted. Indicate TOTAL NUMBER of wells (add"Se:aver in Remarks Box).You nay also attach additional pages if rinse .
drtlbd. 24.SUBMITTAL INSTRUCITONS
9.Total well depth below land surface:m e� 'aid 1 100' (�) Submit this GW-1 within 30 days of well completion per the follow h
➢k we: ➢ J IJ (example- )
10.511atk water level below top of casing: A C (�) 24a. For All Wells: Original form to Division of Water Resources(DWR),
Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If rater level a above casng are
II.Borehole diameter 6" tin) 24b.For Injection Wells:Copy to DWR,Undagrcemd Injection Control(TUC)
Program.1636 MSG Raleigh,NC 27699-1636
Rotary
12.Wee osErtructlon method: 24c.For Water Saiptdv said Open-Loop Ge(hernrl Return Wells:Copy to the
(I.e suss,rotary,cable.direct pock esc.) county environmental Eutlth dcpartmcsit of the county wbae installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Well,lrnwlucing,over 100,000 GPD:Copy to DWR.CCPCUA
13a.Yield(EFm) 4 Method dust:Blow Permit Program,11+1 I\NC.Raleigh,NC 27699-1611
13b.Dlahfectlon HTH
type: Amount:
From G'W.. North Carolina Department of Environmental Quality-Division of Water Resources Revised 64.20111