GW1--03432_Well Construction - GW1_20230518

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. WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information: 1 •
Russell Taylor 14.WATER ZONES
Well Coaaaetar Name FROM I TO I DESCRIPTION
2187-A ' 1140 f` I/'i5 '
• j ft. ft.
NC Well Cotitcsctar Catifrattiaa Ntemher 11S.OUTER CASING(for ma1C-eased walls)ORL NZR Of ttkee) •
Redden Brothers Well Drilling, Inc 1 FROM TO I DIAMETER THICKNESS j KATLRIAL
I- ft, ft: In. JI
Company Name
116.LINER CASING OR TUBING(geothermal closed-loop)
Z.Well Construction Permit#: I FROM I TO DIAMETER I TB1CI NESS MATERIAL
CM all applicable well con rttetlon permits�a.WC.County.State.Variance.etc) I. 0 to I 1 18 ft. /� tn. ' n vc
3.Well Use(deck well use); 1. 11 R ft. I Lk) ft: I v(,//� in. . 188 $ITE E L
Water Supply Weil: 17.SCREEN
FROM I TO DIAMETER SLOT SIZE THICKNESS i MATERIALAgrie:ulttlral uMuuicipal/Public ft. ft. in.
i
Geothermal(Heating/Cooling Supply) EDResidentiai Water Supply(single) ft. ft. I is I.
Industrial/Commercial OResidential Water Supply(shared) is.GRour
Irrigation FROM I TO f MATERIAL I EmPLAMIE\TMETHOD 3 AMOtP
Non-Water Supply Well: fL I ZO • oswae�r I pumped
Monitoring DRecovery rt. I ft II
-
election Well: fa ft.
Aquifer Recharge QGmundwatcr Rcmcdiation
19.SAND/GRAVEL PACK(if applicable)
• Storage and Recov
ery DSalinity Barrier FROM I TO I MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwaterDrainage ft. I ft_
Experimental Technology OSubsidence Control 1 fr. ft. I I
Geothermal(Closed Loop) DTracer 20.DRII.LLNG LOG(attach additional sheets if accessary)
Geothermal(Heating/CooliagReturn) nOther(explain under#21 Remarks)
Oat ! TO I DESCRIPTION Icelar.lordaea.aaerroehtspamtn a etc.)
hi-
0 ft. 11 i 0 ft: I clay a sand
4.Date Well(s)Completed: T/4/4023 Well ID# I /f 0 fr. 11'75 " I granite
Se.Weil Location: J.. ft. ft
Jena_ , �41L]t L ft. I ft. r--s;�--^,^%j=. ':) G i...`'.
Facility/OwaerName Facility ID (if applicable) j fr.. ft. I '� L. •+'L.— `I-- ^:
aoa"IrInnicts biric-iQ(A3t ft- , it. MAY 1 8 2023
Physical Address.City.and Zip i ft. ft.
qq (�l i 11.RESIARECS "1 ;)r•�r�.n?.err. t!r:l
Jll, , lalt.tl tap9500o308Q9 imc:r.:'�ra. . , 3
County Parcel Idcntiftcaticn?to.(FLl) v.a Zal 6
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: e
" (if well field one 1st/long is sufficient) 22.Certification:
36°G28. 038 N 083° 44.061 W Q,t„
6.ls(are)the well(s) Permanent or Temporary Si�tluc ofCemificd Well Contractor 0
By signing this form,I hereby certify that t well(s)was(were)constructed in atxord
7.Is this a repair to an misting well: D Yes or po with 15d NCA.0 02C.0100 or 15.E NC4C 02C.0200 Well Constraetfon Sandardr and 11
If this it a rrpoir.fdl out I'nowa well construction informationplair.the cantern eau. roFY of this record her been provided to the well canen
repair wider 1121 remarks section or on the hack of fib's fawn. a.Site diagram or additional well detains:
S.For GeoprobeiEFT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details ,
construction,only I OW-I is needed. Indicate TOTAL NUMBER of wells
construction details. You may also attach additional pages if necessary.
drilled: 1 SUBMITTAL INSTRUCTIONS •
9.Total well depth below land surface: 'I.. (it--) 24a. For All Wells: Submit this form within 30 days of completion of
For multiple wells list all depths ifd fferent(example-3@200'and 2@100') construction to the following:
10.Static water level below top of casing: At (ft.) Division of Water Resources,Information Processing Unit,
Ifwator•Jowl it above easing,use•• I617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter. La (fn.) 24b.For Injection Neils: In addition to sending the form to the address_in
above,also submit r one copy of this form within 30 days of conapledort of
12.Welt construction method: rL, ! C 1 construction to the following:
(i.e.auger,rotary,able,dircet posh.etc.)
Division of Water Resources,Underground Injection Control Progi'an
FOR WATER SUPPLY WELLS ONLY: I 1636 Mail Service Center,Raleigh.NC 27699-1636
13a.Yield(gpm) 50 Nletkad of test: Elflop 24c.For Water SunpTv S•Injection Wells: In addition to sending the fo:
the addressees) aboVe. also submit one copy of this form within 30 da;
13b.Disinfection type: VIS t-i Amount: (. Ca_ completion of well construction to the county health department of the-6
where constructed.
Form OW-1 North Carolina Department of:av i aarr.moai Qai:w-Division of y:aicr R.=sress itAised 2,11
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