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Home My WebLink AboutGW1--05281_Well Construction - GW1_20230814 P.rlRtl . WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: I.Well Contractor Infortm4tt: • Russell Taylor 114.WATER ZONES s Well ContractorN,m i • I FROM I TO I ; I DESCRIPTION 21 87-A i 1qt) ft I rq5;ni I • I587f Sta.ft' l xe WellConn:ctar Certff eaten Number , 15.OUTER CASING Ifor tnultt•eased wells)GREINER(If • l-ledden Brothers Weill Drilling, Inc ! FROM To I DIAMETER I THICIO has t iIATRRUL I- ft. ft. M.Compsoy Name I I I6.INNER CASING OR TUBING(geothermal cIosed•Ioop) • I.Well Contraction Pexmirlle: Q 03c9,3 P I FROM I TO DIAMETER l TRICIORM MATERIAL Cut all meltable well tatrstruc Uoti permits(Le.WC.Cowry,State,Variance,era) 1• 0 itI ) i i to la' ' P`dC. 3.Well use(cheek Lela aye):1 LIII `4 i I 13 f` I (o 'A' . 188 N5ree L Water.Supply well v.SCREEN: ! PROM I TO DIAMETER SLOTSIZE TIQCIG�SS MATERIAL 1 QMunicipal/Public ft. ( ft. n i Geothermal(bleating/Cooling Supply) EResidenttal Water Supply(single) ft. ft I. in. I In duatsiaVComtaercizl I Residential Water Supply(shared) is.GROLTn Irrigation • FROM I To 1 MATERIAL I nuPt..sentorr METHOD&AMIMM Non--Water Supply Well: I i 0 ft I .20 D• I ec*-sees.. I mooed Monitoring i ORzcovery i t R j ft I Iection Weil: i I ft. ft. I Aquifer Recharge i DOrotmdwatcrRcmediation 19.SAND/GRAVEL PACK(rapnllesblel Storage and Recovery DSaIinity Bonier PROM I TO I MATERIAL 1 EMPLACEMENT METHOD Aquifer Test I EnStoratwaterDrainage ft ft Experimental Technology i DSubsidence Control I h• I ft II Genthetmal(Closed Loop) I DTracer I. 20.DRIL LDiG LOG(attach additional sheets if ceeosar9) Gage"•n++ai(Eeadntr/Caolisg Reaua) flother(cxvlain under 21 Remacks, FROM I TO I DESCRIPTION twice,tcrdanasotiaeektom Irate S .eel Q `r 103 ft I clay a sand 4.Date Well(s)Completed:'7latisoly s.3 Well ID- i I o3 `t 18 ft 1 granite Se.Well Location: ' i ft ft. Hwrtl� S-rricxlartd _ :t I . _ '<j 1.- FuOity/oweer tans i Facility IDS it applicable) t ft 'ft. C PP- . 10ide, f{nrimn tr. 5.o.initlin o?873t'I' ft- I AUIa I c. 2�Z3 i f Physical Address.City.and Zip I �p /)/gyp/�p n i Mica Cz11.1 r I 15/m2MSA 3Q '21.RESZARKS ii..,...t.s.. .t .•s+•r::r v.a Veita163�k$1 County ! Parcel Identification No.(PEN) i 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one Wong is sufliaac l 22.Certification: 35° 07. 3 53 N 083• .1a. Sad wze,..0„,......,,:p j CLi„ 7 .24 a®rl3 6.le(are)the well(a)�rTT�►►►Pe9manent or OTemporary SiDszturc afCe tilted Well Coowec or ! ay signing:his form.I irerfcc certify that t'�well(s1 um farm)ceavnacted la aad'a^ 7.Is this a repair to an Wilting well: Dyes orpN. n-tlr I5d:1rCAC 02C.QI00 er 15.3 VCAC 02C.0200 Well Consnuctlan Sunda*and a /tidr k a repair,fill out Mom ivrll eorsraetian irformar/or. esplair.rise.afar,of fir: rape oftis record has been provided to the,well as+rrer. repair under#2I remark,section or en the back aphis farm. 23.Site diagram or additional well details: 8.For GeoprobciDPT or Closed-Loop Geothermal Wells having the saute You may use the back of this page to provide additional well site details er' construction.only I�E is needed. Indicate TOTAL NUMBER of wellsconstruedan details. You may also attach additional pages if necessary. drilled SUBMITTAL INSTRUCTIONS i Boo9.Total well depth below rand surface: (ft.) 24a. Far All Wells: Submit this form within 30 days of completion of For multiple wells Fut ail depths ifdlfferent(example-3Q200'and 2Q/00') constrsction to the followinm 10.Static water level below top of casing: 66 (ft.) Division of Water Resources,Information Processing Unit, Ifwaterlaw!it above caring.rue"=- I617 Nan Service Center,Raleigh,NC 276994617 11.Borehole dlameter: ! `Q (tail 14b.For Inection Weirs: In addition to sending the form to the address it � n �--�� above. also srbrait one copy of this form within 30 days of completion of trneti 12.Well coasoh method: t• "" 3 Al.� .once cdon to the following: Ct .auger,rotary,able.4beet push.etc) Division of Water Resources,Underground Injection Control PrestigeFOR WATER SUPPLY WELLS ONLY: I 1636 Mail Service Center,Raleigh,NC 27699-1636 I3a.Yield(gpm) Q U GlZ Method of tesU ' 24c.Far Water Suaoiv&Infection Wells; In addidon to sending the fa the address(m) above. also submit one copy of this from within 30 M; 13b.Disinfection type: IA 1 rt Amount: 1 (Qc4. completion of well'construction to the county health department of the u metre eonsttueted. Form OW.-! North Carolina Department of 5-tranra:n::1 Q.aiis -Division or t:=cer ou:cc ItA 2-32