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HomeMy WebLinkAboutGW1-2023-01437_Well Construction - GW1_20230208 BIEIGIL C NSTRU ItECOR® Gw.1 " 1•Well Contractor Information: For Internal Use n Y. Print Pol) CHRISTOPHER WATCHER Wcll Contracror Namc 4448A 14. FROM zoNltfa — TO ft. Dx5C lON NC Well CoahaotorCe,tiAcationN B' f 2C' Number f3.CUMMINGS DEVELOPMENTS, INC ft. t Cum IS-OUTER CASING for mithf. '4 _ y Pant'N°n'C FROM To 'ae,atl wells OR LINER if a 2•Well Co 1 ft. DIAMETER THIClniigag e 08trACdOAperndP*t 5 3 + fr' 6818 In. MATERIAL L!•tl u!I uP1rlirablc wrll t'o»strrrciion rrrmltls r, �Z Z 16.INN •188 1 t7• U7C.Coudly,Stale,Irurlunre,rir.) PROM ER CA81NG OR TUBING aathermal d G.STEEL •Well Use(check well use): DIAMETER W!d laa ft. R THICKNE88 MATERIAL Water Supply Wep; H. - Agricultural ,�._ _ 17.SCREEN Geothermal(Heating/coolingSu �Municipal/public FROm ro Supply) Residential Water Su 1 rr °IAmETER aL0T812E THICKNESS i pp y(single) n' in. MAT L 91,d,,,,ial/COn1Olel lrrt alien ®Residential Water Supply(shared) rr' ft. >�on-Water supplyI°' We1L• —=r���:,,_� 18.GROUT Monitoring FROM TO 1 ection a ft. MATERIAL EMPLACEMENT&fE7Ha &pya�T b ell: Recovery 20 A. PORT.CEMENT POUR � AquifcrRechargc ft. tr. — ji Aquifer Storage and Recovery �Groundwatcr Ronicdiation R• — �Salinity Barrier ft. Aquifer Test 79.SAND/GRAygI,PACK if a Experimental Technology OSton»water Drainage FROM TO cable 11�� tL MATERIAL EMPLACEM 1— Geothermal(Closed Loop) pp�.i�iSubsidence Control ENT METHOD Geothermal 73Tracer fL Heatin Remarks Coolin Return) 20.DRILLING LOG attach additional sheets Other ex Hain under#21 ) PROM 4.Date Well(a)Completed- r0 DESCRIKrioN char baM sa. l(��--�—�. Well)( mlUroek e, ruin olu,etc.)Wenll L°cn: tr. O tL G - tic Facility/Owner Nanic B• IL p Facility IDIt(Ifepppcahle) IL �� J 1k Physical Address,City,and Zip It. County c} =7. Sb.Latitudefield, . parcel Identification No.(plly) 3b. l Rol and longitude in degrees/minutes/seconds or de d ono 1aUlong is sufficient) decimal de p � (Ireea: 22.Cert ¢ N 790 g -osy 6.Ia(are)the wall a i—"'�—W () Permanent or Temporary 1.Ia this a rep an existing SignatWO° iticd III,all Con I (l•IhisLcutzpall1alrt0 letlngwap; traetm• '—� ®Yes Or M}NO nlag this fond.1 hero/{v tPr/!fy t/w![AP wPl!(,�)wuc(wrrt)coo�pt clyd in trccordaoct J/Il otrl knows well caalrrrryu„/ttlorrnullort and Pxp/uid dd•dudrry ol1hP cn +'epalr nudrr#2/remark/srrllod a•ou the back o wilh 15A NCAC 02C, 0l00 or 1SA NCAC the. /1h/s Jw ut. jilrls record/tax hero provided[o the trek'or011rr, PY 0200 Well ConshtleNod 5ioddalds add 1/1a1 a !i.*or Geoprobe/D conshtrctio y or ielneeded P Geothermal Wells having the same Iron may us23,site e theram or back of this al well details: drilled; n'° 1 OW_' Indicate TOTAL NUMBER of wells conshuction details. You may also attach additional pages if necessary. page to provide additional well site details or well 9•Total well depth below land 1;7(� P nr ntulllplP-1111tr1 all dP 1hs• sarface: 31JBi1II7 yAL IN°Tt7eJ_�I`a 1/dt[fPrPn1(t taNlplP->� �1-t�3 ft. 20•Static water level below to 24a, per s 1 W 1 s: Submit this form within 30 days of completion of well !Twaier/rvr11,1 ovt cueing r,�r..P,ofcasing: 3o construction to the following; 21-Borehole diameter. (ft) Division of Water Resout•ces,Information pro 1617 Mail Service Center,Raleigh,NC 276"-1617 H2.Wall construction �~) ��g Unit, (i.n.uuger,rotor don method. ROTARY 24b. or �giecHon WPliae In addition to sending the form to the address in 24a Y.cable,direct pryh,ew) above,also submit one copy p®R gY construction to the following: of its form within 30 days of completion of well A7'ER SUPPLY WIrLLR�M'Y' Division of Water 13a.1tseld(EPmh Ru°urces,Underground Method of test: AIR ROTARY 1636 It/11ail Service Center,Ralef Injection Control program, 13b.Disinfection type: HTH 24c. g ,NC 27699-1636 Water S 1 Amount: the addresses) above, also submit aWeco' In addition to sending the form to Z completion of well construction to the county health de an copy of this Form within 30 days o}• Form GW_I where constructed. North Carolina Department ofF.nviratmcntal Qualityp ment of the county -Division of WatrrRcsourcos