GW1--00329_Well Construction - GW1_20240112

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WELL CONSTRUCTION RECORD (GW.1) -
I For Internal Use Only: •
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' 1.Well Coatractor Information: . - : • . ' '
Russell Taylor' . j : .
" _i 14.WATERZONES • •• . • Well CoatractorNsom . 1 • . • • I FROM - I TO : DESCRIPTION
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.2187-A .
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ric Weil Colmactor CettirmadgenliJosetter
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10.0trr= GIS=innitkasedwellOORLINERaf ' •
kedden Brothers Well Drilling, Inc .
PROM • I TO i ' I D/AMETER I TRICIC635,
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toospsny Name . , • . - I' 1
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1, I) 16.2181ERCASING ORTDBINGfeembertuddesed4oth0 • ,.. Z.Weii-Constraction PermtHit: 1 I ()as- . . ...FROM 1 TO ; DUARTE& : TEICILMS NATAL
. . .. • Zia all.v7:freak wall ecosuractton permits(1.4.L=Camay,Slats,radiate.tic.) • ' 0 ft. 11/415 m. - 10' hi. . Pvc, • .
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: • -SI ft. 1 kr/. ,ft. 1 to b• 3-rxEL
• , - Water Supply Well: ' . 17.SCRZEN
- _ FROM I TO ' DIAMETER SLOTS= THICKNESS ' MATERIAL
. . .. , UMunicipal/Thiblic . ' fr.' ft., in.
Cremberand(lieseing/Cooling Supply) DResidenrial Water StipPiy(single) us. .
huinstrialiColanterciat, Dritesidmilal Wat:r SuPPLY(shared)
Itrigadon - X 154 crtitey . . FROM I TO. - I st,trantat. ampracrairaraterson a AmotO
• . Non-Wither Supply War . i
0 it• 20 It' I etosceOr.a Owned . _
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- - Monitoring .. ' ' :. ' -* . E3iceimgiy. : -- -Action Well: '.
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• AqtiifurRoaauto .
. arGroundwater R=edixtion' ' ' - •• '
W.SANDNERAVEL PACK Of aterneerle)
• . Storage and Recovery ,E3Salinity Barrier FROM I TO' . I MATERIAL Iser.AISINIDTMEtlion
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der Test ! ' DStounwiter Drain' age - ft".1 's'.
. •, Experithantal Technolo&,; , 0Subsideace Control I fr.,I ,, It.
' Geothermal(Closed LOop); ' Erra. • - 20.DEILLLNG LOG facash additional surest truearsasev) '.
I DESCRIPTION melon hardoessollhodt temeargo dm sera
GeOtheanal tileorinoiCooliOgItecUszt) niOther(exignin uudnr 4zi ROD:101W FROM
1 7r)
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. a 44. i- 2'i -.' ' I *61.'16 Sun6
• 4.Date wcu(s)CoutpLeted:14:2 4 cm' .i. weumt-... • • " igr7 ' I le?00 ru I gwat. •
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I , ft. I . . •, 11. I -1,„.•..1( i- .",--.,7-"'--;t r'7,-.-.53.Well'Location:. . , ,
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fr. I fr. 1 -.‘- k•-•••,0....t V 4,..., •
• 31411ine it9' lid 4 itclGiiVat T140 - i • I i
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Faciiity lare".(ifappricable) fr. I ' •. fr. I j/4 1\1 -1 2 2074
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- Lot 34 :414,2ic1-4.3t,iii„0, _ . ' 1 . EC. 1 ''
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PhYsital Address.Cey.and Zip :, .• . . . fr.! I • xt. I DV-X/2 C....
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MONO.e lit.nal"1/41 : ri 5,4 bolo 165 , , ;, 21.REHLAILNS . •
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Coley" Parod Identifrontion 010.(PM 'X 1100 (1-Ittoi + CesiciLueut 4-).
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SD.Latitude and longitudeiin degrees/mixtures/se conds Or decimal degrees: '1
' (ifwe.11 field,one Wong is sufficient)
22.Ce • cation: .,' , , ' .
35°-04.530. - N 083°- a. 765. •w t
' ' Idee • 04,02,e,.. .
. • 1.is(are)the well(s4Perroon eat or E3Temporary ' Sigma==sniffed W I Canoe=
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By stains:Ids Jonn.I hqre by certify that •nell(e)tuas there)constructed in mood
• 7.Is this a repair to an issiStin' g well: DYes or IfiNo _ -Oith 154i NOIC 03C.0100 or ISA=AC 03C,.020D WWI Construe:a Stantforde caul ti
- rags It ct rritotr,Ji7toot knoN77 pyllicoastruntion Worm:ion s?esploin the irM el the. . :=X'VW*mond has'hew FrViigrai°Me Ira"Ter- .
repair safer e21 remark section or es the beck cf rIdrjeen.. . , 23.Site diagram or additiOnal well details;
8.For GeoprobelDPT or Closed-Loop Geothermal Wells havina the Male - ' You=ay use te beck of this page to provid.aadditional won. site details or
'construction details.You ratty also attach addmanal pages if accessory.
• . .- -communion.Only 11,0W-1 Is needed. Indicate TOTAL NUMBER of wells
drilled: • -
. SUBMITTAL INSTRUCTIONS - .
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' • 9:Total well depth.below land surface: OW-
(ft.) ..24a.For AM Wells: Submit this forst within 30 days of completion of
- - •For nudapIr twit:art aU depar ifcliffirwri(exao-4114.•3(41300'and 2e1001 • -• consauction to rho followiu, •
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.• 10.Stale water level helot top of casing: „-Il0 , cst) . . . Division Of Water Resource,Information Processing Unit,
runner level is show cask&tar-.E."'
1617 Ma Sertiee Center,Eiletb,NC 21600.1611
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11.130r0t0110 cliasnerer:- L.L12--L-(1=) - ,
,24ti.For Inieerion'Wets:. In addition to sending the fano to the oddness it
- '12.Welt eontenrotion=Mad: ' .
ei.Lir- itli4P-a-alw• . above,also sennutt ens copy of Cats rove within 30 days of cop of
, Ciao auger,rotary,cable.tamer posh.em) . ' , sonstreeden so,the'followiet, s
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Division_of Wareklesources,Underground Injection Control Progret
. FOR WATER SUPPLY.WELLS ONLY: . ' ' ., , 1636 Mali Service Center Weigh.NC 2709-1636
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• 132.Yield(gpm) . 5' .Method of tes= 6411543 I 24o.For Water Sueetv&I 'ocean Wolk in addition to setFlit.tg the fo
' , .' I the address(es) above. also submit one copy of this form whiz 30 de
- ' I3b.Disinfection type 1-A ivi •Arnett= i 4 oiy___L i completion of weli Construction to,the county health department of dm e
. . waste dvastracrzi.! , •
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Form OW-1 , . . Noun Carcdira Depucarra oflirofkOO=O21 Quziky-Division of Waccr R...maggoo Roised 24:
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