GW1-2022-05254_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD For Tucrnaltse jjNt:Y:
This form c4n be owd rbr sivglo or multilik wcIls
E w, ell:6"tiaetorMormation:
j4.IVATLIK ZONES,
Robert Miller— FROM z .10 OFsCRIP"O.4
ft.
2675
NC.Woll C6ntmclor Ccrtifbcatioa Niu&er 15.OUTER CASING(rorsnulti-cawil ik"',0 111 --'i alicable)
11 L
FRO'31 TO I DTA31ETER, T 11HATMIES1 NIMTHINL.
SAEJDACCO Inc 0 -ft,,. 671 (L 1 6', M. 1 Sch40 Pvc
C-01tvi'my.N;311W IM INNER CASING OR1 BING
FRONEZ� To DUMETER­ TFi10E,NESS ATATERML
Well Comtrli4ioh 061niti: ft. ft, 11L
(fir.County.-SIA10,.1radance..11ft-C601 0117.)
ft. irr
Water SnIjpIv''%Vell:, FROM 1 TO DFA1tETFR I SLOTSIM I TnflM-NTN-*5 1-57ATER(M.
Oftficulitiral 67 871 ft.- 6- 0 .62* Sch4o , Stainless
OCkotficuttaf(Watingtooling Supply) 011esidential 1Viter Supp4,(s!"L c)
13 IndustrialfConintmial 011esidcatial Watcr Suppb,(shared) 18.GROUT
ElhiiO,atbn FRONT 70, MATERUL EMPLACOTENT 3m-rHOD AMOUNT
0 rt. 61- It. Portland trimi
NouAlrat&Supply Welk ft. It.
MRcc1oVcTy
Injection}Nell:`
13 Aqu.ifcr Rcqbairge 1Mdi-oiY7idVv31&Renicdi ation l9.SANDX;RAVEL PACK(IraptillealAt!)
Ir NjA:rV
11A oF-Siom To g6andRcciovcly Mnlinity Birdc'f
64 ft, 92 Ft. ISilica Sand 20/46
ft.
V).DRILLING LOG
dGeothennal,(Clustc!Loop) 'Mracer FRONT: I To
13GLothe7nnal(HentinglCooling Return) 00ther(explaiu under#2 Ulketua&) "(L (L
ft: fL
2/17/22 '%VetllD#EW-68
ft. �n rz
n:
Facility IMM(i.fapplicaktc) (4 (L MAY
ft., ft.
1248 Bill Hall Rd, White Oak, NC, 28399
ft, (L
Cj[Y'­tnd 2 —�P —F 1.RVMI,%RKj
Cumberland Three feet bentonite Seal from 611to 641 Five
lhM0 la"JifificMil)[1 No,(PIN) fee
de'and I.*1TndC in or de0rind ftrers:
22.Certififeatioru,
2/17/2022
Dale
6.Is(arL-)themell(s): mPertuaneat 'or oTchiparary
jkr,m*pj;jrg ihikr!w I hereby certify rLar rh,i!-d7flfs)". Yr fh,vw)cominreied hr weardmce
tdih 15A IMIC 02C.0100 or,15A NCAC Ok,0200 lVell Cvitit;ucdoor karddr4s(ffld duri a
7.h thh-a rkliiaie to an EIYLN- fir ENto voypfrxi,re'ror0rik.,11 pfmi*'d OT'Ax Now fiqViler,
Me morare a1rhr
23.Site dingrarwor additional well details-
Y6u may use the back of dill llagq,to lndide additional well site details,or%iell
8.Nutuberof ivells wttstruet6d: 1 consgructionidefatfs. You necessary.
For;iAqpre viwiljtucer sW5­wi�lU ONLY idr1i the satur r4hiWj;r11P;ry&n(vo
SUBMITTALINSTEMONS
9.lWal Well depth klqv�land surface: a. P
e: 921 14o•Ali M*lls 'Sfibfidl (his farm M(hin 36-dayS of coutploion of Tiell
A)r,;Wjil*i�e'lhhse iiff'zlqAn if d ftrofd MY and MIM'y constrizaidn'to ft fallouing:
10.Static water level bi-low top of casinw. (ft.) Division of Witer k 6'aurcint,Information Prdeessing Unit,
If uunl't kl@el 6-hhure.Lylisilkv;am 1617 Alail.Seff iec'Cetiier#,Raleigh,NC 27699-1617
11.Borehole diamctck;10 _'(in.) 24b.For It ij"ajjHeJ19.0NLV: fnt addition to sending the fornt to the addrm in
24a46e: also submit a pop.%, of thus_forte within.36 days of completion of well
12.Well coustmetiownw-thad. sonic LOTISIMetithl ED thk f0lb%vifig.'.
(['q.zutr.iWa`q.cnb)c.dired V ust L ctc.)
Division of Water Resou rcts,Undirground Inpellon Control Firograin,
FOR WATER SUPPLY NVEL1L90NZLY:' 1636 Mail-Service Center,Raleigh,NC 2 1 7699-1636
13.k Yield(90111$ Method of test: 24c.For Water Supply&InjCetfori WCIK-
Also subtu it one"copy of this f6lnii'within-10 days,of completion of
13b.bisinft ion.ty&: Amount: Avell ns cotruction.-to the chanty he department of ifie couflhc-,vhcrc
North Carolina LK-paornent of Em6forunenvand Natural Resources—DIvi;1011 of Nklatcr R(tau'oe� R-oised August Yft 13