GW1-2022-03030_Well Construction - GW1_20220228

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WELL CONSTRUCTION RECORD(G%%'-1) For Internal Use Only: j
1.Well Contractor Information:
_ 1 V 1/WATCH ZONES t
� TRON TO DLSCRITIIOV
W'<:I Coecte t Name R rL
—_�-13 0,�
NC Well Cmcnctar Certification Number IS OlI1TR CA51NG fur maltteued wear OR LINCR f a Ikablr
Cascade Drilling LP ►po%i R TO R n1AMLTER to 7711CK9rt5 MATraIAI,
Co ,,eeryNYme IL I"Wit CASING OR TURING tMmd e
2.Well Construction Permit N• FROM TO DIAMETER DULWI I51 MATERIAL
lurall apptrrabk well eeuvwetlen penaiu(1,e.NG Cowry,Sbte,Icrlann,eleJ
IL R In.
3.Well Use(check well use):
R" R la
Water Supply Well: 17.KMEEN
FROM TO DIAMETER st.0T 1111 T111CK!rrSS MATERIAL
OAgricultunl OMunicipaUPublic w R R In. 10 v[/
❑Geothemul(Heating/Cooling Supply) ❑Residential Water Supply(single) n R Id
Olndustrial/Commercial OResidential Water Supply(shared) LL GROUT
Oirrt atlon ❑Wells>100,000 GPD FROM To MATERIAL- i EMPLACIMLYT MRn10U•AMoll)tT"
Non-Water Supply Well: --
A,lanitoring ORtxovery 0 IL R f
Injection Well: R IL
OAquifer Recharge OGroundwater Remediation
OA fer Storage and Recovery IR.ltAND/GRTO — to tie
qui g very OSaliniryBatria sTtoM TO MATERIAL cMrtwcLMcvTMcrnoD
OAquifer Test OStormwater Drainage �7,f R 56 A. R
❑Experimental Technology ❑Subsidence Control R. R
OGeothermal(Closed Loop) OTtacer 30.DIIILLtNG LOG attach sddlderW sleets If Weems
FlIOM TO Di1CR1PT10V awe-Yar�auS aatVrwY to ere.
OGmthamal(Heatin liri Return OOIher(explain under 021 Remarks) o R. ? R CGS
4.Date Wells)Completed: d/ Well IDN Al U al P 3 R 14 R F/w. SArv�
�— Sa.Wen Location: 'I
h Pfizer 30 R 3S R 6I4 5AN0
Facility/OwaerNan FaciGrymX(irapptiabk} 3Jr rt VI' n Si g
4285 N.Wesleyan Blvd Rocky Mount,NC 27804 R R �O f` �1�''� z-
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Pbrial Address,City.and Zip R IL
21.RCMARICS
Fab
Nash
C,—y Parcel ldeati6ution No.(PCB
5b.Latitude Rod longitude In degreedminotedseeonds or decimal degrees:
ref rrdl field.one Wang is sufficient) 2L Certification:
W V=pf,Dc Uri
OG 0 !08 OWo`I
Signature of Cenr6ed Well Conaactor Date
6.U(are)the wen(Q: Permanent or OTemponry
By signing I1k4Jwtn.I hereby errrify tkat the wrd(i)was(woe)oouwcted N accordance witA
7.Is thU a repair to an[slitting well: Oyes or X N0 l JA NCAC 02C.0/00 or 1 JA NCAC 02C.0200 Well Co 0.1iw Standards and thaw a copy
. if dw it a repay,fill ow kw-wit came ctlon hrfaretateon and explain IAe nahveof de- oJthis record has-been provided to the well aware.
repair under e2i reamrlaaecdon or on Ike back of this fomr. 23.Site diagram or additional well detans:
B.For GeoprobdDPT or Closed t oop Geothermal Wells having the wean You may use the back of this page to provide additional well construction info
(add'Sce Ovee in Remarks Box).You may also attach"additional pages if necessary.
conurnaiaa,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
ale r 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: U (fL) Submit this G W-I within 30 daya of well completion per the following:
For aruWr ae11J 101 dU deplu plfferenr(asaarptr-J@200'and 2@1001
24s. For All Wells: Original form tw Division of Wata Resources (DWR),
10.Static water level below top of easing:1.2• 20 IN inrorrnation Processing Unit,1617 MSC,4aleigh.NC 27699-1617
tftWer&wl is above caring mr--"
2/D,For tnleetion Wells:Copy to DWR,Underground Injection Control(lUC)
11.Borehole diameter. (in.) Program,1636 MSC,Raleigh,NC27699r1636
12.Wen construction method: Sofa i — 24c.Por Water 5u 1 and Open-Loari Geothermal Return Wells:Copy to the
tie.auger,rya y,cable,deaf puck etc.) county envttoomenta ea epattmeltt of the county w cfe installed
i r
1
FOR WATL'R SUPPLY WEE JAS ONLY: 24d or Water Wells produdn over 10o 000 GPD:Copy to DWR,CCPCUA
Perntl rrogram, 11 SC,Raleigh, 27699-1611
13A.Yield(gpm) Method of tau
lib.Dldafectlon type: Amount:
TmsnGW•I NontiCarWmDepatmcmof Environmental Ombry-DtvwaaofWala11 scea Rerwn16b20Ia
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