GW1-2023-00684_Well Construction - GW1_20230113

W11jy-CONSTRUCTION RECORD('GW-1) For Internal Use Only:
1.Well Contractor Inror`mn__fio``n:+
s lr./�lA �N,l•] DRUMTERZONES DYSkRIe1TON J
WA COahaamrN e
TO
NC Wen Cormactor CestiSrati,Number 1SOR1'EIt CASM farmaDi-osed Wells O4 11 da liable
YADION WELL COMPANY,INC. PROM TO D1AME18R TffiCCaliiBaS DfA7TRr.AT.
Company Name 16.RU411IRCASUIG ORTL1B11NG thermal dosed-imp
2.Well Construction Permit#: s-764 — 2-�22 1IRDM I m I DrAamas Tmclarnss atAT'aui
Ust all applicable a,c11 construct/on permlr(ia UIC,Cowry,S/de,Vo Ito e,eta) / R34IL In
3.Well Use(check well use): R N• in.
Water Supply Well: 17.SCREEN
Mid ft.
DLAMLCER arATaIIa TH[CInVGSa MATecus
OAgricultoml OhdrmicipsllPublic R. ft. io.
OGeothemral(Heating/Cooling;Supply) N�midmtial Water Supply(single)
R R in
OIndustrial/Commucial oResldmhat water supply(shared) 1L GitOLIl'
mrigaticato. OWolls>100 000 QPD FROM TD 11AIMEM . EMM ACEM®NTMETnOD a AMOUNT
Non-Water Supply Well: Q ti' ' R" h_ y/
OMOmtnrng C RmOvay ,R ,I R Mtf'�a+rt n ,
Injection well:
OAquifer Recharge 00roundwater Remediation fL &
19.SAND/GRAVRL PACK da linable
EAgmfer Storage and Recovery OSalm@y Barrier PaoMI TO MArrar.r a�rA�uNratslaon
OAquifm Test OSimmwater Drainage R R
OEzperimental Technology OSubsidmce Control R ft.
OGeath®al(Glaser Loop) OTracer 20.DRrrlmrG LOG(attach additional sheets ifnr a
OGcothermal(Heating/Cooling Return) O0ti1er(explain under#21 Remarks) - TO DasCRIEnoN Wenm,mm,.oaharhWe.grale xio%ft
dr.
4.Date Well(s)Completed:,r.j�-J*Z-U- Well MO AAi7- 4] 7 O R p.,; e!
5a.Well Location: Phone # /y�g' 3'Repw{e/
f'crwk OW icta sag- 5+624 R R
Fam7i6'/Ow¢rrName ,/ paciliryII)#(/ifapplimble) fL fL
/SQq /t/n�d Rt��lnvN(L[�_ R R
Phymod Address.City,and Zip R S.
Y dk,rN J
Comfy Purel Weati5canan No.no O
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if wall field,one ladlong is snffdeut) 22.Certification:
3C— CC 73 77 N �� �. J 12 W 004,1.46'// '
aiall
6.Is(are)the well(s): WIrmanmt or OTemporary siggale of Cattifim Well Contact. Date
``,,
Bysiping thlsform,Ihereby coo that the well(s)war(were)coutrudedin accordmrce with
7.Is this a repair to an existing Well: OYes Or dKO 15ANCAC 07C.0100 or 15ANCAC O3C.0700 ii'e0 Consnud!m Stmtdards and that a ropy
IfthlsGarepalr,fdl out known well cershocMm hrformatim wdezplain the novae of the afthisrecordhor bemproviAdto the well owner.
repair orderf2l remarks sec0on or on the back afthieform. 23 Site diagram or additional well details:
g.For GeoprobrJDPT or C2osed-Loop Gmthermal Wells having the same You may use the back of this page to provide additional well construction iota
construction,Only 1 OW-1 is Deeded. Indicate TOTAL NUNM13R of wells (add'See Over'in Remarks Box).You may also attach additional pages ifnemssary.
drilled:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft
For m aftOle walls lul all depths lfrbf(erard(emmple-3(a)?00'md7®100) ) Submit this GW-1 within 30 days of well completion per the fallowing:
10.Static water level below top of casing: 'Z/O ( ) 74a. For All Wells: Original fora to Division of Water Resources (DWR),
Ifwrter level is above mring,ua"+" Information Prooesaing Unit,1617 MSC,Raleigh,NC 27699-1617
Bit Off. d Aft 24b.For Infection Wells:Copy to D
Il.Borehole diameter. (in.) WR,Underground Injectim Consul(lUC)
Pmgrarn.1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AIR ROTARY _
24c.For Water Supplyand depar of
Return Welly Copy to the
(La,e¢¢gek mnry,cable,drat posh.�.) comfy'envronmentsl health department
mrent of the cmmty whew installed �
FOR WATER SUPPLY WELLS ONLY: 24d.For Waty Wells rod¢dn over 100 000 GPD: Co to D
e �/1� p // P®rt gram,( 11 S ,Rslergh,NC 27699-1611 Copy CCPCUA
13a.Yield(gpm) S0 Method of test: /der kid A" �r
13b.Disinfection type: 70%HTH Amount: > gq 02 DATE SITE VISIT..E��Dyy:��
Pri ry- VISITED BY: ,2U