GW1-2022-00132_Well Construction - GW1_20221219

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WELL CONSTRUCTION RECORD(GW-11 For Intcmal Use Only: I
I.Well Contractor htrormatiun: I I
LLOYD MARES 14.WATER ZONIs
Well Contractor Fame FROM W UISCRIMON I I
2547-A rt rL
fL fL I
NCN'dPConttanmCrnifieationlumin 15.OVI'F;RC%SUNG farmultirlsrdmrlB ORI.INCR ifd Ihahlr
REGISTER WELL CO., INC FROM TO nuslt rER Tilhi ,cal AtA7Eln.\t,
company Nmnc
0 ft. 275 n 4 In ,4 PVC
PWS2021-100654 16.INNr.kCASISGORTLrIIISG mthrrmaldwnl
2.Well Construction Permit d: ►rem+t 1 To D1A+Ir:21:11 nncl:as'ss stATcnty,
1-1alapple-ble-ellronr1ruc11nnn—w0.e.Ulf.'•Cm o%Srum,lnnnre,etc..) 0. IL In.
3.Well Use(check well use): fL I fL In.
Rater Supply Welt: 17.S(:MEN
1110N 7o OL\+1)TrR ::IA r::vi. 711tL7:N1:Gt MAT11111AL
AgneultUfal QMunicipul/Public 275 n• 295 fL 4 In. .016 PVC
Geodlomtal(Ilcating/CoolingSupply) Qx Residential Water Supply It. (L In.
Industtinl/Commercial Qltusidcntial Water Supply(shared) 18.CAOIT
lnl^[IOa FRONT I TO I MATERIAL. I Cxtpi-L �mxr str niou A AMOUNT
Non-Water Supply Well: 0 TL 20 rL HOLE PLUG POUR
Monitoring [_]Rccuvcn' fL ft.
InJr"ion\yell: fL !L
Aquiferltcchargc QQroundssmtcrRcmcdlalion
A uifer Sion Band Recovery 19.5.\NU1C.A.\PSI.PACKifs licuhlel
4 g ry ❑SalinityDanmr tTrast to slsttRlA1. rstrl.tclalrazsrcrlrno
AquifcrTcat QStortnwatcrDrainagc 270 fL 295 n #2 GRAVEL
raprri91cn1a1 Technology^__Qypbsidence Control _
Geothermal(Closed Loop) Tracer 20.ORII.LING I.OG talmth udditlonal,been Irneces.an I
Gcolhermul0iealinelCoolin Return) Odter(cc Ininunder021 Remarks) rROat To alSCHIM0N mmr.h.nlnm.racreru sndre.rrr.
0 fL 5 a. SANDY CLAY
4.Date Wttlls)Completed:8/31/22 Well IBM 5 fL 11 n. CLAY
5a.Well Locatlum 11 IL 20 IL SAND COURSE
JOSHUNNICOLE VINSON 20 A 28 n• SAND CLAY LAYERS
Foeilily:I.mrName fa:ihp•JDa(itapplicable) 28 IL 35 n. CLAY&SHELL
1912 WHICHARD CHERRY LANE 35 fL 45 fL CLAY
Ph)Tiral Addma,City,sod Zip - 45 fL 55 R. I CALY WITH SAND
PITT 21.PUM%1(IS
Co,mly Patel W'.1riiation N''o.(PIN)
Sb,Latitude and longhude in degrees/minultslsetomds or decimal degrees: =a s =•; j _ ,,
(ifn'ell ficl<I.not lu4oaR ii■ean:icnt) 22.CerIfRtRttan: '""+ �•( rys—.¢f•^e
35.665293 N -77.258264
9/20122
6.fs(Rre)llte well(s)JEIrcrntanent or©'remparury slvmtwc olccniw well Cont ecte, Darr DEC 1 q 2022
Nl-signs ie rlds foam 1&c V t 16'elm 11W welf(r)nut(a ere)cmil mrrrd Hr arvant we
7.is thisa repair to an existing m ell: 173yes orENo n•1ds15.4Ar(COX.0100m1SAArdCn?C.020011iUrni-cNrw4wJanL.udr1..5ni�r t=�:") �1 y?•srF (�jli�
1/dnrl.arrrvlr,fillourl.nmvrcllmnoruvuurr nnOno aal er�nN l4r nnmreoflbe ro�•oJlhlrrcmrdhur iceslv.ntded rn rhpurrl u.rntr.
re(srtr umlrr s21 renwris s vam aron s1n•loci a fho ornL
23.Site diagram or add In opal ss rB details:
8.For Geoprohc/DPT or Closed-Loop Geothermal Wells hating the same You may use the back of this page to provide addiiitmul,wcll site details or will
colbTruction,only 1 GW-I is needed, hsdicatc IDTAI.NUMBER nrwTlls construction details.You may also altach additional page if ncccmry.
drilled: SUBMITTAL INS-fR1I('I ONS
9.Tohsl well depol below load surface:295 24a. Per All\fell%: Submit this form within 30 days of eomplctioa of ttrll
Fvrwltiple yells(r.t.dldrrnlo JJfferint(err» e•3$D100'mdl;'110� construction to the following:
I
10.Staticwatrr level below top of easing:32 (fL) Division of\Yalcr Resources,lnforntaliaa cm sing llnil,
funterinr%hnhnve mang,car 1617;Stall Service Center,Raleigh,NC 27699-1617
11.Borehole dlameier.6-3/4 _(hL) 2iiti^nr inleninn\ elis: (ri oddition to sending the form to the'address in 24a
ROTARY ubose,also submit one copy of this form ssithin 30 days of completion or%sell
(2.a.goell co zuy,c li. method: construction to the following:
(i.e.eager.mtaty eaLle.direr Pmlt esc)
Disiiinn ofll'attr Resouren,Undrrgraund Injection Contral Program,
FOR wxER Slt'PLY WELLS ONLY: 1636 Mall Service Center,Rnlri-,h,NC 27699-1636
13a.Yield(gpus)8 ,Method or test:AIR 24e.Far Water Simply R•lniredon Wells: In addition to sending the form to
Uic addreac(cs)above,also submit one copy or this form ssithin 30 days of
13b.Disinfection type:HTH Amount:10 OZ completion of+scll construction to dto county health deparmtent of the county
%%here constructed.
Ftxul Cw'•I Mali Caiolimi DcrWLmm arl:mlrommani Qwllty•Ditiren orivaic,Ru w c, ACYleed 2•)2.2a16
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