GW1--06069_Well Construction - GW1_20241011

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..._,.4ONSTRITC11034 RECORD(Gyir:41 Far Minted Dat:Nip
L Well Oratrattorrularnisemn' . . , ._
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en Nama antc,0„Waraft12)Natilo ',..,.,.mammon,. , .„.. .. :• _ . , , ,_ •,- .
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NOVrenoraractarOatiaosientirabri
'-astettrzle CeSettilhe IIISediel wahlon.lanalt tiraPPootre,. .' - .•,-4• Morgan Well&Pump,.INC p„ DUAIITIA =MIN MAMMAL
orinictlicose
" . 0 it (jj 14 f' 6 1/8 ftl SP R21 PVC ..
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Idateeaniani2WORTOIOG faiithiiiii esii64:- •:—ey:,.:: :'..,'::
2,Well Constroctionkermitik ICI 1 di ,,,,, 70 Marranai varawoo mancrat
i.*-se cuiraare velrearararowirender Ay.LK Cow%Ai*Vorkoce.me') Fr- it
1 Wei Use(thecltisen me):, rt. ft ' b. :
-7-Wator Supply Wdli _ •
Mot tlO To littdcatotal 1:1*,1411Wilic rt. IL Inll TIEtiL-scar saa :ninies; -actramet
Cc )(tlestiagymng Supply yRinideraalWater NO(Ottnite) ft A. b.
akriostria'litomaaold
Okritta. than ClWeRs>14006 GPO swag To , litAILLIAL ii111.;i02:11:10(Tifill[00 hiMOOOT
Non-Water Supply Wdl: 0 ft! 20 ft• bentOnite pitied
0Monitodug [Recovery it ft, ';Injection Well: • — .
U. It.lildraifer Redrage LIOroindraterReradiadcri •
.1:Aquifer Storage end Recoray t:3Sanniry Stria FROM TO- MATOIAL Coartacesszer swam
ClAgoifor Tat CL.StormsoiterDssinage a. ft.
Daperimental Technology 12Subsidence Ccancol ft. I . .
EiGeotheccoal(Closed Loop) Mhos TO.DTOILINGLOG adfiaii4Etfail dailtilf iiiiiiiiT) •' ''-'.' •:":.'-.- l'.,
Mead:cm:al(licating/Cooliag Retool) pother(=Oak=wet Rannt3) M4344 " 1743C22."4:e"'I.T241"7"'Aulindit"Pli;"1"."')
'0 cy,Q ' rON1 Gii-r,.
4.Date Well(*)Completed: it--2-7-?.(1 Wen MP _1)51 ft' )11 I (Go(g'1 /2-001/
5a.Weil Location: ' 11: qp7 11. 01/CIA iitii •
MIC//WC I kAM iii ( .
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PacnanThrarNsasi Facility=fdappnable) . a. .ft.
. 1 i V i'-''' P sr',' ;', f k-7:-'. •‘,
1 0 Cli 5jiCKS10/0 gAi ft. . ft. ,. - ,-,.. . .2 k...:.
?bow Adirms.Qty.sad DP it it. I' 0 C T 1 2024
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5b.Latitude and lassitude in degrearainatestmeands or decimal degrees:
(if welifield.ow ladicog Is sarsacim* i:
35.371e N //°7°I 1 W 1;
Sipa=of Wdi j Date 6.Ishire)the wee(s): elPerrainent ar alraiporary
;
diotPrOa driciorat rhadyczer*that tka yell°ma Own)coutnaled la cccarciagice Iva
7.1s this a rqsar to an misting Irak f3Yes or fRio MN=02C.010ti ar lid 11C4C 02C.0200 WO Ccesttiatis Secalawfr end that a
gaff Lie mar,ftH egibmay well coarriabm isforeratosard might de=bre al* Ole'mold kee bervivorEdat to the wet I 01.1tOt I:
rye&older al recorb icecksa or an du bock cfddt farm
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23.Ste diagram or additional ITta deta3: i
S.For GeoprobeJDFT or Cloud-Loop Geothermal Wens Ira*the sane You Tftay ftsle the bat*of rbie AV to Provide*Weed weld oscaoreticato5o
constraction,only I GW-4 is needed.Indio&TOTAL RUBRIER of wits (add See Over'in Remain Box).You rosy dm anseb edition!pages Roo:enty.
dolled:r % U.SUBMITTAL INSTIWCTIONS 1
9.Total well deftb below had atrium - 1915 (IL) Submit this GW-I will&30 dap dwell eoropledan per the knowing:
Far azIVE Ica s Est all liggla rigrerat is:my&*Par sji43140) ,
ao 1
2Aa.For All Well=Original form to Division of Water Rescenem (DA'R)
10.Stade water level below top dasher
. (It) lenomodon Prooreortrit Wt.1617 MSC,Raleigti,NC 27699-1617 ,
email'foci Li*ban raft ass'+'
241i.Far Infection Wens:Ccpy to DVni,Undagtound*diem Conixel(WC)
Cio-)
/L Barra*diameter:6
Progam,1636 MSC,Raleigh,NC 276991636 11
rotary
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a WeE earta-trodko method: — 2.4r_Far Water rad Oven-Lora Geothernial littera War Copra the
(s masa,mom cable.&at sash.etc) cimaty wen..... With depart:nod of the emery Thaws=piled
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FOR WATER SUPPLY WELLS ONLY: 24d.Far 1Vattr Wens prodndna,over 2g0(99.11%T:Copy to DWR CO'CUA
13s.Yield(gpm) 7 Method of frit air pressure p...},Fromm,361 1 MSC,Italoah.NC 1
irsalatut diatom * .-5°
13fr;Disinfection rype: Amount:
' F G19.1 Ns&Ozzoles thvartraco ofEritosmostat Quay-DireAmt°Mt=Immo= Revisal 642012
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