GW1--02869_Well Construction - GW1_20240510

. WELL coNSTRTJcrial RECORD (GWa1) For I an]Use Only: �•••�+
I.Well Contractor information: C
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Rosso!!Taylor ; I4.WAX Z
ONES
Well ConnacrorNsme FROM t Tea I t DESCRIPTION
2187-A 1750 f4 175- .ft: 1 •
NC wen Conan ooe ConffoadaaNumber 1 ' -
!-!widen Brothers Weil Drilling, Inc . E FROM CASING arozmm RReusf1 THigIffess L
Co N m ft1 I
• 1 Id.nthNERCASEIG MIMING raothesmeleioletWo n)
I.Wen Coo astfan Petra*: 031 aa�- . . I FROM TO 1 M4
TISTAL
Ziff ail(*pfieable arlre cap e.g..U1C Cora*States Trarienrr.etc) 1. 0 ft..� flLC', ft. to. •
3.well Use(check well use): fr. i % I as
,WateT Supply Weil: 17.SCREE,\
PROM I To DER ,SLOTSIZS TfIICI� r Eta=
EiMtmicipaf/?ubiic ft. I i; ,ft. IDIAMETERTin.
Geotissernal al' g Supply) RRes)dential Water Supply(single) f fr. 1 ! . in.
lad liCostmtadal D a
(shared)al water Supply(shared) . !
�,,.; ,t,,,, la GR�Lrl
. FROM I TO I MATERLti Ltarrt ezuMTa(tlEDD&A1tt
Non-Water Supply Wells { it. f '22 is 1 �. f w „a
Monitoring e,y ;1 ft. {. a. I
eaten Welk 1
Radars: CICzoundwaorrR.cmed(xtioa I fr. I 2 {
u
19.SAND/GRAVEL PACK(ifappEnbie)
Storageendaucconny DSaliaityBusier 1 FROM I To t MATERIAL EyrnAe►te>:rrrstaThDa
Tat EiStaanwaterDraiaags I ft. ft. I
Experialentg Technology DSabsideaca Conn! I 1 fr. ; i ft.
I -
Geothamal(Mud Loop) OTTaee; i{!{ ZO.DRILUNGLOG(mash addi(ionelsbaes ff ereesarT)
Gtodic:mai aleatinsucoolin¢Return) fOtber(exalaia under MI Rsma3s) i t FROM I To : I DESCRIPTION tinter I arseer atiffisa Ma.Irate tea,,
! CI j i'. ' II' I day a sena
4.Dato Well(s)Completed: 41 f o6/.?OR4 Welt Ili f1 f`' i s _ _—
•Sa.well Location: n l ft. i ,`
�/� �J iij`c4>..i..,p ,d .I
F�ureis PtLC i ° fr. { ' , fr. j �/ C r 7
fernityrowserNama Faonk.m_t;opps cloy ! fa fr. I MAY i LUL4
b!,%.rder T i 1 FaAi a in 8'73 — ! I trf,. „.:. ...:.,., .:>
Mahal al Address.Coy.and yip l 1 (L ! t. I . s
' G"rct, ....iv
,late& COur.rr.ry /M 6o45a88 i any. ee
County 'Parcel IttednreationNo.LPN) ;X b at,L.l.t'I, b EO a78D'—8b0' 16'604.)
Sb.Latitude and Inagl>sttiefa degrerstmiasseestseconds or dedmal degrees:
(Iran!'Md.one I:Yiong is svllicieat) 2e Certfticatian:
.-?5° 12.47 N D83° e23.08 w 6caip:_gp 3 genisiv.
L Ware)the weA(s ereenneat or DTeroporary Sforaaue ofC=Ified Well Cooro .- . .
1.Is this a to as 3y*arias tell jorar,I kern':a that well(a)ow(titre)ara*aaced iu tax
repair easing wens Yes or !o hair!Sd:MAC 02C.0100 ear ISA CAC 02C.0200 to ell Caasaatalaa Starter dr an
If thirtra repair,fdtoat balm well arsYctatioa .,c 1 e - e plcir.the ne ,oferr ropy of his morel hgls been ptaridtd to the well motet.
repair raw AU reararfsm:ior circa the back ofrhisfmm • 1.Site diagram or additional well details:
8.Per GeoprabeiDPT or Closed-Loop Geothermal Wells having the same -feu!nag use ice back of this gam to provide additional well she details.
conarrnctioo.only I GW.I is needed. Tricker TOTAL N'UIrIBER ewes om details.You may also attach additional gayer if ties asaly.:
drilled: '
3USMIT AL'INSTRUCTIONS •
O.Total well depth below toad surfacer Boo (ft-) Via. For All Wells: Soeacit this far=within 30 days of cotapletioa
For=Ito&wits-lift all depths tfdrf frrrat tiaager.IWO°•cad 201001
eorsssue oa to;rise followia=
10.Static water level below top of-caving; (fr.) Dion of Water Resources,Iafbrmadon.Processing Unit,
watt lave is abat'r eastag,'ar i� 1617 MasiSer vice Center,Raiei6h,NC 27699-1617
11.ISorsbats dtaaiotar: i
(tu.) :4D.For Inieetton Wellsa In addition to sending the faun re the addict
ri_ /� , i, st t- above,also scbr-t vac Tmpy or This farm withty 30 days of eomplafoa
12.WW1 adz
Cps a rotary pole.trout pugs.arc) C C1 J�• 1``u(fir aonsCscdoa i�e follo�cia€
Division of Water Resources,Underground Iojectton Control Prof
WA WATER SUPPLY WELLS ONLY: j (I636 Matt Service Center.gale igb,NC 27699-1636
13a.Thin.%pro} 10 Method of WS= €3060 I:ire.?or Water'Snop1v&Infection Wells, In ado to sending the
tS ! f _} 1 the addresses) above. also submit one copy of this fotas within 30
I3b.Disiafeetfoa type: Ti i ;;aocar. t t 0 vim, { eoapledon of Well comm.-action to the county health depatteseot orth,
c . where eonstueted.
Fern OWi Nora Carolme Dow:mini sfEr.virans=a2 Q.,l ._ l.s-.on _e 2zourco RCtited:
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