GW1-2021-03155_Well Construction - GW1_20210625

WELL CONSTRUCTION RECORD � P�.tr�rawussoxly:
TIM r mu can be rased rm sftk of MORk wells.
1.Well Grotractorhlformation: \�
Zach Thompson BROM TO OPS-J . IO
Arell;CO *acterl+:ank 470 fit. 473 G. Fracture ,
n. ft.
4478A
NC Well CoramciorCc1itkmlio4Ntrni>ba
tS:t)IIstiP8 ►513Ht3: neai►l7titiei3rdule `0R3lKE:A73f'" -`
FROM I TO OtAMETGR. TIttCKItT.SS MATERiAt.
SABDACCO Inc 0 fL 273- fL 6° ile. Steel
Carpfrcury Name'
iROM DL1AfET6R TBIC MTSs I MATERIAL
2.Weil Conshv ctinn Permit*; 2021-838 NA 0. NA ft.
LW 40 awficoblr urtl psmrfPs 0-r,Caunty,State.Vadawe.I(Itec6on sic?
NA R. NA
3.Well09c(dwkR'cilasc):
WttIrSupph Well: FROM TU _ atAete,Tt ttI wr talc IT1tt. M 1r tAt
OAgtimtitiitni ONttnicip lIPUbtic NA ft: ft. Ins open sole
©Geoth mill(Heatingtoolin$"Study) OResidential V4WrSIT ly(singe) NA fit: fL' to
Oludasuiallcomm"cial ORrsidenthtl Water SlWb(shared) ,S;(3Rt?m
FROM1O AUTRRIAt PIACE MM"r MUMOn fi MOW,
❑trri atipn 0 fL 273, ft, Portland CehMn4mie
Non-Water Supply Well: n. a.
Omou torin Oita of
Injection Well: ft. (L
OAtluiferPecliarge Odm-utidm4tcrRemedistion
OAquifcr Storage atxl Accoven OSaiimty 8amcr re w to u�, ". V
NA it.. ft.
OAquifer 1CO D$lomm-ater Dtainmc NA R: ft.
0ExperhmcntW Itchnoloa OStft&—W Sc Corttt:i
t)i R {i=],tf6. eM addititrradia" "
OGeothemid(Closed Loop) OTImoer FROM ITO 013"tMON cslor bard" tow"Wk lypt,Owli , .
OGeothenuat(HeatingCooliSSRetum) OOther( *n under#2l Rematts 0 fL 28, n. Sand
28- ft. 140 i ft. Brown clap
3.DateWCR(9)CompIeIed: 6-1-2021 i;ID#WSW-1 140' tt. 165' tL Red Clay f"
SILWCUluitathyn: 165' ft, 273' f4 Gray Clay v
Gregory Rubenstahl 910-308-3556 273' f(. 473. IL Rock
Vwflty)MmrNium FncOity'lMOfnRlimble) fL �1�
2015 Catman Road Fayetteville, NC, 28312 ft, fL �tpUy�`�
Pktkal Address City.and Zip t ltliFi lf4
Cumberland Open borehole from 273'-4731.
Coate, Pared Id fflin Lion tJe,(Ptt+t)
Sb.IlAtihrdc and iwongitade in dcl rmx/mimttWgcc6nds or decirrwl 4egmcs: 23.Clrrtirmstion:
(it well flew Oar taUlens is srdikkni)
34.985615 )\ -78.761125 �}� 6/l/2021
Si6ml refCeitifiedWcllContsamy ; Date
6.Is(are)tltc:rreil( iBlPermaneut or i?iempornt}' by*Aini (frit join 'P herrin Frrr fp rbru thr r,YlHfl wai lat"ietl ,wrmerrd fn err rardmirY
addr I5A ivCAC A2C A100 ar I SA NCAC 02C.(200 HIM Consr ian Standards mrd iher e
7.Is this a repsir to an existing wdl: mVe$ or ONn nanrojthirnron3 as8wrr+pnnhJrdrah ;�trft vKerPr.
fjrhls&a rrpnir,fill oxrkrrei�wrtleaurrtmlarr iirfotmn(9otr arerlf�dpfrrthe natxrs ryf fht
rrmir corder b?1_remarbArrlim or tin the barl.af thisfornr. 23.Sltue dhVum or additional Well dmtLe:.
You mov use the back of this page to pmA ide additional wdl site details of well
8.14irttibcrotxrci)s eotistrncteti: 1 cousuut6fi details, You may also attach additional pnges if txcessary.
For ntu iVe tgkakm or mm-iimsr jWplr w th ONLY ufrh thr same eonsomAon.vox can
t 0mit aw form. s.UB� SnCn=
9.Totatn-rltdepth below land surface: 473 (il) 24a. For All Will Subntlt this fume within 30 deryt of Oormletion of"ll
larmxPr3intrwetltlisratlrlryriGrfld($tr<ualsran tc 3 'd(ltt'end?l1lt(I1 constnEcdontoftf0lkm rag:
l0.Static Water 1e4e1 below top of Casing: 107 (R.) i}it°tslon ctf Water R �ttrctw.Itsform$tion FrnctYtsieg Bait,
lf;4m,level is 4&m't ene(((�xar"+a 1617 AfAil Sta aticc tenter,Riltio,NC 276"4617
i ,
t 1:13otwClutitc tliametux 6° (in.) 24b.FnX Int all Welts ONLY in addition to sending ft form to ft Wdim in
24 abm e. also submit a copy of this fom)within 30 Gams of completion of ttell
11,Well CanStiValon m4lbod:Mud Rotary/Air Rotary eonSt cdon tothe'tallowhW
(i.e.stintW,iamy,table,dbw pmb.cm.)
Dhision of Water'R.esourcfsmUttdergmund Injection ContrnlPtogram.
FOR WATER SUPPLY TUL S ONLY: 1636 MAR Sen ice Center,Raleigh,NC 276"4636
I3a,Yidd(pPm)40 Method of feSt Blow 2�.For Water$annul lSr'fnjtstim►Wells:
Also submit one cop) of this fohnI%%Ithir -10 days of completion of
13b.Disint"on IyVei Chlorine Amount. 1 lb well construction to the county'alth depintrtxm of the county w•bctc
conwuctcd.
Perim ov-1 North Cmotim DcFmimcm of 1=tnirnmmnl and Mnuat Resowees-Dn isioo ofAratcr Rcsbtro@s Rc%-bed August 2011
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