GW1-2022-00220_Well Construction - GW1_20221216

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WD. C,&ON,slTRUCTION RECORD(GW-0 Tor internal Use Only:
t,\\'rIl[onlrantnr InfaTnation: I
14.WATER ZONM
Wd11 CemlraetnrNemec l'(ON I'U DN.BCIiII'TtOY _,
ws � (ffi
Nt',Nell C'nnlr�clnr Codificatlaii 7uml+cr 1S•EIiJTRR CA91NC for mall-cased well UR LINC:R if n 1 cnlelc
Co.nmde Drilling L-P -FHOd1 ' AS 1nAalETI:n • -1IIMI Ss afXMIaAL
164INNI:R CA8 NG OR TI1R1N(1. colberntnl closed-1 Dan
) _
2.'%Vcll Canstruclion-Permlt 11, FROM TO MAa11CPET1 T7IICIMN8 I MAURIAI,
List all appltralrtr.urll rnnr[rVCl/na promitc ry`.r,t)!r"Courtly.,Stara,Variance,flea)'
1.Well Use(check well use):
'Water Supply Wc11: 17.SCREEN
Pena I To n1AUETER' SLOT5I E TIIIGtt1FS5 j NIATERIAL _-
C7elgcic1t11ural i7Munic)paUlhlhlid ��'n: It. in•' 1p fl�G -
OFicolhernial(licalinp/Coolin£Ste ply) ORcAdcntial Wille pply(single)
Clfndt:sU'iallCommercial ❑Residential Water Supply(.shared) "
t&GROUT '
F-11ni pion OWcl[s>100,000 C;PD.: . . _ I+I1031 To NIAn,aIAL RNPLACL3EN't 1fY.77101r&AS10U�t.'
Nan-Water Supply Well: / n. p h. -�- -
fcenitaring ORccovery -
11iJecUnrt Well; n. n..
f'algnilirr ltci,Imrpc OGtciundw:ucr itcinedintiml
19.$ANDIGRAYKL PACK'If a dictible
MAl)11kr Skint[dtld Recovery. Malinily BarriCr FROM To MATERIAL E IPLACPMENT blt:t11011
f7AcpfiterTrar UStormwater Drainage
lt'sxpatimsn[nl'Ccahunlogy OSubsidcncc Control
1"10:01lummil(Closer)fAnop) OTracer .20,DR]MING LOG altaelt additional otlects ifnecessa •
1`11031: TO. �' I)MCHIPT10t/color tn hente solOmcte1 c.glnetbe'rue).
UGcolGetmal(HcatinglCtroling Return)' Miller(cx lain undcr1121'Rcmarks)` ft. IL
SAM
4.Date.Well(s)completed:' `- Wcll 1011
Sa.Well Location: - -_,
AbemadeCorporation
n
i cili)�Qw:xrNntin 1°ncility11311 il'nitplicahlo) _
34II Holiday inn l)nve. IQnqs Nlaunlaln tNC 7.8086 'R.J Ur"I -
Pbyseco)Athlrms,Cdg new zip
Cleveland
Cannty I1amr.1 identification Nei.(VIN)
,;h.Lillilu(I gild I.in{Bode In degrceslminutes/seconds or decimal degrees: "
of iveli rield,our hirlbull;is surfieiull) 22.Ceetlilentiml:
signaturcafCorlilic AV 1ibontractor ? Datc
b,is(nrc)fhcwcl((s):r`4�tPcrmnneaf or fTl'cmporary- - +'
11y rignbeg rhir form,l hereby rm ltfy that(hp vwlf ft)ma,(acre)ronstrurird in ae(ordance with
7.IS.1111s rrPcpall'to Inn elfir,Uuy well:. 'Mes lir Mee 15A.NCAC 02C 11100 m•ISA NCAC 0217.42110 11'rif winter rain"Stawhirdy and thrtt(I.n7pr
frthia 1,a trpair.fill out Amoral wrtf ronsim-1htie btfru•morlitii nail explain flirt nolurr of clip
n Nt0 woorel hdc.bei!arrorldrd to thewcil owner•.
trpmr mn,b'r 021 rcenarAs'dCcnon or Feet lho back ofthis fornt. 23.Site dblgrnm nr addlllomll iVcll detrllls:,
S.For Geo)robeg111Tor Closed-Loop 1 Geothermal Wells haviu tiro saint: You,ulay list;tile.back of This pitgC;llJ'llrovide 8ddiltnnal wall con.slmrtion Into
I 1 & (tidd'Sca C)vcf'.Iti Remarks Box).You Holy nlsaaltncl addilimml pagan frucccssnty.
cctustmctiml,only 1 OW-I is uccdi:d.'huliealc'r0'l'AL NUMBER arwells i
24.Si1BMIT1'AL INSTRUCTION
n.7ota1 well depth be[nw land snrfnce: r 1 (ff) Stlbndt this(rW-1 Nithiu 111 days of well cnnlplellon,)n r.lhc ingnsving:
Ane-m:dtiple wrlir list all drpths ffdir7erme(crampla-3()200'and 2@1100)
24a. Fnr All Well n: Original rnrnl w Division or-Writer Resources (DWRI,
ill.Nintic water level lielow trip of wing: (ft') ftirominlion processing finite 1017 413E Raleigh,NC 2769.9.161,7
!/'r:ritr�aoreif ra ubmY;iminp:ups I
2Afi,For inledtloii'\VeI1F:Copy ni MR,Underground Injection Control(11-10
11.Itnereliole diameter: u (111•) 11ngratn,1636 MSC,Raleigh,NC 27699-1636
12.Well'conoractioll method: `JIG 2dc.'For Witte-Sit -I awl O vu Lon Geothermnl Return WON:Copy to tit a.
(Lc auger,renny c7IlC,direct ptwl;eta) colfnly cnVironnrenla Ica t)i deparu1(incnt at the county iv)crc installed
1`(bit%VA11'lilB.SIli'ttIX WKIA.S ONLY: 24d.For Water Wells Tiroducln r over'100 000 GPD:Copy to MR.CCPCU A
Pennit Prligram,16 1 MSC,Raleigh,NC 27699-1611
I3.1,yield(gpn►) 3lethod.of test:
13b.1)fslnfcr9lnn tylle: Amount:
Fm1it61V,1 NanhCuialinabcpmuncniatL•nvirunnwmnf0emlity-DivsirritufWmcrRcsuarccs� HcviscdG-T-2ar