GW1--06268_Well Construction - GW1_20230926

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CONSTRUCTION RECORD(GWV--11 For Internal Use Only:
Well Contractor lnformmfans
1 I•Cameron Basin 14.WATER ZONES
Viol'Contractor Name
FROM TO OPSCRHTION
4518-A 5B5 ¢ ft. 1(2'1
{ NC Weil( etorCertification mnber rt. rt. J" �'
Aqua Drill,Inc. IS.OUTER CASING for motHce3edwJls ORLlNEtt[dTo }
FROM TO DIAMETER THICKNESS MATERIAL
CmapMyName V rt. 5O ft Gj hi.� c.- ,;
16 IlVIVER CASING OR TUBING(aeatheraul closed-loop)
• 2.Well Construction Pam[t#e )"7 . 0 7 FROM TO DIAMETER THICKNESS" MATERIAL 3
{ ListaA applicable well ewutruclionpenglis(Ka(RC CounOtState,VariancSeia) it. ft. In.,
3.Well Uee(check well use): R. ft In.
Water Supply Well: 17.SCREEN'
k
It �'Cait11lal �MIa nCIpal(P11b1iC FROM TO DIAMETER SLOTSIZE I TRIMNESS MATERIAL
pa!•••" ft. ft. in.
Al Geothermal(Deating/CoolingSupply) ideolial Water Supply(single) ft. ft. in. _
RI IndustrinyCo ial Residential Water Supply(shared) lk
!Ideation
FROM
Nan-Wale!Supply Will; FROM TO • MATERIAL E.DSLACEMENTMEFHOD&AMOUNT
0 tti 2 S ft GiAiinc
1A Monitoring ®p ecovery tt• ft.
wept
Ng , t.. Ruh ft: a' �3
�GtouadwaterRemt:diation
.,1StmageandRrxovt�. � zris
SaliaityBa ]9 SANDIGRAVELPAC[C(ffappilahie)
i MI FROM TO MATERIAL EMPLACEMFNTIYIETHOn
• -Test DStomrwater Drainage ft. ft. j —
V ExperimentalTccbaology °SubsidenceConttol ft. a. I
Geothermal(Closed Loop) pper�}},�
•," fall 20.DRILLING LOG(attach Metcalf shads if necessam+)
ii Gmnletmal(f1eatln!CooiitmRehim)' rimer(explaiaunder#21Remarks) FROM TO DESCRIPTION(mmnnaufam.m/.«nk Kraft.tu.cte1
a.nateWen: a l3 L tQ a'ft. f: 5c , i
()Completed: `7 f / 3 Well cl'0 It CGS 1 ia0Ci
c 6a.Well Location: ft. rt. 1`": :' a; 7
tM,t€04 5rci e,/ R m CF� ,< li L
Fi 1+alltyrOwnea�Ne� // a• Facility iDg(if applicable) ft. a. i _
rif#•' Aria LroSS G/1 Co—/Gale tA' (/11/ ft. ft. JCI " V LULJ
' Physical Adams,Can atffiZip 1 it fa r tea fir.^ sx N'-�lsf,
f 21.ltEIHARRS ({ . •A.e.r +7.V:^
County' • Parcel Idem(HeadonNo.(PI )
II
56.Ladlude and loagdadein degrees/minutes/seconds or decimal degrees:
6fweIt field,ono laUiong is sufficing) 22.Certifcadon:
r 31, 92 6/ N 2/t#200v W 9 zi
A Si afCaatffiedWellConbmtar
6.Is(are)theweII(a) etTnanemt orTemporary Striatum eta
1' By signing this farm,I hereby anti/•that the wells)slur(nrre)constructer!in accordance
4 I 7.1s this a repair to an existing wen: QYes or o with rSA N AC 01C.0100 or ISA?(CAC 02C.0100 Well Construction Standards and that
I/thrsirarepehiJlrloutlnonnwellcomrrucAlonieorawtro rate die naive ofthe GfthIiucheeeprowZdcdto wait attest.
repalrrmder NV re narkrsection oran the baekgfUdr/amt. 23.Site diag
ram or additional well details:
j S.For Geoprobe/DPT or Closed-Loop Geotlurmal Wells having the same You may use'dte back of this page to provide additional Well site details or well
ii 4 construction,only 1 G W-1 Is needed.Indicate TOTAL NUMBERofwelis coastruetitm details.You may also attach additional pages ifnecessa]p
if 1 dn7led: s1mi igFyAL INSTRUC110IVS
9.TOW well depth below lead surface.•
(ft) 24 All Wwe t this form within 30 days of completion of well
PornReaweHa&Anre/depthsr/dffenttt(example-3 'emdZQrdO)
1' 10.Static water level below top of catnip ° (fC} caristnicii(mDivlshm of Water Resources,Illfotmation graces
filmier level rsabot�earte$ass+" /' 1617 Mali Service Center,1 aletgb,NC 27699-16 7 fit,
iLBorehole diameter: eb (ia.) 24b.For-Inle�p Weps; In
(' above,also submit one copy iO st ndiTtg the form to the addles:is 24a
12.Well construction method: ) b; 'u'1i constmction m the followmggy:, this form within 30 days of completion of well
(Ie.mo.romty,W+le,dcatgash,eta.)
j Division of Water Eesonresn,Underground 7njtxHoa Control Pro
! FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Canter,R etelCh,NC 27699_16,38 gra1O'
Ii /
1 13a.Yield(gpm) ! Method of test I31 tr-� 24e.For Water SuooIv a..r a_W�
f ,�/ the addrass(e9) above, also submit one �additiontoseadmgtbeftH�to
type: N//( completion of well ooasttuction to the cou�uty°f this f0� 30 dale of
11 13b.Disinfection e• Amount z^' wham conshucted. rinteat of Aire counts,
FomiGW-1 ' North Carolina Dgmdm Re
:Dorcas
Revisal 2.22-2416
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