GW1--06355_Well Construction - GW1_20241025

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WELL CONSTRUCTION RECO —• •
(G?4P11 For7ntemnl ilia Only
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•• 1.Well Con,apt r Information:• • , ! I.
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•14.WATER ZONES t
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, .well ConbeCor' grilm° I MOM TO t : DDQW TIOH
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597,� ! ioQ ft.. ?2d!ft.
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NC wen cootredor coruscation Number. le
15.ODDCE CASING(for un it-eased wells ORLINER Of Ruble)
13 'et)�_Lir$ it • MOM ft. DIAMRrIRhi. 71 GM=�!QIT0
MAISIIAL
ComgNeme ' 1 J
2.Well Construction Permit K: /� / li 1NNEIt lASI1VG.ORTMING(ee.tbamal cbied-lass) - '
L// 3�...6 PItOM TO. ', .Dissmrst rm rdsmu IAL
list all epplkoble well conrhrdfon paeyd�f!/C.Gmrrq Stets,Yertaocs ire) / f. a�. :!t la
fi' '� ��� i�'/t- Pam,
'�' 3.well Use(cheek well eras): tG •
Water Supply Well: I 17.SCREEN Y
• OA eniturel PROM I.TO ! - DMMITIR SLOT SRd THICKNISS MATar
gri OMunieipeUpublic R it. !a.
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OGeothermal(Heating -ooling supply) adiel Wafer?ripply(fie) ' . . n .: " ft. . II; '
_ ---- Dlmduslrialt ommerciel Reaidential•Water Stipp!),(shared)
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1e.GROUT
OLngn6o(r OWella>100,000(i)'D h PROM TO MATaltbtL narucrMsttrlasiBL.tODa,AM Non-Water Supply Well: • • i S 0 R ZZ'R Qu r ,.(
•• DMonotr Wen: ORecovery . 1 R I Vo r-Y1 tJtiln.� 1�
°Aquifer Recharge • ' OOtoundwaterRemedietion h A.
•OAquifer stonge.tmd Recovery OSelinily Bonier D.9M�T�LFACA(MA1UJAble) : .
OAquiferTest MAMMAL It IACiMWrbQ7HOD
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OB�cpaimentnlTadmolo OstolmwataDniiDage R �, ,� '
tiY ['Subsidence Control u
• OGeolhermal(Closed Loop) OTmcer • n I •'m •
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• '2Q DRILLING LOG(attach additional sbeeb i/seensary)
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OGeothermal(IieatiogCoolingRetum) • °Other(eaiplaht under d21Re Remarks) PROM DISCSIiR'1IoN(ab,ranl■e�,s.a/,edrrsr.,p.te�,'
G 'mil
.4.Date Well.(s)Completed:. % 2 -2fwen u,1 • t� n
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• _ft. "7 t, .c , ,- Ct d 5tiication. j
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/ "zee/ i ft. OCTi � :" 4n2 :• • Penlity/Ovenc Facility ID/(if applicable)
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—S' �� I,., ii4 _eh
Fbr.... Ad 6ty,Ind Zip •
rc� /-d!/thr SFr.: ;€':iy.t s�rd� m�.. } ..'
RC/• it tt
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j 1LREMARKS/ • E ?' �~
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Tacalldcntlscation BIOME)
5b.Lrititude•and longitude In in or decimal degrees: • ,
(ifwell$ :cca Iatlloes it mffieieat)
3G. ri • 22.Certlf - -
•re407.: •
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6.Is(are)lb.ireJI(s): erm ora anent or OTe t r
' ,Coolrador Date., .. .•
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Blit7.Is this a repair to an eslaling Rent• OYes or No. ISA?"l"a&low Ihncbyow&'hot thetiellNi nrOar)wnRryraedtn'one
If this lro npcl�ftnor/braNn well natfonISAJ4CAc olc:oltlo or7sI11VCdc oIC.oJoo lridCwrrrga/on
•repot•rnderI)Ironr"Asmnonorontheback� �Whthe avhn.rfthe ofthfrruordhosbeenprvddodbtirc well ornrr.:' •
'jO^bmddiali
23.Slte diagram or additional well
S.For GeoprobeDPT or Cl details: " •
• Closed-Loop Geothermal Wens having the male You may use'the baOlc of•this •
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sea etlm,; y 1 OW-1 is needed fridicaMpage to provide additional well pages i nee i
drilled TOTAI,NIIMBfiR of well' (add See Over'in Rdt:arb Boxy You may also athch additiaoalpeges if stew
• 24.SUBMITTAL____,•,_,
NS RUCTIONS •
9.•�`itlal well depth below land surface: ��d
F'ornndHple wdlr 14►ell depths Ifdsesrnt(ePfe-f an•n , (�)
02 QI00� Submit this GW 1 thin 30 der of well completion�J � n P per the fillo�irg; ..10.Static water level below by a�ua)rg: r 14e_For A11 w l' • •
fearer/nelaob`oiraQtrEpe'+' If 40, ow form to Division of Water Resources
Information P wg Unit,1617 MSC,Raleigh,NC 27699-1617 - ��
11.Borehole dlateeter. �, �' 14b•For Inleetlor�'• ..' :Copy' D
{in.)
12.WeI1corslrvetlor method: • Pro6am.ICl6MS �'36d�1Oa�injection Control(I
a f arm -• f �' E1tib.NC2T699-1636
Cu ratox cabb,dial por)ti am) ';Y' 24a For Water Sun- - .
and O rtmen Geotberimd Relrrti weW:SPY to
FOR WitTER SUFFIX WELLS ONLY: • •; CO11utY mvm atmen cpertmmt a county
24d For water Wells roduclq erns 100 000 GPD:
13a,Yield(gpm) i 24d.FPro Method of teat: ' i Y i gam, 1 SC, E1gb C 27699- I) �Py Dom•CCP-
136 D'p ifeeHie type: h 1,
Amours: 1 . - .