GW1--02406_Well Construction - GW1_20240422

WELL(()NST1(1'I 12VIN ttl.l-Vitt/tl,‘r-It
I.Well Contractor Information:
Landon Phillips 14.WAFER ZONIq _
Wal Cmnnerm Name ---- _rim 715_
hE3f QAKK]N
;441 A i4C ft•- Z h. _ 20 Yen
h. O.
NC Well Cancan'n Ceni licuion Nomt,rt
11,OUTER CASING(Ear nu,IN-caveat welhlr30 111,1ER Of ay ke la ___ _
NW Poole Well and Pump Company rnosi _TO _ or.tmrtrx (j Tutu;n_e/s xttxmtL
t 111 JJJ��
"nt`na�N"ne rd.rkNER CASING OR TURING enthermal efined. rei
ZO?/1VSCR _` FROM _ TO DIAMETER TIIICKNII.SS MATERIAL ___
Well.Construction I'cnnil N: L J�\ r-- —� ---
.,n. i•pli,nhlr Welt Cansracn✓n pr•,antr 6.C.U/C L'mary,$ralo,rat WIC.,ate) ft. ft. i+`-
3 Well Use(check well use): h. /r n.
Supply Well:\Cater 17.SCREEN
FROM TO DIMIF.IEx SLOT SIZE 71f1!'fCNE53 MATERIAL '
°Agricultural °Municipal/Ihrblic 0. ft. in.
'
OCcothennal(I le:fling:'Cooling Supply) )(Residential Water Supply(single) 0, h. in,
CImitistrial:Cornmcrcial ❑12csidential Water Supply(shared)
Ill,GROUT. _
,,°Irrigation OWells>100,OOD GPD IMAMaTO� MATERIALEMPLACEMENT�t(F-TII405r h114r.�q �_
Non-Writer SupplyWelL: It. :�0 rt. �ti��f/�� --
GMomtoring ❑Recovery It.
Injection Well: -
h, ' ft.
°Aquifer Recharge OGtoundwalcr Remcdiation —_
19.SAND/GRAVEL PACK(if applicable)
CAqu,tcr Storage and Recovery °Salinity Barrier
retort TO MATERIALEMPIACE.11rh-r sliorrtrr
°Aquifer Test OSiormwaler Drainage 0. it.
0Experimental Technology °Subsidence Control rt. R.
°Geothermal(Closed Loop) O'Traccr 20.DRILLING LOG(attach oddido.at sheeaa it necessary)
OGcodtctmal(Heating/Cooling Return) ❑Other(explain under 021 Remarks) MOM TO Df5Cfl PTION(, I nrdan<,swuroeS rvr<•ara;n slat.s•
0 a- ft. O
4.Dote Well(s)Completed: 11-i 3 Well Mgft. //y It. T-k Y _
,a.W el Location: - 1/ 0. t` fir G,r„,, ,/i� •-.i4 • ,
nti .r mete-4iee5 rt. rLJ J L--:L• .:. +.r 1:_:J..
facility/Owner Nairn. raciiity ION(if applicable) rt. Cu.
Z����� ti� a�5f APR 2 2G�4
I I.7C 1 '� ft. ft.
P
Physical jAAddfdreesrss...City,and Zip h. h. `-
"1LJ1`k 4-on 21.REMARKS ` �r'•,•,�.''� 'J f:k
( !in Used hardened steel drive shoe. S��
County Parcel Identification No.(PIN) —
5b.Latitude and longitude in degrees/minutes/seconds or decinud degrees: -_
(if wen Scld,um;la/long u r maim) 22.Ceriilicaii
35.7 cr) N — 18•_9NRG \i' met . ( (— i7— 2
6.!spare)the well{s): cnnuacat or °'Temporary
Signature ofCmiricd Wcll Contractor - Date
0y rlenesp t isforr,./hereby certty alrnl the,ra/I(4 wn.r(went)etumrnue:n,ncc: :;floc: .:
7.1s this a repair to an existing well: ❑Yes Or o list NC.0 02C.0/00 or(IA NC.0 QC.020a Well Construction Stiinit,,nts cud 1-n,,-a.
If der n a repair.fill out k„una,..ell cosum:icons,irfonnnunn curl explain the nature of the of ilur mranni lns<bunts prnnirl nl in the wall awuer
repa,.under 1121 rcntarkr seer,,,,,or on she back of dos farm
23.Site diagram or additional well details:
S.For Gcuprobc/Dl'T or Closed-Loop Geothermal Wells having the sane You may use the back of this page to provide additional+cell cons:1:ctiu5:,...
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Rernorks Box).You may also attach additional pag•:a is recess:
drilled:I (I 24.SUBMITTAL INSTRUCTIONS
9.'!'otal well depth below land surface. 6 S (ft.) Y Submit this OW-1 within 30 days of well completion per the fallowing:
Far,,ndiuple ux/n Oil all dcpair if dii furs,t(ssxa «?n,plc-d 00'owl?©I N') P
7� (IL 24n. Far All Wells: Original ;Corm to Division of Water :.csaert.. t0'
10.Static water level below top of casing: Information Processing Unit,1617 MSC,Raleigh.NC 2769 9-1 6 1 7
If water/ere/Is ubu+•e cusnrg,toe
6 241,.For bicetiuo Wells:Copy to DWR,Undergm,a•S In xtion Cur:ti o.
11.Borehole diameter. (in') Program,1636 MSC,Raleigh,NC 27699-1636
Rotary
12.Wellconstruction method:
24c.For Water Supply and Open-Loop Geutherttsal Rcsrn Wells:Cup,
i.e-auger.rotary.cal/c,ducat push.etc.) county environmental health department of the ccur.:y when:installed
FU1t WA-1 Eli SUPPLY WEISIS ONLY; 24d.For Water Wells producing✓.er 100,00d GM):Cony to D`AR ,..','
1 Permit Program, 1611 MSC,Rideigh,NC ?76 ) 1,1i!
I 3a.Yield I(pm) Zv Method of test: BLOW
j131..Disitfecuon type: HTH Amount: 1 lb.
I eau.C/I-i N,udt Catulua Dcpuraucut of Euvinnnnc,dal Wilily-Dinsrut of Winn Itcos.wcs ., ..