GW1-2022-01592_Well Construction - GW1_20220120

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WELL CONSTRUCTION RECORD(GN�1 'a�� For Internal Use Only:
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1.Well Contractor Information: � �., j.
>. /l/ tx/n �/C �/ i'7�fJ er �� WATER7.ONF,s
tN TO DESCRIPTION
Well Comrtcurr Name t. ) ft.
.3 7 / 1 ft. ft.
NC Nell Comraetor C'cmfication\umber 15.OUTER CASING for multi-cased wells)OR LINER If o IfcablcI
C�S L r I h /�l n'� FROM 1( DIAMETER 7'MCKNESS NATF:kI�I.
4i-(�( LJ U v fl. ft.
('ompana Name T ✓
16.INNER CASING OR TUBING edfhermal closed-loop)
2.Weil Construction Permit g: FROyt to DIAME1'EIt THICKN6.SS nfATERLV.
LINT all up/r6rah/r•wel(<oncn•urnon la•rmit,el L7C.(bwrrr..Gntr.Ironton.rrr i (L ft. ; in.
3.Well Use(check well use):
ft. ft. in.
Water Supply Well: 17.SCREEN
FROM 1'O DIANETRR SLO1'SIZE. TIUCKNT.SS MATERIAL.
_?Agricultural 0municytal?Public /9 ft. `/ t. Z in. �. 0 �/O Y�
❑Geothermal(I leating/C'ooling Supply) OResidential Watei Supply(single) L fr. ft. in.
❑1ndusit is I/Conitoere IaI ❑Residential\V:Der Supply{shared) 18.GROUT
,Fllrrigation ❑\fells=100.000 GPD FROM ro�-• MA I ERIAI. F.PIPLACt:MF:N'I'ME'1'110D6 AMOL'N I'
Non-Water SupplyWell: L
7/�C� ft. �7/j t. ler. It,,_,, �irAvl f /iy,aJ
i�imitonng 71Kceovery fI- �f, & e
Injection Well: C, lt
.vGrt 1 I , Ge e}A tt a
❑Aquifer Recharge CGroundwatcr Remedlation / t -
19.SAND/GRAVEL PACK if applicable)
:;Aquifer Stnragc and Recover) OSalinin•Barrier MOM TO M,rrERIA'I. I EXIMACEMENT METE OD
-i:\yuilcrl-cst C]Stormteaterf.)rama:;c 5 �.,(i ��fE',�s•'�.�L s
f-'Expenincntal Technology ❑Subsidence Control ft. ft.
E Ckothennal(Closed Loop) CTfracer 20.DRILLING LOG attach additional sheets if necessarv)
FROM 'f0 DESCRIP"PION(color,Inning+.+.snit/rock type. rain sne,etc.)
uGeothennal(Ilcating(C'ooling Return) ❑Other(asplain under a2h Rcniark
4.Date Well(s)Completed:�a ��_Z Well I Lm �� 0 ` I. t. L`(a f W�' ��, /re, -/ feQ I
5a.Well Location: U f t' U t �rI G f.-r � ,a �u m_,_A r �
Al
.-C.�I G-L6-�r� J C��tl�C rt c��L 36 fL �j ft.
n. ft.
1'ecdit}'O+rncr NameFacthly IDe elf aaPphcahla i
�S//j��s--�,G•�--c� �"�sLsr��T-�' 'fir�a/�^�s(/:�l t. rL
PhN,tcai Address.City.and/_ip
21.REMARKS
l6 2- /lee,
i'uunn Parcel ldcntific•:uwn\o.1l'IN1
51).Latitude and longitude in degrees/minutes?seconds or decimal degrees: I F /^ Su r Fke-R
id++ell field,uuc IaPlottg is suf ctentl 22.Certilic ion•
s, Y,47 7 5 / 78_ `7'73 �- W �,/�r/�. � /z- 20-z l
6.Is(aret the well(s): t ern tincnl or QTempurary gnuwre o1'('cditied Well Contmoor Date
Bi srpnmsg This form.!hrrrhr ef"far III •"'Ls.r n a.r tx.vr)I is'trrcted m acrordmtrt•lord:
7.Is this a repair to an existing well: ❑1'es or 11 5:+AC.4C 02( 0100 rrr 15A NCAC 02C..II_'00 11'e/i Cnrurn•rriun.1'rundvri.and Thal o Top!
It dr:s ro a repau.lili%nu Artutnr r,ell rorrab'(a tion mfo station and etplrn,rhr nnrrrr o/the a?lhrs Teeter)!nu!Tern pro*h-d to drr rrr•/!nnio•r
repair un;k•r:!21 rrmnrA,Nero....o+un drr hm A nl7hr:r Juan.
23.Site diagram or additional well details:
S.For Geoprohe/DP'1'ar Closed-Loop Geothermal Wells having the same You may use the back of this page'to provide additional well construction info
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).Y'ou may also attach additional pages if necessary.
drilled:__ _ 24.SUBMITTAL.INSTRUCTIONS
9.Total well depth below land surface: 6 (ft.l
!„r rmduld nr•2+lire nu depths it,hpr-mar temn,ptr-3w:fi(; and':a nu+l Submit this CNN'-]within 311 days�f well completion per the following:
24a. For All Wells: Origmal fi)rnt to Division of Water Resources (DWR).
11).Static water level below top of eating: Gct Inliantauon Processing I Init, I(I'\,1S('.Raleigh.NC'_7699-I617
!1 realer?nod tr share rm+inj.m:
11.Borehole diameter: 6 (in.) 241). For Injection Wells: Copy id,MR.Underground Ililection Control(IUC)
Program. 1636 V1SC,Raleigh.NC'7690-1636
12.Well construction method: J`0 N C 24c.For Water Supply and Open il,onp Geothermal Return Wells:Copy to the
u.e steer,rotary,cabic.direct push,et-i county rm•ironmental health depanMctn of the county where Installed
FOR WATER SUPPLY WELLS ONLY: tad.Far Water Wells producing L,er 100.000 CPM Copy to MR.CCI'CUA
Permit Program. 1611 MSC.Raleigh.NC 27699-1611
13a.Yield(gpm) Method of test:
13h.Disinfection type Amount:
Puna(i\\'-I Norlh Carolina Depanment of lin+mmmemi l Qualm-Division of Waler Resource l Revised 6.6-201N