GW1-2023-01437_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