GW1--05820_Well Construction - GW1_20241001

W EL ,CONS TRI`CTBON RECORD(VW-1) fife lmclTul(i ix t _ --
I Well t'ontriactot lnformattrmt:
- .- It WATMt 7.0MIS
pie• •_ilk* in Rtat lane
4605-A 14,: n- //c..) ft. G
`h 11 r .'nnrractr^,'C rrtrt r e.-r Nwmber
N W Poole Well and Pump Co. is.OMEt CASINO Owraelaea.odw�l
►r,
'Ctmt t 1 R )0 R (p 16' ./
It IMMIX CASITIC Olt UM at ' �tTs , ' �
2.w4 Cocwtn Inn Permit I:()Li —e,,i, j 3 -dot" ( _i*nN To
R. R. ilia
:.het di appir�,t`�le re:'cra+.et.,,e�,.,h;permitsdR IIIC Coma nog Ventre*tX.I
Ma
3.V1'ell l'�se(check well taxi:
a N..
t7.30TR12t rortM�l C NATO
Water Sul[pls N'eA: auaRIRTRTI _SLOT MAI
i1MM TO
LAgricultural °Municipal Public " a- im
Dikothe mail(Ileattng'Coohng G, Supply gl ) " ti "`
pph) tdcnhal Wata Su v(sin c
°tndu.tnal'C.trnmacial Residential Water Supply(chaired) it mow
utmgatton DWdk>1()t).t)QO GPt) crest [Z� TtgMAn patnwCtNaJ,►K i --
Non-Water Supply We': 0 R 0 a t�/Ir t l
Monitxtac Dl2acnrn'
Injection V['ell:
it
°Aquifer Recharge
re.
DCaourdnatc Rdrtodtatwsi t9.ta`1isrGRAtTSL PACK inMe
:L'Aquila-Storage and Recovery °Salinity Berrie rR u Tn F1,�TiPUf, rwpt�C.t sir r Nr IHOO
C.4quifer Test CStornvvater Drainage " "
CExperimentai Technoto¢y
CC othCSuU<_ideece C xttrel " rt.etmal(Closed Loop) 2$.MILUrG T.01:(attach eddlnanel sheets If necesss a<_. `
mom To
O DESCRIPTION fair hariens,slliew trp4 try
Geor thrnas(HcatingCooting Return) COther(e plain under=21 Remarks) " " 1-0,Spt l
1.Date Was)Conipkted: 11—.� -,1.3 Well IDo ! ft. l D rt. i �l c ' "� ` •
Ss.Well Location: . t o " f62 " 6far);tc f T i_� 2f 24
" ft. o
Po 5J y perm " " _ .,
orvabFacility ID*(if applicable) ; + til:'t
FaeititY' Name " " ` .`.�: -'-.t �
? I C_ ref illes eel Ed F TA n - " " - ter,•
Pnyaxal Address.Cap. Zip I
r 21.RF.MA tXXS
L-;:,-.iee._ Used steel hardened drive shoe
Comity Parcel IdeattfteattOn No(PIN)
Sb.Latinnde and longitude in depeesttatimtes/secoda to decimal degrees:
if watt fell,
me la:long is sue class) 22.Certification:
O 3C , 1Z1 OC3 N `1!S.`il 5 8&(.G W �Cik6. P 2 // ?( —,4 3
r - Permanent or CTemporary S,cnui cofr , ell r Dace
G Is(att)thcwvlt,$). C
13y.ci_Qnrnq ekes Ann/4aai) got the weflGrJ was(aerr)c,xattnCrdrn c,:cer4orrr antk
well: 0 Yes or G No i.5.4 Nrtc ox.0108 o.till NO CDC.0200 WM Candreeeno Standardssna that a copy7.Is this a repair[o an existing tlrs record has bps In the writ o•.r<n.
Ijtlrs u a repair,fil oat ksowu lad ateorcaat aFl^^h1enn and co,.der.tun,of r1 c of 1
rrpa:r Feder#21 remarks season or as dr halt afdks form 23.Site diagram or additional well detalkt:
IL For GeeprobdlDPT or Closed-Loop Geothermal Welk having ilia same You may use the back of this page to provide additional vteli construction info
(add:Sec Over'in Remarks Box).You may also attach additional pages if necessary.
construction,only I GW I is ttee iai. Indicate TOTAL NUMBER of writs
drilled: 24.SUBMITTAL INSTRUCTIONS
9-Total well depth below land surface: / 5 (n') Submit this GW-1 within 30 days of well completion per the following:
For inn:epie,.ellr kat all doss(4fe rm(example-34200'and.a?I00')
24a. For All Wells: Original form to Division of Vaster Resources (DRR),
10.Static water Lewd below top of casing: tit•) information Processing Unit.16(7 MSC,Raleigh.NC 27699-1617
If miter trial rs(stem carang ear
6" 24b. For Injection Welts:Copy to MR.Underground Injection Control((L'C)
11.Rorehek diameter: tilt) Protttam,1636 MSC,Ratan.NC 27699.1636
12.WeilWeilcomtrurtlea method.:Rotary 2.k.ins water Suppiv and Open-I nop Genihrrn tl Return Wells:Cops to the
c at.a.ray.c.,:c.Carcat pick etc F county mvuhmntritlat health,eparmtrn;.if the:.urn what ms[a4&xi
FOR WATER ST PPf,Y WP.LES ONLY: 24sF Fur Water Adis producing;over Ithy M)GM:Copy to() R,CCPCUA
Blow Pantit Program,1611 M .Raleigh,NC 2'uY)-gel 1
lla.Yield(mu 3 G Method test:
HTH
!lb.Dlstnfectkan type: Anemia:
*a* Quality-@vain of Wrier Res.k.tce-. kayoed 6.6-Zol4