GW1--06261_Well Construction - GW1_20241021

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WET.• ,CON_ �.1 CONSTRUCTION RECO ~ (GW- ! Forinternnl Ueo Only:
1 Well Coe onnatlon:•• 'a
t?1 •14.WATER ZONIS' '
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N PROM TO , DDalQI70H
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NC Well Coau,tetoe C fiationxum6a I 1L OV1ER CA (for ttaltl wed wdtr OR LINER Of Home)
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PROM • •TO DIAMRIZ l
cy,� • 13 ry i—'h-e-vs R Tat MATLRiAL
oYN•me �
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� II 1L INNER CASINO ORTIl81NG(etattene d desei-leq) ! .-' •
2.Well Construction Permit Al: .iinm ' TO, •DrAaDTTie'- Tnm000iaa MATIlum•
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Listellapplfeshlstned1.....v ifonpermits(Le.V1tnCorn*Shk V Ne) " •-t-I R lQ.�R . S?Yla. .7titcr , p
3.Well Use(auk well nee): it tt ft. 1. l
Water$apply WeIL• . q ,17.SCREEN• ii F
• j MOM TO s • DrAMiIIIr PLOTalmi• THICKNESS MAIaa
OAgriculturel O unicipal/Public. u rt. te
OGeothermel(Heating/cooling$i Pply) denlid Water Supphy(.idle) n ft, v
DlndusbiallCommereW'c Raudeatel•water Supply(scanal)
1a.,Boer
• ['Lrigatiotm DWella>100000 GPD !'' PROM. TO tHATIIUAL 1GID IJ►COItZ ITMZmROD a Aa1
Non-Water Supply Well: v -R Z 3 n /Yl�.4#- .'y-t
['Monitoring ['Bern eiy A. � R
r1'�( /7fi�..�.�.N1n ettloa Well: ' I
DAquiferRecharge • .OGmundwaterRemedialion - R tt
['Aquifer.Storage and Recov atmity i 19.SANDIGRAYL"LPACR:(iraat llnbla) " .
oAquiterTeat !Manny OS Barrier' - ; • moM m.°; MATERIAL snar.►cnusrtrmslaol
O9tamweter Drainage { P. II; _ R. - . . .
OSxpenmentalTechnology • • ' ' OSubaideioe:Canirol ' : , ft R "
OGeolhetmsl(Closed Loop) OTraar .{ I•
'10.DRILLING LOG(.them:aidl lisad,daxb If reason),
['Geothermal(IieatmgACoolles Return) OOlher(eaplahm minder 921i Remada) PROM TOi'. Dt IfliONte,..i,, ,: ,,w;, .., y ,•,�ta.e,,
G Z � '� 1';, R
d Date Well(s)_Completed: -! *'� Well mil '11 • te l • •ri-
so:We Location . "�!'I-. -MI' , R
RA,- Bri- - . llc�s `I' . , Il: R tR pT ; t" 2021
r' FanBiq/OwnerNaoie . FaollItlIDi(ifepplieame� '•
• 1) _131r-c' a.-h s ' 1< .b o 6. R4- --.-fe. R
r Fhyai?a7 Addce�, •y,aed Zip li;� -•--SC E r x r ��
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/g'1 -P !`� � 2L REMAR1l8/k
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COmt�, ) Fatoel ldeolifigtioa No!'(P)M • . {`,,t , "
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56.L pt■de and b■gftude In d !`
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(ifwalt Bride a kUloug w mindonteaheeoada or.deelmal degrees .
12 ' oo._y-z5
6 Ia(are)46e well(,) rermti■e■t or •['Temporary 3 /0 d ' 0ia.31*/bf .Coatrsetor,.
7.Ia lima a re ay+fd"fngddifern.t hereby«HOrthetthsiiellO)war Ovens;coNi►apY�Areicoiikr;i
P!U to a■�aWg neu.• ['Yea or
. . flth►rfsa.repalr,JNfor Amami;iiip No , LTA thaIr7C ilisL OPt00 aJde,dfathewe JOOtreJ: . . -.,d '.:'.
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aorohee!r.k hjhIsfi nrr" erp►eptIhehaMo•.jihs. elrAi,rec,nfhersbeoirprorldedanc�nrSoinsr,
►epafr ruder f7J iemsr6mtren or en the backs rtMijorrn• it
• -: '[ ' 23.Site diagram or uddl11o■al hell details. ••tf For Geoprobe/DI T or Closed-Loop Geothermal Wels haying the more You may use the beck°Htble � :
• eonstrmietien,,ady 1 GW 1 is needed Indicate TOTAL NUMBER Rbt arb BOX)ou m profile additional well page i
' ' •' � dn7ied: IiR dwells. ' :. (add'3eo Over'm
• . . �• Play also atirh additional pages ifneea
! trial hell depth below hind inrfaee: . • • U.,SUDMT1TALiINS1RUCflONS :
F'ernipft/p/enelltAirall hr � 30200.�� • ', • i
�t Ufd�f (n•) . i
:,. .. •. '@mere) Submit this GW 1 trlthin 30 days'if cam letla■
10.$tatle taster level below hp• iR t P per the fitlonLge
10 Stade wa t:le c l p o - D �R•) 2d�armF�tio F !mg-r""'otaa to Diriaien of Water Resources (Dl
U 1 °� MSC,Raleigh,NC 27699-1617
• "11 Borehole diameter. :b " ) 1db.FotLieetl '` om3 WeUa:Copy to DWR;U ilechm Conho(ii
12-Welt eo■alraetlon method:_ . '�-a-rPm6tar. - MS(;' '_ NC 27699-1-
(r.e.norm totem eable,'dieei -• Ir r
*"ak ate) '24e•For Water Su and O n-Laa Geotheri■al Return Welb:Copy b FOR +ITLRS[1PPLY�VEI,Lg ONLY:' • • • • tYengaenmen , epamuent county
' 1!d For Water R'eW ndidn aver 100 000 GPD:
13a Yield(6Pm) Method 0I teak •` PemuC Copy to •D
i 1' 6�. 1 S emgh, . 7G99- 11 CCPt
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