GW1-2021-00846_Well Construction - GW1_20210322

WELL CONSTRUCTION RECORD (GW-1) F'or Internal Use OnIN
I.\\'ell Contractor Information:
NICHOLAS HAYES u.NATERZONES
N ell Conlr.00r Name FROM TO DESCRIPTION
A - 4121 10 n.
D. I ft.
\C\izll Contractor Certifcivion\umber �' � IS.OUTER CASING for mulct-cued wells OIL
ifa livable)
GEOLOGIC EXPLORATION FROM TO DIAMETER THICRNFSS ATERIAL
( 0.0 f
Company Name L 75.0 ft 6.0 in .188 GALVANIZED
16.INNER CASING OR TF NG eothermal clILe` oo
2.\\ell Construction Permit N: FROxI TO DLUIEI'ER \NICENESS MATERIAL
loran appfi.nnle.re//....t,rrn.ru..I...nt.,ne. /att rnunn.sor.. rart.r�,...et../ 0.0 fL 98.0 R- 2.0 ' SC-I PVC
3.\\'ell I'se(check well use): ft. I ft. t
Hater Supply Well: 17.SCREEN
FROM TO DIAMETER SWTSIZE 111WKNESS 9:\TERIAL
7Aaricudml CMunic ipabl'uhlic gg 0 ft. 103.0 ft. 2.0 1O .010 SCH 40 PVC
TGeothermal(Dcating/('oolm_SuppL') ❑Residential Water Supply(single) B ft t
Dindustrial/Commercial ❑Residential Water Supply(shared) 18.GROLT
❑1Rloaron ❑WfIIS 1 I100,000 GPI) FROM TO MATERIAL E\IPI,ACENF-\TME'rllOD3A\IOISI'
Son-A\'a ter Supply Nell: 0.0 ff 74.0 ft o1ea11eorovrre SLURRY
3Moniloring ❑Recovery 0.0 a- 75.0 ft' 10.'LAnDBrvTCNITe SLURRY
Injection Well:
IL (t.
❑Aquifer Recharge ❑Groundwater Remedialion
I9.SAry 0/GR:xV EL PACE ipplivable
C'Aquifer Storage and Recove x ❑Salton) Barrier FROM 10 MATERIAL EMPLACEM ENc ETHOU
❑Alan let Test ❑Stonmcater Drainage 90.0 f'' 103.0 ft' 20-40 FINE SILICA SAND
--F\perimental l'echnoloav ❑Subsidence Control In. ft.
'--Geolhennal(Closed Loop) 111 racer 20.DRI LIANG LOG nanacb addict...I sheens if necessary
76eolhernal(Hcaling/C-0Ohng Relum) �Olher(ecpImn under 921 Remarks) FROM TO
DFSCRIPTIOS Irolar,hanlness.loll/rock Lie, ra ze.eu.l
0.0 ft. 6.0 D' RED SILTY CLAY
4.Date Nell s)Completed: 03/09/21 \Nell[DO M W-1 D2 6.0 D' 11.0 fL BROWN SILTY CLAYEY SAND
5a.Nell Location: 11.0 f'' 14.0 f'' PWR
CARR MILL MALL 140 ". 16.0 D' FRACTURED ROCK
Fucllin O.vncrName Facllin ID=tifappjicabk) 1&0 ft 103.0 ft' ROCK
200 NORTH GREENSBORO STREET CARRBORO 27510 ft. ft.
Pin sical Address.Cn,,and Zip ft. ft.
ORANGE 21.REMARKS
Conan Parad Wemihr iloii N'o U1LN1 BENTONITE SEAL _ 74.0-90.0 FEET
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
fit ell llzld,one at/lone is si5eiein) 22.(ertification: /`///
35o 54' 41.47" N 790 04' 13.24" \�- 10611 AIA�111 03/10/21
6.Islam)the welly): TPernlanent or O'1-emporan' S..'atw ,ofC,mifid Wdl Ccnuaamr Dme
M a,¢amg rlur/don.I herchl rem{II/ Irhz aelll/io"(irerry eon,rrner,d ar...cr+rzlnnu-note
7. Is this a repair to an existing sell: ❑Y'es or JNo /s,9,vi'at'112, 0/00 rr 15A Vrd("02( 0'00 utd/('urnnv.min.00...h"A„n I doe o.iipr
lJ,)i a rgxr r./d/am berm a ell.v.xrtnmvma tq/or ¢eon.nn i zrp/aoi tlm naavr 't h,, nJ d...ruurd far bear prunded m the ii M nu ner
rrryur under-21 remarks sreeun ar on the back J do for,,
23.Site diagram or additional well details:
8.For Geoprobe/DI'f or Closed-Loop Geothermal\\ells hmmg the same You may use the back of this page to provide additional Dell construction info
construction.only l GW-1 is needed. Indicate'101 A].NC1,1131 R of wells (add See 0scr'In Remarks Bos) You may also attach additional pages if neccssan.
drilled 24.SLB.NI ITTA I.INSfR L CT IONS
9.Total well depth below land surface: 103.0 (ft.)
I or�ni,lnpfeud/.leanOd"'i"'Idill.renr mvao...1, 3("00 a.i 1'dI T)i Submit this GN'-I within 30 days of well completion per the tollmsiug:
10.0 24a. For All Wells: Original torn to Division of Water Resources (DWR)_
10.Static water level Felts, top of casing: (ftI Information Processing Unit, 1617 MSC.Raleigh,NC 27699-1617
//i�m.-r lerrclrcahore cwvq¢_um '
11. Borehole diameter: 12.0/6.0/10.0 (in) 24b. For Infection Wells: Cop} to DWR-Underground Injection Control IIUCI
Proenam, 1636 MSC,Raleigh,NC 27699-1636
12.Nell construction method: AUGER/AIR
24c,For N'ater Supple and Open-Loop Geothermal Return Wells:Cap}to the
1,e vu_ rmap,cable.djrect piah,etc) County'ein ronmental health department of the county ohere installed
FOR VA:ATER St PPLN'N'ELLS ONLY: 24d. For AA'titer Wells producing o%er 100,000 GPD: Cope to DNR C'CPCUA
Permit Progmm, 1611 MSC,Raleigh,NC 27699-I61 1
13a.A'ield(gpm) Method of lest:
13b.Disinfection type: .Amount:
Form GAC-1 N'oilh Carolina Department of Fn.irn..... l Qualhq-Division ofVJahr Rewurces Rn isca 6-6 2018