GW1-2021-06346_Well Construction - GW1_20210915

WH , CONSTRLC'I-ION RI CORD (GWI[
1,NVO)Contractor Information:
DAVID COOK
W61("'ontra';torName -
4495-A —
Wvh Contractor Certification Numbcr
DAVID COOKS PLUMBING `"- ``-� '"F PAM.' ------f
f ..art;."•n Name y ctt �+'w�e.�4:r`�3�*'eR6���'ii�sts tmzr�.r:s�=r�ct•Ar1<ut�c: _—�t
�� ��k?wSS1.L3if..:3.}�
2.( 'ell Construction Permit#. D l" 1 ? 7. —{--- - - -
e r
'F ! vp/llicruhlr well construction/u'r+nit.+'(i.e.U/C.Cnuntf',S 73..i`rrro f .....
r� ir
i,Well(Ilse(check well use): --
61'ntcr Supply Well: -- - -
Pp r�'fit i 0,'t <'L±r�' Cry' A 1a r?iF csT FLrc;f4t'ti'E5. SS 1E?Ft:9A3._
A➢:r'icultural [DMunicipal(Tulle
+(,c ttherinal(Healine.'C'ooling Supply) [DResidential W-,,%<- ,,, .`, i 4`a
Uttdti,dnill Commercial DRcsidentlal V aztcr y cm1 l,sffit,,md4 ! - -- -- - ------3 -_-..-__�
dr'P.Sk'. i 1..: < tb4F a:l4 ' h t 4f1:@i3Ar'Z-G z9$t'::SS't A-V.TvuNI, i
'Irrir;ltinft _ fir-- I r
Non-Witter Supply Well: r l3.
Alanieoring Rccoverw
Injection Well: i;----- ---> �t -_ --�_-----�
Af:niki,Recharge DGroundwater
i c I;I ;'i�9�C�3"+1TM'SF ?�.� 4a` iraYhrt k
Aquitcr Storage and R.ccovcry OSalinity 13 rug rrs?c --1 va ) Y xaars:t ) :%3yt ,: st.,naarnarR r��
Aquiter Test 5tonmvattF L�rv`;; t I 8 {+ell
'` � _ `G�t A r°
FxperinientalTechnology DSubsidence.Coumpl.
tit'oihenl,al(Closed Loop) [DTncer
_
Ocotltcf7nai Oieatin /Coolin A Relum Other(ex laity ar:K� v )
0$124/2021
d.Date Well(s)Completed. Well lf) r w
�.
5a.14`ell Location— ,e
CURTISS LEE MATTHEWS ( ''' 4 .—.—
1 aultty f0%vuer Name Facility ID"Ftt y,F,r ;,
3f� COBS DAIL RD EARMVILLE, NC 's"" `
-
I hy.t•.'a➢Ac{dress.City,and Zip t t t
PIT-r 82689 --
t't,n+y parcel ldcmiti_ mr_ . g;x ":: SB E-�ia
i
Sh.Latitude and longitude in degrees/minutes/seconds ter d. Q�+!�R S?pCClOn
i 1'r'u'cll field,one latllong is sufficient)
-'l�.Asa H2O '} xfr°'
b.ls(are)the well(s)oPermanent or DTemporar)'
t.l�i'31+4 t.�. '.i.f5:-A
I -+ A- R f��..l.� 1 :P'i' 1, t:C' l�<I ( 1' M V'-< :i.ril,.l..i:..�^ri ],._.J iT1;'i.➢t7°i;:f a
1�thi a repair to an existing well []Yes nr XNcs
1/,)iA.''fr Er rcpmr,�tl mfl 6novm+^e'fl von<rn,rtiun mfAnaat;rlu and es/rest:r,�A.:..r::-s4.'>�r
/'f.t3 1.:,.s'i t1.,..t..
ri-poir ana:er t,_/remorks,crs'tiun ur Ar,:fhe Luck ojlhisfiarm
R.ror Gcoprobe/DPT or Close6-Loop Geothermal Wel}s ha vir 6::e-Carl--; Itiv hm i<t 'r1 , s x tin�at �r I &tits+rr%x'::tl
cnn-,auction,only I GW-1 is needed. Indicate TOTALN`t-iiIJS.BFp'.ert
f➢rilie+A.➢:_.,.__ -- - ��'f3.8���£��..c"\'�," Pi_'�"ETA'�'.?
U.Total well depth below land surface: kD Cf-i ,�,4,, el;,.km r�t}'oic ti'£<r � ;,.. _*0 eays a *'-r tetinn o4 v:ell
1'00,r,:idriple wcils list all depth,+i/dtlfrA-nt(craniple-
4N.?r.:r�'^§',IIt: tr!s.(..ti::'f`7 .•z�C:'_^,`.
10.Static water level belmv top of casing:_ j _tir Ft rr ss sx 's8 >ke n re t,1,e*TrAg&'T pr�vv--.simg tJ'P7t,
(%utft,rA A'ret is above cusia.,' use + E? o'hT ,Gi :se:knn .Paty>ft NC-'.g-eA -461 p
11.Iloreb4le diameter: td_? (in.) :W2.i L €OIM"n ,5-14W:�- t4, C a++ r *ira f. tr v't +ae+;,ate 24
} arrEr ti Ara r < f cs^ s s-.(t 7 3 ec_.:Ec,ite3 of r{ '.i
17.iYell construction method; -
ox,nogc�r,rotary,cable,direct push.erc.)
. 1 s' t is Etts tic r,�r�x Y d "t ra :?*:tt ?l lTragrasn,
FOR IIYA,rFR SUPPLY VVELLS ONLY: � l,E�v�t i�Zs^a,��u +t..vWt',.r.(wt �C 1 7is;'Y_6it,
rt t
r {
Iiat.Yield(gpm) Method of test: `u'-',; i rk jr--m %'A�fr ,s.f de:11:F"*�tan r- r :�ri f x s .3 L.the.S m to
{U4 `L sh remit tl .ht c �.: trrs e r' .s fi r t ch j r r sti t[ s, of
1.1b.Disinfection type: 44 Amount: �� I
xe c i,..t aY 1.yr 7 v. r'ttrcc¢If.?:t= l_z4:fi: e r urF"r.#� crJsrtt}-
� r-:?t -estztsc.•��'rttU� . i
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