GW1--06028_Well Construction - GW1_20241011

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WELL CONSTRUCTION RECORD(GW-11.
Far Internal lim On1T .
1,Well Craticiefor reformation:
,,,,.°A ,Thdr1---3)1L
%it& ift.„4, • FROM TV ftxr.mmo---rft . —---
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J5...r"'''. 6 .. . IL
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IL D.
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ISM,A.7"Et Creetmtcr fkrtifmstkrt Tfuzacr -
1.1.OMR CAM%(fof ts&I-and wens)Oir LEVER(If" ' tale)/ 4
Morgan Well & Pump, INC MOM r i. DIAMETER ,TRICIOCES5 MAMMAL
— 1 IL 10 0 il• 6 1/8 l'a- SpR21 IPVC ....___
Company num
2...Weil Construction Fern&P:IA,C1) itiD7nc- n
—Lr - 7 .....__
-iereaut chilim OR TIMING(giatilirtial illiintle=p).1, .. , ;.•:, ..._,,_
room TO DIAMETER_ TRICipliA3 MATERIA_______
LAC e ajtyNcr.44 wractrzYntrOcapaRaS g.e.WC(33.7,0 SIC*ral=4 64 It U. IlL i
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1 Well Us*(Chtek well use):, ft (t. li.
Water Supply Weil: Ti.scam. .,:- - . . .. .. •• ,•
..... ....
°Agricultural Cilhinicipol/Public '
. /Rom TO
ft. IL DIAMEJTIE SLOT Eiji THICX1135 MAMMAL
la-
Membrane](Readng+Cooling Supply) ,4Resideatial Water Supply(single)
It rt h. i •
ClIndoshultammercial °Residential Wider Supply(shored) is.ra .. . . . ... ,
... . ..„ .
Olt4Llitat °Wells>100,000 GPO FROM To MAIDUAI. LVIPLAUSAZfrI)(MOD a AMOttifT
Nan-Water Supply Well: 0 ft' 20 ' bentonite poured •
ONicuirraing °Romney It. ft.
Itijrction Well: ' .
ft. . II.
0-Accifer It tEtur ge . OCiromichnber Retwxlition i
19.SAND/GRAVEL PACKJIIIptakible) • i• • • •''• ' •• -
ClAquifer Secenge mul Recovery °Salinity Ranier • FROM TO MATERIAL ,, RaffIA0.1Mff HET=
°Aquifer Test CiStpeos -litainage ft.
0Experimenral Technology 0S1thsiderce Control IL It. -
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Meothennal(Closed Loop) DB= 20.DPILLINGIOG(itttieliidrz6iiiii&habit iiiiiiut-6) .'•`::." " ''••• :...F'
Mosthermal(lIntineCoorom Retimi) 00ther(esplain coder t11 Remaths) Ett5 ft. 1 ft. TUTICafj
036.-4Nalt.cas,..:Irrork ens,p-rlo sir;cm)
4.Date Well(s)Completed: V.....4()—747/e111Dd HS- it. IL 13(0 V''.% d),6- .
Si.Well Lxpçton. 61 il i, EL 1,)/0 VP\ a J(
7L÷ V 141 450 .
6 i 1 ft" )1,21/4911. C-1 rail i-t:•-Q . •
F?.raity!Chmer Ns= Faciloyln8(If apptiaBle) . it 'ft..
Li 7 7 Z i,e bon 4 d/ clin,trehAti t •f ft... .,, -
r-;,.- L::••<,..,,i:.:.';: '44, i....;,L.)
Filysiral Address,Car.and 7.4 R- tt.
600 ki bal 21.21.824AMIS•-' .': '' ••.-..;:-.:0(t.,...T. 20
Cy PeralldeatilleationNo.(PIN) I;
7::-:,:?..`"..i.
St.Latitude and longitude in degreeshnbutraiseconds or decktal degrees: :G:47::•‘:•L••,-.•0
(if well Ea!,ort Wilms is Suirs:ical)N X7',„.1,,OT/4-3 27.Cer71.
35.cs75I W
a=of OrtiRed Wail Dee
4.is(are)Idle well(s):el'ennancoi or °Temporary Sip ,
Bysigartg Akron%I hereby ea*did the wellt4 WiT1&eta)conxtrarizd in aroxrdsnor aid
7.1s this n repair to an existing well: OYes or EINo lid MAC MC.0160.or ISA NCAC 02C.0200 Wel CazurtsetEan Seragtxrcis gad 0 w.la eept
ri2rix h orqofrflThot1rovm mil costra22122 beors2421241423 siptain du warn ethe ef Ai'Fure"/Ads luxmpnvami ork-...en C.arr•
repmi=Ler VI n2=42 ataka CFOn Lk back of ihlr form . m
23.Site diagram or additional well detaiM
F.For Geoprabefilff or Closed-Loop Geotbaural Wells having them= (Yaia°,s7Ye use thi:*k of thisths BoxFaro:o foovidc wird/mai.woll ocustnedon. info
construction,only 1 GW-I is needed.Indicate TOTALNUMBER of wellsR ).Y may also atria adthneral pages If necessary%
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• drillect' , P) 24.sumurrAtommucrioris ,
9.Total well dePth below land surface: , (It)
Submit thb GW-1 within 30 days of well completleurper the following:
For mad*we:ff.lia 411446 V cyfitrou(cosayste-M200'mei atiu)
242-f cuin For All Wells:Orig.irts1 form to Divine's of Water Rmandens(DWR).
N.Static water level below top og: (-2- (10 InSarcatitud Proccising Unit,1617 MSC,Raleigh,NC 27699-1617
r vow.Ind is ahem amity kw'I''
24b.For infection Wells:Copy to DWR,Underground Injection Conned(WC)
IL Borehole diameter:6 OIL) Program,1636 MSC,Raleigh,NC 27699-1636;1
12.Well conalructieut method:rotary 24e.For Water Supply and Open-Len'Geothermal Return Wet*.Copy to the
(ie.sugst,racy,able,died pailk er--) county hull&gotta:at of the eouaty where irstall
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells• ..cedar over MAO GPM Copy to MR,CCPCUA
, 13a.Yield(gpin) .5" Method of test air pressure Parch Program,161114C,Ralec1C 27699-1611
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garestakd dick*
13b.Disinfection type: Amount
ram 097.1 Nadia Cam b=&prim=crEaviroaatutal Qtsday-Mita=DEW=RE:cdmrsa Revised 645-20111
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