GW1--05035_Well Construction - GW1_20240828

WELL CONSTRUCTION RECORD(GW-1) j For Internal Use Only 11111111111
I.Well Contractor lam: I —
Ricky Cattier mom rotiescitierioN
Well Contactor Name ft. et.
2464-A tz ft. j
NC Weil CaotractorCU ftC an?ha ---------- ---- -- ------ — ----------------.----------------
>ornai-- .. -To ntne�ltlel ; _
Frank A.Comfier&Sons Wet Drilling, Inc. R. t3.
Co.pany rime Q
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i'filplitfaill
r ( - —
�o - _ .
M* �cneas A A
2.wai Ca■mractiaa Permit it
1a all a�-..r�.well > ru u1G Cam,s�ra w etc.) .1- ) s- 32 ft- 6,1 '` soul .K
,3? q it 3 . it- )(- <.(4/
3.wet Use(cheek W else) /
Water Supply We: • .. iL''i R- .-81:ar Ea/ -1.7.:.:..,_:.:4- --
_
ft. ft. in.
M.
i -..: (I Cooling Supply) it 7;=.._..:. water Supply(single) it. Ma j•
_:. Dllesidetnal water Supply( - . : .
-FM361 To MATERIAL DetActrxr MITHOD s AMOUNT
I . err. ft_
Non-water Supply well: � — ,
I 1, onI.ng L.li vaY ft ft_
Needle Web ft. ft.
Guamanan=R.emedsatwn --- - .. _ _. .
i ....,:- nonage and Recovery DSalinity Bonier raps[ TO amniont r..1 sorrow
('3Stormwate Drainage ft. ft.
II • .�.._ Test —
i 1:.--tsar_.•, Technology °subeadmce Cot�ol ft.. ft. -
■ e-... (Closed Loop) -loom To 0l8t]tIP7'Fol'I(ear jp+aa,ma mettr.ar++is. i -
■ (x lteaaa) (ecplain antic#21 Remarks) 4) t: '' ',. t< / J -
4-Date webs)c —�q-d 7 oval mtt 311 " 3�J u ., C__A
Ss.wd l otaidem:
t ft. ft.
SCOT f("b frayfrlL eitt /J/2
7,11.4.1r--451a.4,16 l� Ar Q PJ1,, ft.
- — ..-
°may >
SM.Ladande tad imegitade la degreesiminutesiseconds or decimal degrees:
—
Owed field,ale is=t ot)
35# ' t(), ' / 8°• c7/5"c -7 ) ?? w
i �/tr<Lt i,21
l
SiSignaturewell Coaaae*s
6.Is(are)tie welts or D'Teaperary Dace
BY.sialgi8 this fora.,I Aeb ery certify that the*elks)was(were)constructed ix accordance
7.Is this a repair to an existing well: Dyes or with ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Conarrcim Samdmds mod that a
yaks is a ow known'well construction riot and explain doe nauvv of the coDY of tlra twee d has beat provided to the wait aware
re�ai.-liknown'
repair ando fill reearfcc section or on the back of tins form 23.Site diagram or additional well details:
&For Geoprabn/DP 'or Closed-Leap Geothermal Welk having the same YOU may use the back of this age provide additional well site details of well
unction,only 1 GW-1 is needed_ Inds TOTAL NUMBER of wells construction details. You racy also attach additional pages if necessary.
drilled: //n SUBMITTAL INSTRUCTIONS
9.Total well depth below laid surface: U�" eft) 24a.For AB Wells: Submit this farm within 30 days of completion of well
For enrhiple we&list all depdts rf elrffrrent(araarple-irk 00'and 2@100) cation to the fonowixg
iii.sae water level bedew top of c: 5
m 0 (ft-) Divisive of Water Resources,Inisrmatlen Processing Unit,
1jiater lead is abase roam&use"+ 1617 Mai Service Center,Raleigh,NC 27699-1617
1L Borehole diameter: �� (in.) 24b.For Infection Wells: in addition to sending the form to the address m 24a
Air Drill above,also submit one cam,'of this form within 30 days of completion of well
12.Well e. .tea ethad: construction to the following:
(ie.vague,ry,tee,direct Fob.etc.)
Division of Water Resources,Uodergrouo6 lajediee Control Program,
FOR WAIXR SUPPLY WILLIS ONLY: 1636 Mad Service Center,Raba,NC 276991636
Method of test
Air 24c.for Water Sough&injection Wens: In addition to wading the form tv�
Yield�) i the adddieaae(es) above, also submit yone copy of
of this form within 30 days of
1 typr. . Amount Fj (/,.-T/Y-Jy completion of well
construction to t,F wont health department of the Carat
where
Farm OW-1 North Carolina Depertroena of Eavao®msal Quaty-Drvnaoc,of Water Resources Revised 2-22-20i6