HomeMy WebLinkAboutGW1--02176_Well Construction - GW1_20240408 ,• ai. , . .
. WELL CONSTRUCTION RECORD (GW-1) For Internal Ike Only.
1.Well Cootractcr Information: I 1
Russell Taylor . I.14.wan ZONiES
Well Canada Noo .
i FROM d TO I 'I I DESCRIPTION
2187-A C22t ft I c9�J.l.gt. I
YC Welt ComaeCan cation Number i 15.CIITTERCASING(for mald.asedsreIIs)ORLIDDERA!
Redden&others Well Drilling, Inc. - i FROM TO r i I DIAMETER 1 Txletc= maw.
Company Name I
ft I; fr„; ht.
2.Well Cabin Permit#t: I ao 9 a 3-P • i Ill.LM•NERCA OR (¢mtheraot eteaa•:aepl
I FROM i TOO i i. DUMMER 7ffiCiL'!!35 MATERIAL
UM ell al:An hie MU etnrancasit penults a e.WC County,Stag Variance;era) . . I.
0 it I ft. ha.
3.Well Use(ed eck well nse); I 1 f. i hi.
1 Water Supply Well: 17.SCREE ,,
FROM I TO DIAMETER SLOTS= TRIMNESS MATLAiA
. +3Ajaieultual uMttaicipai biio ft. ( i. fr. in.
'3Geothem �
aal n5/Co Supply) 11Re sidea:ial Water Supply(single) fft. ft j •in. 1
IndustriBUCoutmaeial Rau' easial Water Supply(sib) iS.GRo l' c•
Illialtion • FROM 1 TO I MATERIAL I EMPL.% rwraEET$ODsfi111C1
Non-Water Supply Well: 1 •' ft ! as , ....sm... ' I maawa
Monitoring - - lag ery 1 i I ` i
Jeetion Well; ft. I
.uiferRalmsgs 0GroundwacrrZemediation fr. I
Storage and Recavay DSatinity Barrier �MYD TO/GRAVEL PACK f}�la notAecluor i etRoD
nlferTest OSto=waterDrainage i ft f fr. {
Experimental Technology Subsidence control I f fr. ft.
0eocha1(Closed Loop) CTraeer 1' 20.BRILLL- LOGfetteehadditioaelaheetsifarswv)ar
FROat TO
GeotheMal(13eatia(r/Coolin�t Rerun) (Other Cm:plain undo#21 Remarks) f f f, ft. DFSt.AtP1TONtee]er.Mrinur.aaOtHeletep�eeafestrs.N
clay ti sand
4.Date Well(s)Completed; 3 JiY/a4 Well ft. ft.
So.Well Location: ft. I ft. I I;.. , r,•-
tarok. V. )..u.Jtbu,,o ft. ft.
APR O g ZOZ4•
FadlitytOwac.ta so FaciIir.r I(if apgeable) ! fr. II. fr.
)QO CoXe -A- fl1 I ayr1 S 7814I re- ; ,n,, r_ A r �.��N (10Physial Address.ray.and Zip ; fr. I ', [ika C.1 W OG -
. maxim 00wory (((/// 7 3 9 484 514 • 21.RELNI RKS \\
Cooney Pareei leleadfreadon No.(PLC) Of• D wu.E W&L DEE PEfL.. L 804. —3004 .J
5b.Latitude and Ioasitadeia degreestminutestseconds or decimal degrees:
awl!8okl,ma tatltong is sufficient) 23.Certification:
S6° off. PM, r 0 83° 14. 0I.o.l w t �_
6.Is(are)thewel(s} ermaneRt or Temporary SigtatotoafCatiSed�YeliCoatracmr
TT�++++�� 3y.r."guing adt font.I herrbc ceriif}'that wars/gr(irtei csaWracrd is,.am
7.1s this a repair to as existing well: DYes or wait!Li 1 C 03C.0100 or/S,4 VCRC 03C.0202 Wall Caattraertar 9artdardt iv
Iftlir es,a repair,fdl oat loomwe/ea:tcau:t(on irrformetionyjNo
espleir.:irc na;urA Oar ropy ROMs=o,d.loos been pra1idrd to the isre omen
repair tinier R31 recoils section or at the book ofilusfcrm. 2_
23.Site diagram or additional well details:
S.Far Geoprobe/DPT or Closed-Loop Geothermal Wells aavine the saute you may use the back of this page to provide a,iRtt4 oe'well she bid;
• construction,only I OW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if Da�sary
dallied 1 SUBMITTAL INSTRUCTIONS
• P.TotaI well depth below land surface: 3 CO (i) 34a. war Al1 Wells: Stihz:t this form.within 30 days of completion
For multiple terlk rat all depths if-different t scarple-3( 2o0'and 3(g'1001 coffitmictian to the following:
10.Static water level below top of casing: 1 0 0 (fr.) _h4aitia of Water Resonrees,Information Processing Utah,
• ./'==what/1t alms,casing,use"1" 11617:Main Semite Center,Raleib,NC 27699-I6t7
11.Borehole diameter: t 0 (la.) ;4b.For role caon Welts: in addition to sending the farm to the addta
A. � �'(/�►'�` above,also stbri-t one mpy of this farm•nitoin 30 days of emvplsaen
12.Well coast ructiari=otta ni: • f.�_ 1"`a"il •const-uedaa tp the fdUoaria
(La.anger.rotary,Cable.Qat push,etc) 1
Division of Water Resources,Underground Injection Control Prog
FOR WA 1 TER SUPPLY WELLS ONLY: f 1636 Mail Service Center,Raleigh,NC 37699 1636
2 � f
I3a.Yield(gpm) 30 Method of test: �YM� j 24o.For Warec Suooh'S•Infection Wells In addition to seeding the
FF I me addresses) above, also submit one copy of this fora,within 30'
I3b.Disinfection type. ' Aaoturt: t l4 CtRZ I con pie ton of Well conscuctioa.to Me county health department of tit,
,,, where c*nstlucttd.
I
Form OW-i Nord:Carolina Dean Card sr:of -5 oa onsi Qtaii -'Di',is: of%:a.:a:Row..-on Raised: