GW1-2022-03029_Well Construction - GW1_20220228

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WELL CONSTRUCTION RECORD(G\Y-11 For Internal Use Only:
I.Well Contractor Information:
ter.WATER YAMA
�''vrAn4- FROM TO DL4cRlrnoV
Wen Coffer w,- A. n.
a-731D4
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NC Well Convacttn Certinution Nurnivi is.OUTER CASING rer mdLLeased wen, OR Lllat►.R f• tlesbte
rROM TO DIAMETER �TIIICK!/eS1 MATERIAL.
Cascade Drilling LP n. R Ini
-Is,INNER CA91NG OR TUnINC tbrrnul e
2.Well Construction Permit 1: FROM (L TO P. DIAMETER Id T111CK!rt51 MA IAL
List all 4^14"ble WU roavnetmn pn-al A C.UIG C~W.Sma Ymiescr,etc.) -/�' D VC-
A.
ck
3.Well Use(cbe well use):
Water Supply Well: FROM PTO DIAMETER SLOT sin TIIICK'R.13 MATERIAL
OAgricultoral ❑MunicipaUPublic 3DR qo R In. .010 5[}1 V(r
OCemheaul(HeatingaCooling Supply) OResidendil Water Supply(single) (L tL In.
:.IndumiaVCaamacfal ORaidmtial Water Supply(shared) ILCROt9'
Obri tion 0Wells>100000 GPD FROM Tonn MATERIAL , EMRACEMEYTMrn1OD a AMouvr
Non-Water Supply Well: �J ILP-7 n. 46 O l
,lonisoring ORecovery n. A 3 R
Injection Well: R n,
OAquife Recharte OGloundwater Remediation
19.8ANDIGRAVEL'PACK fa Me
6lAquifer Storage and Recovery OSalinity Barrier FROM To MATZ AL VMPEAC►.Morr METHOD
CL%gwrcr Test 17Stmmwater Drainage 7 IL 0 n j7Ou f
❑Lcperitamul Technology ❑Subsidence Control R R
OCKo:hat:ul(Closed Loop) OTracer 20.DRILLING LOG fauseb addldead beets if
OGeotbaanl(Fleatin lira Return) OOther(explain under t121 Remarks) FROMI To I DrsCRImO:I t■wr,a..a■ ..Ivrxk as arz
-- R 6 n VSel Lfl
4.Date Well(s)Completed: 01_09-x Well fDO MI A n n A IIh Vn
Sec.Well Location: ( R n_ I� Np
CIA
Pfizer �S R 3l n CLR.
r&cdffy*ai=Nanz Facility MN(lrappbeable) j I n. NO R N 6 l G G p ,
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4285 N Wesleyan Blvd Rocky Mount,NC 27804
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Payscal Atditw Cry.and Zip
21.REMARKS - -
Nash
Cpuw.y Parcel IA—ifiution No.(PLY)
Sb.Ladutde and longitude in degreta/minota)seeonds or decimal degrees:
ttf we fcid.our It'bmt a sulfciew) 22.Certification: Y
N W
6.Istue)the we1)(s) rXYerlmaaml o► tJTemporary Sipattae of Certtlled well Contractor Date
By rlgwUy th0 fora%I hereby eertI&Ant the tveU(t)was(were)cownicted is a rw4a tee*,A7.to this a►epW to an eaistieg well; DYn or Ah0 11:f NCAC 02C.0100 or IlA NCAC 01C.0100 104 Cowrtruclioa Suiul rib aid 9"a copy
II00 Lea repay,Al a w"wl1 ca"V a Ww Iq/wtttatWr and uplatn the Rawer of the of thu record Am heew proWded so Air*wU owner.
"par badm r)1 rrAtarlr saroea woo w bael 0/"tom • _ _ - 23.She dlsgrem cr addlitenal well detallt:
R,For rwprcbcMFr or Closed-loop Geothir mal Wells Fusing the tame You may use the back of this pate to provide additional%%vU construction info
coesvuctim,ottiy I GW1 Is eved - Indicate TOTAL NUMHER of wells (add'Seo over in RenwU Boa).You may sho attach&"tioaal pages if oa-CLUry.
drilled. / 2/,litlIMITTAI.INSTRUCTIONS
9.ToW wdi depth below land surfa e: L` O (n') Rubmll this M-1 within 30 days o(Neii tompletion per the follewtng:
far-nNr watt Iut d/drpdr(f/offoreu trawto-I44200'6,w 1(jl ow)
10.!static water ind hebw by of eadag; ,7• 7 (fl.) Ib. for All Wells, Original form to Division of Water Resotuca (OWR�
(/.1it lrtd 4 a6o.r cadAt w •- Infomulittn I'mceasing Unit,1617 MSC,Raleigh,NC 27699-1617
I I-Borehole diameter._�an.) 2/b.For Inlection Wells:Copy to DWIt,Un&Wuulnl Injection Control(IUC)
L I'mgram,1616 MSC,Raleigh,NC 27699-1636
I Well wnstrvctlaa sisethad: Sa ell 1 24e.For Water Supgly and Open-Loop Geothermal Return Wells:Copy to the
Its tumor,ro+*r,w's,d rcn pta2L rc) county cuitutiturricrital licalthepurunenl ot Me County W ere uUUUCd
(,` I FOR WAM SUPPLY WFAI S ONLY. lid. 'or Water 1Vcll roducih over 100,000 GPD:Copy to DWR.CCPCUA
Yrnnn 'ruaram, 6 � Raleigh, C 27699-1611
13a.Vield(gpm) Method of tear:
13b.Dlslaftedon type: AmoonU
Forte GW-1 Nun.,Carolina Urpertmcnt of EavwnmcoW Quality.Division of Wsta Rouurcn Revkaol 6-6-201%
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