GW1-2023-02664_Well Construction - GW1_20230411

s.,uaimccor information: .
Russel!Taylor
won coateaetor NES
2187-A Fc TO ft DESCRttrfl0l\
KC Well Ceatract;C ra Nom
tiaber O rj Ir. j � - 8" '7
Redden Brothers Well Drilling, Inc Is•oaTEFiCAsmlG rmuldemadwdis ORLII�F.I't(tf eabre
Fztosr ra ; nienr�ERm yu
CompaoyNartu 1- R ft. 1m
L Welt Construction Permit#: 16 LSNERCASING ORTUBII\iG ermdclosed ion
Llrl aUappJlcobir rtTlf cartrtrtulfon pdtttitr�,e j/fc Cotmry,5tat�Variance,etr.) I asf R. I '' ti, DLvntEFER b1A713RtAL
16 MI
3.Won use(Checkvvell me): fr I
ft.
Water DPP$'Well: 1�SCREEN '
Agricultural 7GROTIT�M
Dbt11I R SLOT SIZE TFQCIt\i F� Sit L
�MuaicipaYFublic
Geothermal(13mting/Cooliag Supply) JEResidential Water Supply(single)
Indust ial/Cotnmercial 5�t ft.
Residetutial Water Supply(shared)
Itri tioII
Non-Water Supply Well: FRaa T6 MATEMAL EbIPLA -r%MraoD�,utob
20 R; st�aats�eu Pranced
Monitoring
Djectton Well: ery to fL
AgtufcrRechatgo EIC=uadwatcrRcmediation fc fL
JAquifer Storage and Recovery Salinity Barrier 19.SAtNDlGRaVEC PACK tf a ifeablal
FROST TO -MTERTAL EvfPL tGEiFt�T]tErttOD AgaiferTest �StormwaterDraiaage iG tG
Experimental Technolory Subsidence Control
Geothrsmal(Closed LOOP) UTraeer ZO.DRII.LLt1GLOG atmebadditloaalsbtxtsita
Geothem)al 211—riffmVC001ing Remm} Mother( lain under t21 Remark) Oat Ta arscRttrrtoS moms trardets.svAt sitestet
0 ft. I jp(p fL I clay&sand
4.Date Well(s)Completed:*k0_43- Well M# it. I 00 m 5�
4a.Well Location: ft. II
Facility erNMU Facility IDS(if applicable) j fr. fr. AFK (.LJ
�S( ll r
oNIP..w,7� 4 hrae to k�`r-1 I�tl�l('cltr �'8r�1� r` st• 7 rl tin.
s
Physical Address,City,and Zip fc. fL
wjt . 0-A11rrh1 �oo�5�D5 II.Ri;alaRxs
1
County Forrci Idcadfication No.(?LC) 1
5b.Latitude and longitude in degreeslaslauteslsecoads or decimal degrees:
(ifwoll 8e1d.one 1110oag is sufficient) 3:.Certification:5� 28.a' na3° 22A4•. LA5
5.ls(are)the well(s) Parnanent or OTemporary SigmttueofCertified Well Contra= oat1 Tf—
�r�, .1� By sgaing this form.!here!'certljy that srrll(s)Ives(uere)constructed in aecanim
7.Is this a repay to as esistiag welt: i1 Yes or 1]�iNlo utdt:Sal DlCAC OIC.Q100 or lS.i vCaC 02C.OZOD JFtI!ConrAircllttn�aadardr�d tlu
if dtrr L e rrpafr,fdl oat kaoo7t Ivell eonstraerion inforetatian a-Mlain the natu"-of the ropy Rfthis record has'been provided to the trell oumer.
repair under 01 remarksseuion or air the back ofthisfarm•
23.Site diagram or additiotal well details:
s.For Geoprobc/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or a
construction,only, G I W-I is needed. Indicate TOTAL NUMBER of wells cansuucdon details: You may also attach additional pugess if necessary.
drilled:
SUBMITTAL IIVST1111MOL IS
9.Total well depth below land surface: S Q09 (fW 24a. For_411 'Wells Submit this form within 30 days of completion of
For multiple llvlir)Err all depths tt d ffereru tiaaoyrlr-3Q200'and 2Q1001 construction to the following.
10.Static water Ievel below top of rasing: 180 (fr.) Division of Water Resources,
'_l Informatioa Processing Uait,
Ijtvaorrltvr!tcahala em6rg,rtra^= I617a l Service Center,Raleiab.NC 27699-1637
I1.Borehole dtaaretor: (ta) 34b.For Infection!Wetly. In addition to sending the form to the address in
Wellabavc,also submit one,copy of this form rithin 30 days of completion of c
12.-5-eoastrcable.method: li)�, �_ construction to the folloiria
C�auger,rotary,eabk,tlireet ptWr,etc.} g•
Division of Water Resources,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY; 1636;Yfail Service Center,Raleigh,NC 27699 1636
13a.Yield($pm) J15 Method of test 24c.For Water Stiooly Bc Infection Wells: In addition to sending the fart
the address(es) abd,,% also submit one copy of this form within 30 day:
I3b.Disinfection tyke: Amount: � completion of vteti construction to the county health department of the eel
tvhert constructed.
Fonri O1V-1 ?fiords Carolina Department of Environmen:zi Quiin--bivsion o:%:accr Rtsoa-c s Revised 2,:2-: