GW1--06267_Well Construction - GW1_20230926

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1 I Prir
3 WELL CONSTRIICTIONRECORD GW-! For Internal Use Only:
4 rt Fo rm
I( L Well Confraetorlttronna.an:
7
FROM
Cameron Bazin
Well Ca a aarorName WATER ZONES.
TO DPSCABTioN
4518 A /e 5 a 0. 20(jr,c.,•
NCWeatBmlmckaCatifitatimlNtaaber R, rt.
j'
Aqua Drill,Inc, 15.OUTER CASING(for moltisasednetia OR LINER CJoP➢►
FROM TO 'tr DWi/47ER 7ffiCKNoD DIA7EWAL j
1 CompanyName .p it 4s FL !a i°"1 ' r�
' 3 art 1 �/� 16.INNER CASING ORTus G(grathermddated-IooPL
2.Well Construction Peradt#: q l I PROM TO
DIAMETER 70IClQ1ES9 MA78RIAf.
' Uri angpprleahirp ,p, „
pennies(i.e.WC Comfy.State,Yarlmtaa Ue) it. IF. ta. j
; r
3.Well Use(checicwen use): @. ft. la.i
# Water SupplyWell: 17.SCREEN
Otigticultural FROM TODTAMSfER 57.Or9IZE 'IF(CIOaPSS MAT6RiAL I,
OMuuicipaUPuhlic (n.
©Geoth� CODLeg�Pply) Residential Water•Supply(ale) I ft.I la.
Oladustail/Cammercial rt: },
IQjp� Residential Water Supply(shared) 1&GROIN ., 1;'
MOM TO • r4A7ERIAL EMPLACEMENrME KOD&Ammon
Non-Water Supply Well: o re 2S G/I ZP5
f.�,N,•`• fo 1
Infection W �RscovecY fL fZ ; 1,
II •.1-Recharge OGroundwaterRemedietion rt.
i Stomata 19 SAND/GRAVELPACK(ifapalicebIe)
°SaLmtysarriet FROM TO MATERIAL METHOD .'4
16 Aquifer Test ciStoamaraterDraiaage ft. ft
Ttshnology t�Sbbddenae Control ft. It _1
ill
F..r
Geo:h ual(ClosedLoop) T 2o.DRILL=LOG(attach addrtalslmfs[anifIterwary) j
D�°Th6ID01(geatmg/Cooliag Return) FROM I TO DESCRIPTION(mla.Lardaea.inflin ictsee.orala simileI + s
nOtita(explamtmder#21 Remarks) '
4.DateWeJ(s)Completed: 917/7 3. Well ID# 8 S a z„S ft. ,p o f
•
sa.Wen Locution: t.
ft. ft. . ••
C tril/Gr' MLimPcft. IL
Paerletq/OwncrNnma Pam' ,1 4 v
FaeilttyIDO(ifopplicable) t4 B: a ti ®fie rr rc x.m
SE �,r,Vt ss �� Srp�,r+f'� p �. ► 7023 1
Physka1Addrers,Cty,=drip ft.l ft.
• Alie9..i 21.REMABRS �� PFi'£il fG:: 2�en::lj r..
County • PueellderaifeallonNo.(PIN) i(i 1?1r'arGY'3'
Sb.Latitude and longitude In degrees/minutes/srconds or decimal degrees:
fir well Se1d,arc tet/lang is aut5eieat)
22.Certification:
36. 16e4.7 N ig7. Oi 1-2( W
6.Is(are)the wells)permanent er°Temporary Si oEC eetiiei Wet Mahaetor
i Da
7.Ifs this a repair to an echoing wen: QYes or _ o Rp signing�B IMs/o.,,,r hereby amp Mat me lwPlt(a)kas,(•luau)eo arraucd In
with 114 NCACO2C.0100 or MA NCACOMC.02001PeU Construcdon g accordance i
lfildairarepai'Jillaatblolyi Wel1alliftraaon..k/ornrariar explain the nature of the cammofthirrec'ord has banpraPidedre them*eivner. Standards a
weir:Wesel re madeseNonareashebadeofWirf
23.Site diagram oraddlflonelwell details:S.For Geopnobe/DPT or Coded-Imp Geothermal Wells having die same You may.use the back of this page to construction,only 1 OW 1 is needed.Indicate TOTAL NUMBER wells construction details.You provide final p Da(well site details Or well
doh noayelsoattachadditionelpagesifneoessely.
s n>;.lrtmimma
9 Total well depth below land surface: 2 o 5
For maluptetleltslin all depths(f�fuan(mompre WOW at) �°- c l VI►pJls� Submit this farm withid 30 der
construction to the following days of completion of well
IO Stadewaterievel below tap ofetuing: S b
lfieuta)evdiscboczexabignre+ ��) Dlvlsi000iWaterResonr
diameter: C- 1617 Mall Service Cent"---.1
Processing Unit,
�'Borehole - '�) a R"leigh,NC 276991617
• 246 For InterH„�w�; fa�tioa m s
12.Weft eoDatrni2ton method: r6'�G1^).- above,also submit.one copy f�>• g the form to the Rdd e 0 in 2Aa
(Le.sage.roars.ab% path,era.) construction to the fo marix , . days of tom 1
P etian of well
FOR WATER SUPPLY WELLS ONLY: •
Division ofWate-—r lleurnmust>Jnd i
13e.Yieldp 1636 Map Service Center'
�grottOd Injection control Pr
(gym) Method oftest: t/ 24e.For Ware* ' C1�,NC Z769g:1636 °fit°'
_ S•eDnly&Teri Hon W 1
]3bt D1�tifaHon type: f Amount: the ed inn of) above. ` L►addition to $t,
completion
omwhe a red'contractor, di mit "'FY of this. bi 30 ay6 to
aonsttucted. minty health d .of 0 hY:i of
FatmGW-1 NodhCamliaa eount
�P° of161vi[onmcealQustity-DivisianoEWeterResoumes
ys e Reeked2-22-2f 16 it :e sg�L._ s , _ ,. f.s$ .,-,t, ..r.-c u ;,, + .ti'u ^,r .._