GW1--06284_Well Construction - GW1_20230926

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WELL CONSTRUCTION RECORD •
, IntontalUsc.ONLY:
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This forme=he•usod for Sinaloa:omltipk wells• 0
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1.‘Vel1Contractor Infit rotation: ()J • ,
\ -\.0.1, ..,:14AVAIERZONES.:-
Scott Hunt, •JrWHOM DItSCRIMON
Well Cor4ractorNatoo - - 9.3) . 11 ft, 15 ft. silty sandy
O. ft; I
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4561-A . • 1 ' • • •
NC Well Contractor CartilicatipotNanter . I .OUTERCASING'tfoiqiiiiftkiiiid[nctist OR LINERtirtiVtlealitc1":„ •-.
.FROM ' TO - OTANIETER ' THICKNESS MATEHIAL
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SAEDACCO • .• ft, l'IL:
Company Name- IC...INNER CASING'ORiTURING.,'end:I:Mimi clai.cd4on'
FROM' TO ' IHANWTER• THICKNESS MATERIAL .
• 2.Weil tritiitruttitin!Omit 0: o 'ft. 5 rt. 2 i.in. sal-4 0 PVC
fliratinptiifrotnetFdlpentrits(i.x..CoioultySto,te,iforiarrce.1.6ectiqne.fr,0
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- 3.Well.Use(chock well use); -_717:SCWN -. -- - . • . ! • ..- , •. • -
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-- •-7- -- . '' FROM • 10 • ImAMF.TE.K storm*: TIRCR.NESS i INATERIAll.
Water SupplyWell:
5 ft, 15 ft. 2" llt•, .010 SCH 7 40 PVC .
0 Agticidtinal .
[Municipal/Mlle:
ft: • ft. in.
1:1Geothemml aleatiiteCooling-Stipplyl. Clgesidential Water Supply(single)' R. .
181 GROUr. • .- _ ,,.
• ClIndustrial/Conumacial GIResidentiat Water.Stipply(S13Med). '.FRom. :-.70 NIATERLIL - EMPLACEMLNT MEHIOD&AIVIOITST -
IDIrrieition . • . . ,. 0 . ft. .3- fr. Portland 'Poured
' . Non-Water&mid,'Welk' .. . - rt. .11.
NIMonitoting .011ccovely •
Injection Well: . • .11.- • ft. .
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IDArptifcr Recharge LIGtoutichVoIct Rentediation "..•;.19'SAND/GRAVEL.P.ACK61.1Multeibtcr: • -_ --.-7.-r"
WHOM. la MATERIAL , ENIPLACEMENT METHOn
0 Arjoifcr$toragc•atx1 Rccoveg CISOlinity Dottier • .
4 R. 15 ft,- Filter Sand #2
°Aquifer Test 1;1Slorinwatcr IN...aim*
- ft. . ' ft. ' .
Ons-periincuml Technology CiSubsidcnceCentru I. .
:".liti:DRILLING:LOGIattoctisdititionitt shie&if itecessaryl r• --••- , .•-•••••---' •
EIGeotheitnal(Closed Loop) ID Tracer - . . • ..FlIONI- To nescturnox(color.hasdncs4,sat:nick type.trsiin Arc.tic.)
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OGeollteonal(lleatituttCoOlitle Rehm) , 00thei(explain under#21 Rethinks) 0 •1.4. , ft. sandy grey fill silt 5
. - . 5 it.. 11 Ft. silty;•clay black
4:Date Well(S)coinpleted: 7-13-23 'Will 1Digmil-5
11 - ft, 15 •rt.; sandy i silt white/tan
40.Will Lacatina: ' ,ft, • 'ft.
r .r--,,,--r,;-•,i., if:,,,, ,
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1 --si......‘,.,/p......, ,.•
Watson's Grocery • ' - ft: ft, ,' .• .
Fa9ilGivrier Wame Facpity ID#ilcapplkable). "
4. 11., i SEP 2 6-2023
102 Wards Rd., Rose Hill, NO, 28458 - . .ft.•
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Phytietil.Addt-esEc•City,,,Mn1Zip
7,21.1-REMAE115', ' '•
Bentonite seal from 3-4',,
Duplin
Camay Parcel Itknlificationllo,(PIN) ' • • •
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56:Latitude and 1.nngitude-in tlegreesiminutestSeconds or decimal-degreesi 2 2.Certification:.
(il'm ell fiCILL'poc,lationgIslatItickto • ,
34.818870 N -78.101229 3"cettfituitt- ,.i . 7/16/2023
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Signature of COMO Well Con -tar "; Dale
6.4(are)The:well(s): iiPenitanent or. 1:1Temporary , By,3Ignias ileg fono,I hireby certify r1tzt the ire10)wra itTere):cor-vrycled iir at:earth:vice •
with ISA NCAC 02C.0100 or ISA NC4C 02C.0200 Well Ctinsowaian Stamiards.and rims a
7.-Is this o•trepair to ann.cxisting well: DYcit or 181Nat awypiiiiis reco1 hax bt ni on i*if kw we?owner. '
ill-N.5'1s a repair,fill ayt kitiiiivt Well consnircriaa ilifonaariaft and orkaht tile'curare oldie . ' : • - 1.
rep-air iiritier#21 rroiarkk iertienz Or on thti 1)&1 alum form. 23.Site diagram or additionat.lel!details:
.1irou Maj.use the back of this page to provide additional•Avell site.deMils:or well
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tr.Number of i'ells constructed: 1 . - consttuetion details.You May also!'apach additional Pages if itecessaty.
For mialtipliirdeesiodoi apailicirer suxily*lb ONLY Wilt the Seriflif anstiaetton,you i can -
RAN:at ooglorin. •ST1BMITTA I,INATUCtIONS I
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9.Total well land surface: 15 , • 410 24a. For-All Wells: Sulainit this-forth within 36 0.31 s Of completion of well
For'ordiiple ivelfsliir oil depths if'ififfereou fravaipk,3W-09'and 2@ 1pOli construction to the foltossing;-
. 10.Static Water level below top of easitorg 4•6 - • • fft) . Division of Water Resouoces,Information Processing Unit,
I/ntnet kPf..11.1'above easiax use"+" 1617 Mail Service Center,Italcigh,,NC 27699-1617
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11.Borchote diameter:6" • (in,) 2-lb.Far risjectipn Wellci ONLY:. lit addition to sending the form to the address in.
24a aboye.also submit a copy of this Tann within 30'days of completion of well
' 12.Well construction method: sonic constmclion to the following: t,
(i.e.pliger4c4m.cable...clued mush.ctc)
- 'Div11.0olk of Waier Resources-,Undergrotind Injection ContrOl Emma,
FOR WATER SUPPLY WELLS ONLY 1636 Mail Service.Center,Raleigh,NC 27699-136
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.Z.le.For.Water Supply&Injection Welts:
13a,Yield kqtr11) Method rifted.:r
Also tulip*.one copy of this fatin within 30'days Of comPletion of
13b.Disinfection type. Amount: well conslinction to the•county ecalth department or the county where
- - - constructed.
Form GW-1 North Carp lima Ekparttu of Envirotuncnt 31Id Natural Resources—Division ofWalcr itiatroz Revised August 2013,
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