GW1-2023-00825_Well Construction - GW1_20230113

WELL CONSTRUCTION RECORD(GW-11 For Internal Uac Only
I.We0 Contractor to6rdWn:
Kelly Grant 14.WATER ZONES
Well Contractor Name -. - IrnOM Ttl nRanITOV
2730-A ' :. eL -In.. n.
N(W'cll ctwuanmlmitiurm Numnrr JAN 1 2023 ILODTERCARINO w..rkaotw noel tw IANER
in
AN Ttn %e A
—Cascade Drilling) P _ R. R. k
r—Poo,^tune .
IL INNER CAMPir OR Tl)RING
z.WtD C"U"Ctien po it b: PER EPA APPROVAL rRom To I In 4%IT
lag aft rgq.Sroblr x(!rwuolrcnon Prrwbr li.r.UI(' flnwrt..1ub IarlunT,efrl n. n. h.
3.Wall Use(check well
Water%apply W ell: ITSMLXW
nm Ile I INAMRTRR m a1Ta Ts11(7fnem VAT 41
rIAgrwlluml f1muoicipol/pabl:c n. R, k
:JGeolhAmul(Hesm5cmial Supply) (1Rpidandal Warn Supply(single)
OlodmmalVCommwcitl URntdenOol Wpm Supply ldrered) IA
Olin roe, ❑Wells,im)(K100ffy rants TO 107t111M. [ _nn-T er rivNrA rori yr
Non-Water Supply Wen: IL R
rwf TrtL Pj J I
AMmminn I:1Roanay n, n.
tolec/bo Wtll:
OApollet Recharge R. R.
art gUm"It, ler RemtthohXl ot./AND/ORAVEL PACK
UAyur/n titonge and R«mny OSalimly Hama ritem To 1AL tRMtd%ter
0Atlldar ten (7Skenrwalcr Drainage R. It.
UtaperlmrnLvl lechlallogy I]Sub%id,we Comm] n. R.
,Kinoth,,m:ll(Closed loop) 011racer 10.DRILLING IA(:fall sdAllsaY%Y!n Hoe
"1Gc+NhrnnNl lHrnnn 'A1o1' Realm) OOtller(evolmn under 021 Remarks 1`11404,1 To nraellPnna eats w-
h. 0.
A.Da(r W M M Cmispleted• -30'7(l- wtu 1DP SA -K �' R• n. —-_ -
5a.%%ell loutln0u n. R• s-
1-wmer Barry Tech R' -..-- -� -- 1 [�` /Z•rr
J.rihryl(lwrer N., F'riltry lIle(KappS.ebkl n. It.
3G5 E US Highway 64.Leainglon,Nc R. R.
Phyla Addle%.,(-nf.and Zrr LL It.
Davldson 21.1"ARK3
panel lOewrfaslon No (PIN) r•r ORSZ✓C
5b.lAtilude and longitude In dttreevminuttvle<ontb or derinnl drama:
of ne0 fa IS:na ul Erna n%utllnam, 22.Certification:
7s^9 80'.1T N l b 3119'177. ray
4.INaMilhenthlY• 7pardntnt or 5d'1logernry Sipwrore of CenifiM WeD Carrbclls Duo
By NCAR 02 Jarw.J orrk.NCA tAw M.'ad N war Iq ml rrl Sas rdhr an,r i,n r M
T.Is this o repair to of ethtlq wdl: ❑Yn or �0 11A NCA('01('a!W or ISA NC'A( 02C U:W Neil Corurnrrrew Saa.ory owl dv a rqa
I/INr.1111J 11.All Dal/roan.elf caa.bangn ovorwaoo.tots rgAan Its natarr o/Ae of All rrrard Aar her.P�n Ar r )Doom
.rpv under a)I.ewurp rNnra o..w rM Aurl n/AI.Faw
23.Site dtotnm or additional wdl IkthW:
A.Ior GeoprobvDYl or Cloned-Loop Geothermal W ells hR mg the same You may use the lack of this page to pmvlde Mldlpvrla; rMl.%rann..rm mfo
cralunrcrNnl,only l(;W-I is needed. Indicate 10TAL NUMBLR of well% (Add'SM Olve in Remark.WlX) 1'ou may alw+sninch r1dh0ooW pan,:!'na•....nry
dnilvl _ -.. 24.SUBMITTAL INSTRU(TIUNN
1.TOW wee depth below bond angnee' -s 7 c M.)
Lac w.f irw xll.cur mi.lgeb/Ifrvm le.eayok Jfig2W'.W 7410 1 kebmll this 4K'-1 wllhln 30 da%%of nth.vmyledw per lag fNhwiq-
IR.Stodr wow lnel barer lisp of"do&: r� y • U IR.) 14o. Wlr All Wrflu Iblgulal loon I' Ito.w.rn of Aurf Re..wne. rt1WN1,
4'..4.rio otoN.ruut(.a.r • / IpIIarIW IINI PNMr%%lag ll�ll,IM7\L\l,Relergh,N\ 1'O'b1-Ihl'
11.Rorrbat.dhmeter: 4' (18.) 24h. for loleclloo N'tllf: ('Ip%to DWK. LlmlagnwJ bl^hon l onemi It 4 1
Irnrgnnr 1616 1,1M,Kaleah.Nl .`l6w-Into
Il Well t"Itenrtlm sertherd' Sonic
(u a%p,nuq ...e.t nvu.Pun rl r -- 34r.Far N'ehr No1Tle and(grtl.•1 toe G hk�.nrl Rerora W.IA:l.gyp+ur If.
ftNudr anvmvnnrmh w 1 61Avnnent ol"1he eweov�-ra�La7
p'Ot WATCR hurry-Y W Wb 0!RLY: I4d. �'o W'Uer e.er l tOD Gpb('upv h•DNR s'CPl l %
17iL YW 1/pml__ MMW a tow: 1'amn I"lJ-aynm,Th ITN 1. n ti . t � h -TI T-
13b.DIMRNcd"7Pt
Initial 1•rm f.r•Uru 14�rnnN=a uI laNnrarteHa Owhy-Inanw of WNn seawrr.. Xnml rv-.•:a

20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soillrock type,grain size,etc.)
0.0 ft. 5.5 ft. Reddish brown silt,trace fine sand,moist
5.5 ft. 8.0 R. Ochre brown fine silty sand,little gravel
8.0 ft. 56.5 ft. Altemating It brown silt and gray very fine sand,soft,moist
56.5 ft. 57.0 R. White,black,and pink Granite
57.0 ft. 60.0 _ft. Light brown to light gray silt,some fine sand,wel,weathered
60.0 ft. 655 f[. Dark gray fine to coarse sand,trace gravel
G5.5 ft. 70.0 ft IBlack and white Gneiss
ft. ft.