GW1--05797_Well Construction - GW1_20230901

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WELL CONSTRUCTION RECORD(GW-11 For Internal Use Only: ti
1.Won C.oafraster llamado':
if‘-- kilff/.5' .c e-+4
'wall Coairmicg Name PROM To nescarrama
)693
NC Well Centeretar Catification Numbre
'It ettflell CASING Oar Malltkzigell 1044 144141triftdtilithi - - •
' ' / I snow TO THICiaelfts Kamm. 4
ft. ft. 91177 in.Company Nato
. •
2.Well Construction Fern*#: 4a 3 %OW 9..7 49- PROM TO DIAMETER TRICRIDISS ,' MATERIAL
List all agplicable ts.d1 canttraction partnitt(La WC,County,State,Variance,etc) ft. ft. in.
3.Well Use(auk well ear): ft. ft. I: 1*'
•Water gnipli Well 47
• 1
011061 cid aa
TO staresini •kin'ifl/DI TRIauss iisirmt„---='
jii:Agficuteiral • boltmicipai/Pubfie ft. ft. I*.
III.- -' .• "; (Heatill-FiCneling RuPP137 Residential Water SuPPly(sink) —
40,.Intinaa/Cortmtereial flRe:Meanie:I Water Supply(shared) • '
„iiiitopeur . _:. 1: -,,-,:: - ,-...,A, . . .'-..:..:,. .'4,
• !atom To saaTrftlat zatmenefriaternoo ta astourik
Noa-Water Sap*Wine ' rgb ?
ea 41 d rug ie.__
.•..--•.. -7).•.-. DRecovery ft.
ft. • .„- ,.._. . _ _ _. , _
Jr . 'far Recharge DGrcundwatMRemodiij
II Aquifer Storage and Recovery DSalinity Barrier - swat. TO MATERRIL UT
authitio
1111'- . •,--- Test DStormwater Drainage
illf Eve:image!Technology r)Subsidence Control ft. ft. ..
II ,-,:7:.;',•-. (aosed Loop) DTrater - -'•• - -••'' ."•--"-- •- A-lt, tatatlAIL154-011.00 taliactiparscannlontiftiffeallitar21 •:.•••-,,, ' ,..-:-'',-• :
To (War,bonbon,sallfroek inix‘arida sign' deo c.--, ,-, r. Asa:ling/Cooling Return) nOther(explain under#21 Remarks) ft. • ft. .
- ••• • • .- • : .--A•, pi L." ,.
4.Date Well(e)Csiiplated: StijA9P-3 Well IS .*V 3 1J 7,3e ' se- .ft• -• - t . • • .••-- - - ''. '- - ' • .
5a.Well Loudon: ft ft.
*--WY/4 ‘;jJ P--.42.4. Vt:14-1e.,Y''-' • —
.... _
__.
Facility Illa(if applicable) ft - -- It•
' ' -5' . ..-.‘''' ---''' ft. ' ' . it. ' ' Or.aik ll-PrNW;AI,Ag.,S'.10;i,
rrd=l:..'i'',111.4 •'.5•,t-'-',•-i.litt' fY-,..,--i1,-,,,- '---- i- •- -,.- ,' ,..-
rqYfrI4#11111!9%11011P A-,-""--:-.:' "--..- " ' '',
Pilit*:::---:,;;:::., ': .7:',". .:..17.',...;r,:•.,,::::,'s.7:"--"Pincil klaitifliainaiNa.-(111N)''.:---,-
Sb.Lalltude aad lengllatie In degreesfmlistates/secoads or dedmal degrees: • - • • :
•
(ifwell fftlkere ftilong is meds;itiet) . - .'• - 22.Certifies don: •
I' '
N - W / /17374iL Mf-rjr.jja--...:.::-. . (22227-40
6.h(are)the wall(e)CliPernsanent or 0:Tempo rat7 Signature of Cenified Well Conte:caw 1:
By signing this Ain,1 kenzby cert(61 thin die trell(a)um(utese)conetructed in accordance
-.7.Is this a repair to tin existing well: DWI or 4No With 13A NCAC 02C.0100 or'SA NCAC 02C.0100 Well Construction Standards and dial a
. "dile IS a rtpair,fill Old known well construction infornoation' zgylabi--thellantre of - - c*of&inward has,betnrovIded to Itte 1711 owitt#7-• - . ,.. -. .
rqinirateder#21 remark dram or on du beck teddy-fork' .,-,1-
. 23.Slte diagram or additkonsl. viell details: .
8.For GeoprobatIOPT or Closed-Loop Geotihermal Wells havingthe sanie You may uae the back of this page to provide additional well site details or well
construction,oni9ley,,,I!...is needed. hulicate TOTAL NUMBER of wells construction details. You may also attach additional pages !necessary.
drilled:
sURMETTAL INSTRUCTIONS ,
- IA
,
• q.Toad well sispes below hind surface: ib3 (ft.) 24a. For All Wells• Submit this iform within 30 days of completion of well
For arialsiolitnnlle list 411 dip*(ideates!(awkiple-3@)200'and 211;100) . , r.mittruction tc;the folloiving: . l'
, ,.. , . . , . . ,.. . .. „
10.-Stalle water lewd below gala of easing: --g4;;-v';---,•'-' ''-., .P::,.(1:19., .j. " Dividea of Wide's.-iteaa—ureea,:iLl:'Inf-ormaallo— asPr-e-casting--Dab,- -
eaniti,,Issoiss ottmt owing,one;+ -- ...-„._ -•,..--,.t., ',,,‘,.3 ' "..,'% 161TM-sill Servin-CeNtirt.Fs44114-?!ic;70S1f17..,-,_:-..:....,„. .,-•:.\:•iN,*k- '":1-Iv ----'. ---- . --. -' ,i.,.;,,..?„... ......,...._,,_—...„.;_.,,,... _..
11..poretzliii 0,0,12 & kat (in.) 241/.- ,BiLialgaff2LESp! In.add on!,0 eP441s the bat to.the-addivss-in,24a
iii-:*-44,41i-etti„-iiiii-a,---.--- --;:iiethilid---f'•i''':',....:•.,:-C-4-0,-.,„,f.:..,...-',.::,1::'''-::::,-- '-- the, Ve;--alSO-SdeitriecinaOZOirtif this form within 30 days of completion of well
(Lei it4re,rotaly;Cabis,data pub.etc.) Construmien tabs folloWing:
.,.---'-_,-!:-.:••-• -..":,.•-.'.')7,"--'.. r- '.'
• -••-- -1,-,ThitriSiim.0f Wateriesaurces,liadargroand-Injettkor CentirolPingliro,--.
Fpft:w4lritarst.nwovELLO'oNLY: . • -,: :1636 Mall Service Ciatter,RAMO,NC 276594636_
13a.Yield(Erse) - t.5 Method of teat:1&.,-1'7, tie.For Water quertiv,i1:Infect Well : In.addition to sending-the form to
.i.) • -• - -- Mei addrest(m) above, aka submit',one ccsoy of this form within 30 days. of
13b.Diamhettos tilise: '....cPstk• ''- -'' kallginilt: /./,42:5a-'-'•-- completion of well constniction-a:Abe county health kit:mann Of the county
. - Where constructed. '' , .
• . i
:Form OW-1:. .-_ ,..,.• !. . ' Non6 Caroling Dep:Mment of Sawirourazaial ciligilti'.Diaimien of Water Resources: r- • -•••' - •-"—Rained 22.4016 '.
,. •:--,..:.-• .,....-. .;;L....•-:...--_, :',. . . ., ..,. .. , _ , i • - '- • ' - " •'
• 1 .