GW1-2021-07023_Well Construction - GW1_20211025

WELL CONSTRUMONRECORD(GW-11 For Internal Use Only:
I.Well Contractor Xnformalioat
Eiri5' rk'. oe.
Well Contractor
ryIII= FROM to D cnurttoty
ft.
ft. it.
NC Well CominclorCeniaoalionNumbor
Cascade Drilling, LP ft. To
To DtAMEIM THICKNESS• MATEI ►AL
�
Compagy Nano
LG NIOR i1' GM d her llzidt"tl t 'k1:` '= 1 a
2.Well Construction Permit#: FROM I TO I DIA Wn I THITCICNFSS I MATERiAL
LW aft 4Wl9ahle well trortrlruclloa pelvalls P. 111C,Couaty,&ale,ValYart%aft) fh I n' I tn'
3.Well Use(check well tier): iL it. In
Water Supply Welli k 1 JS• S 'A i::r,( ..tdl,yyYn?:)a">m7y":'1',Iffy`!�:o'r"dr3S'aii<+�}Y.!Cn:riS:`f�..=pr�,.!`.•1t1F;7i:G':}i:;.�
FROM TO I DIAML7MIS18R I 77II dC MATRRNr.
Agricultural 13MunWpal/Public O it. IL Ira
Goothormal(Heating/CoolitigSupply) 13Rcsidontial Witter Supply(single) 19. tt tG I", l00 SC: r 1. .
Industrial/Commercial [31teaidentlal Water Supply(shared) W10000l y. r, ;• let%) ,,}+ni'.1't."Si-?1ti' ^ tI4".y;�t ':''cyfn�`
Irrillation pit QM TO MATERIAL MI'LACtA1IINrME11100,&AMOU T
Non-Water Supply Well:
Monitorin CCOV
lnjccuon Well: C - ft. iL
Aquifer Recharge r3Gmundwator Romediation
Aquifer Storage and Recovery 13Salinity Barrier LFROM ro Mnr�itr I EMP A HM HOD Y�
Aquifer Tort 138tormwatorDrainage /47
Experimental Technology [3SubsidcnceControl
Geothermal(Closed Loop) ElTracer ' t ' i "trdIV 1 Val sib e,
Goothennal e9I2 in Return Othcr lain tmtlor92l Remarks FROM n trite oe or ImNneu Irve t n toe ate,
4.Data Well(s)Completed 1,,.2d wen IDII
r 5x.Wet}Corona
ft. ft.
�crJ/QitJi� l Jlee rt to
Pncilllyi0wncrNano FacilaylDO 'fopplianbloll tY. fit
agog It. III
Sstn9
Plq��g�i�FJa,I,Ad�d/rofls,t3ry p:ut z;p /' 1 /� rr. rt. rt3,ti0 Ct�jp(1
aT�CKI�i4 Ucl/,Si C�r ������•y� •Ss.,.. ,.a .pa t"y `IxN+.+'-,. •a;s'El:b �, •.a:p)u•: i't};;t.i �
County porcal ldosKlfiandon No.(PIN)
Sb,Latihlde and longitude In degrees/minutedsecands or decimal degrees:
(Ifwell held,one lutpong issultleiant) 22.Cortiticalio
�y N W ' � V 9 �- ()
6.Is(aro)the well(e)+jPetmlonont orTempornry signwur , ZI!Con uor Date
t 11y signing dw fawn,l hemby carl(fy Thar ilm uWI(s)was(ware)catDracrad in accanimica
7.Is this a repair to an existing well: [3 Yes or 13No wide ISA HCAC 02C.0100 or MA NCAC 0217.0200 Well Conrrnrslttnt Satndar&and Mel a
ythir 1a•a rcpah;f11/oat known trall eoarrntdllon hifatnur0an and dxploln ilia nalanr of die coAy ofAts reconllim barn provided 10 tita trmN tumor.
mjWr under 021 rentarksswil ul or an the Back of dilrfarm, 23.Site diagram or additional well details;
g.lror Geoprobe/DPT or Closed-Loop Geotheratnl Wells having the same You may use the back of this page to provide additional wall silo details or wall
construction,only I GW-1 is ocakA htdicaloTOT'AL NUMBER of wells construction details. You may also attach additional pages If necessary.
drilled' SUBMITTAL INSTRUCTIONS
R Total Well depth below load surface: (R) 24a. For All Wells; Submit this tmTn within 30 days of completion of wwl
'arinuhlplo x+ills Avi all dejAvtfd1&rdn1(oxruryile-3@200'and]®1aa1 construction to tho fillowthe:
10.Stalle water level below top of casing: ((I.) Division of Witter Resources,Information Processing Unit,
4fwararlard la ahovfaann,two N." 1617 Mail Service Center,Anlelgh,NC 27699-1617
11.Borehole diameteri� OIL) ` 24b,For Injection Wells: in addition to sanding the form to the address fit 24a
1L Wag construction mothodi ,a eylld� connssttrruction to tie ibllowinit one g of thiti form within 30 days o4 completion of wall
0^auger,ratsty,cable,direct pink eta)
Division of Water Rosources,Underground Injection Control Program,
j J C'OR WATER SUPPLY WALLS ONLYr 1636 Mail Soviet:Center,Raleigh,NC 27699-1636
'4../ 130.Yield(gpin) Method of test: 24c.rap Water Snnnly&inieelidn,Wella: In addition to sending the tbrm to
the address(es)above, also submit one copy of this form within 30 days of
13b,Dtehlfaatlo11 type: Amounts completion of well construction to the county health department of the county
when aonstructed.
Penn O W 1 North Cmollm Deporlmaat of Etwitonnxmnl Qumy-Dlvivioa of Water ltmomm Rov6cd 2.22-2016
r