GW1--06030_Well Construction - GW1_20241011

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WELL CONSTRUCITON RECURD(ow..1) ivr Glut nal1 1iji iri17:
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NC Wnlecatriear Oasiticatin Thcrda ir _of 1:-.Morgan Well & Pump, INC -"'oIIrr CA `thm wells oRtz�t,�f �bte)•
lROh1 m . I---7�Duman MOMS, MATERIAL
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3.Well Construction Permit 8: v Mug To Dw rsrxn t7rlt aMs. surrmpl
lie eit vbdr usSmu-U e=perm*ge.i/1G Cowtti'.SYcra rardaq etc) R. R. to. '
3.Well Use(chuck well use):, ft h. is
17.SCREEN: ..:' DI
Witter Weil: FROM 7o MAMMA ' ii7rErn T1rt0C T5 MATUL 1A
CiAgrienlismltn1 ObbtunicipallPublie R d Iv.
TaGeollwsmal($tsting,? poling Simply) *midentiat Weir Supply(single) fr. m to
Obido alitcom sti* °Residential Weer S (shored) M cat L. : _ .
Olni t tar ❑Wells>100.000 GPD FROM To uAlreILL votwClamtT+cetuna•Aa rorlKr
Non-Water Supply Welt 0 tr- 20 R- bentonite poured
OMonitoring °Recovery it R.
Injection well: - EL rt.
OAgnifaRe a C1GiotmdtrattrRttIIrdiation .9.SAND/GRAM PA02_111 404:ibis) i
ClAgaiftsSarage and Raarey t3SerinityBonier • FROM Tel MA7EurAe TOKFLACIRENTMETHOD
DAguifer Test OSiomswvaie:DeinDge 11- n.
DExperinieersdTechnoology °SubsiidenceCoatml R. R.
°Geot nal(ClmedLoop) DTratcr 20.DR11214G.L GCettaskeddiriabildsinire ajl : . • • '-
T a isarar soadmr.sdtTa$t>�tam��=1
L1Grothnnl(Hra ng/CoolingRetu/mj ttrher(esplainonder:21Remarks) 7. tr. 7 f Lz, 1(—j
4.Date Well(e)Completed: -(,..46`�.►Wen13Ts y it 13(D i ( :r, /
Si.Well qj n- 1 R 13/0 ON K-'.
j±( y 1� e i 1 It C 11 scan; .
Forilnyiowso Num !/ Fez:11),MS Cif applica b 1
) ft. h.. ^^ 7.77, ;:;_'\ '-;.:i ---,m1.
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Pbprial Address,CO.end Z7 t< It O C T.1.:.: _ 0'"
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Ccuoty P IkL-adifintimNo.(P1N) li _
Sb.Latitude and longitude in dsgreesfmoutesheconds or decimal degrees: r'" -',y-=- ..
is Racket)
(dwell "35 �'S7,SN TJ1,0T7z--, w /� 6)-5--�i.
6.1s(are)the we l(s): °Permanent or OTempornry artureof Cats c4 Well I n>_
Bys;gnbt8 air fore 1#exTby ant iltddoeta4(r)+daOar)aacwsi:din¢aoasfaneaash
7.11 this a repair to an existing well: °Yes or L7No Lid NCAC 02C.0100 or Lid NC4C 02C.0200 lMcX Caamtrt7aa Mansard•cad that a eapy
ydrir&a main Jill eat brown we!!auntrirran ilforxxxcisa aadapIts dt=oared. efts nnmd tar breiPMVlyd O&winm.crr.
repx:r=der F21 7reurEkr sonticas aranthc back aJfirfaro 23.Ole diagram oradditionalwelldetain i,
g.For Geoprobe(DPT or Closed-Loop Geothermal Wells having the same You awry use the bank of this pate provide additional well construction info
man,only 1 GW-1 is needed.Indicate TOTALNQMBER of wells (add See Ovu m Renisib Box).You may also attach atkiitiacatpageo if nxrssaty.
drilled! • 2 24.SUEMI1TALINSIRUCIIONS
9.Total well depth below land sabre: (It) Sabsrdt this GW 1 within 30 days of well completion per the fenmving:
For=Ad',peg ligrd7&OnSi t(ample-sem'
r y�, 24a_For All Wells: Original farm to Diviner'of Wets Ramnws (DWR).
10.Static water level below top of cuing: C-29 (ft) Infn®ation Processing Unit,1617 MSC,Raleiab,NC 27699:-1617
Oen,God is above wavy LW
1 L Bar�nle dlame3er S .T.
(tn) 24b.For Injection Wells:Copy to DWR,Undergroundhtjection Conned(rue)
Program,1636 MSC,Raleigh,NC 27699-1636
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12 well coaslrnetioa method rOtary
24c.Fos-Water Supply nod Open-Loop Ceoihermat Return Wean Copy to the
(t..stir.rainy,cab;,der c ) county cavirom=tal beslth department of the comity whco
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FOR WATER SUPPLY WELLS ONLY: 241 Far Water Wells prodnein aver 100,800 CPO:Copy to DWR.CCPGUA
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13s Yield tHethedofttst air pressure Banat Program,16111rSS('.Rnln ,llf'276991611
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13b.Disinfection type:oramtrrd afrbl® Amount
FoonOW-1 Needs Conlin DepafozmofEe Q'dy.1livksieeatWier Rrent464.257I11