GW1-2023-01436_Well Construction - GW1_20230208

WELL CONSTRUCTION RECORD n'CWI� _
1.Well Contractor Information; For Internal Use Only: PNi)t Font
�• •CHRISTOPHER WATCHER
Wcll ContractorNarnc 14.WATER ZONES
44&A FROM 10 DESCRIPTION
ft. n.
NC Wcll Connector Cwtiflcatian Number
CUMMINGS DEVELOPMENTS, INC f•11.OUTER o
CASING for multi.ae Company Name FROM DIA
ced wells O R L INER if a lica6le
TU MER
+1 ft. u/ TE
THICKNESS MATERIAL
2•Well Construction Permit#; 16.1
I ft. 6 W/a l"
Lill all applicable well con.....c ionp �t � 16
to .INNER CASING OR
ermtlr TU 188 G.STEEL
County,Slaa.,Murtwu e,eve.) r'R°M TU BING eothermal closed-loo
3,Well Use(check well use): ft. DIAMETER THICKNESS
ft. in MATERIAL
Water Supply Well: ft. IY•
in.
Agricultural 17.SCREEN
Geothermal(Heating/CoolingSu ®Municipal/Public FROM To DIAMETER SLOTSI%F. THICKSS MATERLtL
Residential Wt aer Su l ft• ft
IndusgiaUCommercial pp1Y) pp Y(single) In, NE
Irri lion ®Residential Water Supply rr. n•
pp y(shared) i"•
Non-Water Su 1 18.GROUT
PP Y well: FROM
Monitoring 0 ft.ft TO MATERIAL EMPLACEMENT METHOD AMOUNT
&Infection Well; Recovery ZO R' PORT.CEMENT POUR
Aquifer Recharge IL
Aquifer Storage and Recovery pp{{Groundwater Remediation R• & "—
Aquifer Test tI�ISalinity Barrier 19-SAND/GRAVEL PACK
TO it.
FROM a lie is
Experimental Technology Storm nr.water Drainage MATERIAL EMPLACEMENT METHOD
----_
Geothermal(Closed Loop) Subsidence Control
13Tracer ft rt.
Geothermal Hearin Cooling Return) 20,DRILLING LOG stfach addlflonal sheets if necessar )
Other ex lain under#21 Remarks) FROM to DESCRfPT10N(color,ha do soil/,rock e, rate slze,erc.r
4.Date Well(s)Completed:�()'2 FI'ZL- n• a(, >x ,-
1
58.Well Location: Well ID# ft,
r 'r.� ft. ft.
Facility/Ownery � B• f` - o 'i.�
9 1-1 yR (ifappiicabb) ft. ft.
O�1 e n ft. %
County X 8��[�9 j-)-�+ 21.REMARKS
Parcel Identillcation No.(PIN) a�f
Sb Latitude and longitude in degrees/minutes/seconds or decimal degrees: -
(ifwcll fieldgqono lat/glorrg is sufficicnt)
3 L o G I • 1 6 j N '7 9 b Z 7 6, 22.Certlf on:
6.Is(are)the Well(S) 3 • / W
Permanent or Temporary 29- u
7.Is this a repair to as existing ,gnat Woli Contracror
/J'lhir is a repaht JJ//otn known tVf,b CW entrcllu®�e9141 or a N Inge the nulma o/Yhc• rn Datc
dY l ISA g A 02+ /he+rhv certify Thal the.0200 rl/ onsu.con.Nrncled is rrccadmrce
+'epa/r under#2/remarks sec vio+r or on the back of tbls fora,, wilh/Sd NCAC 01C.0/00 or/SA NCAC A2C.0200 iYy"'Coash m'liorl act ed in and lhol a
Py of This record leas been Provided to the well onwer.8.For Geoprobe/DPT or Closed-hoop Geuther 23•Site diagram or additional well details:
construction,only I GW-1 is needed, Wells having the same You may use the back of this page to provide additional well site details or well
drilled: Indicate TOTAL NUMBER of wells construction details. YOU may also attach additional pages if necessary.
9-Total well depth below land surface: QG SUBMITTAL INSTRU[Trn vc
For multiple wells//sl al!dep/bs fd[Qereul lr ramp/e-3 e�i 200'and?Q100')
(ft.) 24a. For Att yells;
10.Static water level below top of casing: /VILE Submit this farm within 30 days of completion of well
construction to the following:
Il,vale+•icve/is above casing,nse'•+
(ft')fl l•Borehole diameter: 6 Division of Water Resources,Information Processing Unit,(in.) 1617 Mail Service Center,Raleigh,NC 27699.1617
14b
H2•Well construction method: ROTARY abo Fonfection W lls: In addition to sending the fare to the address in 24a
64-auger,rotary,table,direct pu),,s etc.) above, r i
also submit one co
py construction to the following: of this form within 30 days of completion of well
FOR WATER SUPPLY WEB fl3a.Yield(gpm) PR_y ONLY:
Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
Method of test: AIR ROTARY
13b.Disinfection 24c•For Water SUDDIy&Iniectio Wel
type: HTH Amount: QoZ the address(es) above, also submit one coy In addition to sending the form to
completion of well construction to the county of this
dform
within 30 days of
Form GW_) where constructed, department of the county
North Carolina Depanmm�t ofF.nvironmantal Quality-Division of Water Resources