GW1--06393_Well Construction - GW1_20231009

. WILL CONSTRUCTION RECORD (GW-1) i Fo:?ntemal Uslle Only.
1.Well Contractor Infaa'ntiti _
oa:
Russell Taylor
14.WATER ZONES
Well Comma Name I • FROM I TO t I I DE6CAtettoN
2187-A _ IQo f` 11951" a?a'7-fJa
NC Well Contractor Cartifseaticci N w 1.648's.
:' IS.OUTER CASENG(for mnietnsel wells)ORL'CVldt(Vwel6nbk) •
redden Brothers Well Drilling, Inc i FROM I TO I I DIAMETER 1I TtatacIESS MATERIAL
Company Name I ft I I' 'ft' he. I -
i id LNI ER CASING OR TUBING reeotbamsl elesed toord •
2.well Coastraaion Permit*:.1 2- /pAIR-q- 1178 9 IFROM I TO I• I DIAMETER ! 7EXIC ma MA7'sStAI.
Lin all appfhvbft wall eataorratri�tinpaatfrs(La UIG Coney,State,Variance, • ,�+0 ft. `6+ I to ln. f 1 VC
U
3.Weil Use(duck well use): � R I�'74 zL I (D m. . 188 STEEL
Water.Supply Welk I 17 scam I
i • FROM I TO I' DIAMETER ,MOTHER THICK S MATERIAL
a 1GGlRiral i Li-Municipal/Public ''. I jft.1 ia.
Geothermal P:ICoo ng Supply) sitesdential Water Supply(single) ft. I ICI I I.3adlrslsiaUCoaaaeselel ; eaial Water Supply(shared) is moms s I
Irritation FROM I TO I . I MATERIAL I nurse titorratttilton_teA3100
Nett Water Supply Well: I 0 fe ! zo I 3- 1 .:�� I name
Monitoring OReeovery 1 ft. ft. I
jaxion Well: __ I ft 1
RccI a ge OGrouadvrarer Retaediation '
19.SAM/GRAVEL PACK Of apo&mblel
- Storage and Resaysry •Salim y Barrier FROM ! TO I MATERIAL 1 FSTlLAGEMMTMETHOD
niter Test i1 EaStorsnwaterDrainage I fa , it. 1 •
Experimental Technology 0Subsideace Control I i fL i ft.
Geothermal(Closed Loop)_ DTraeer 20.D�` LOG(attach P additivMPTIChN es'
slvratst,pe tataa em
Geothermal(Idendatr/CaoltngReturn) flother(explainuad=_21Remarks) I' w j µt'
ri II �
0 14 day a sane
4.Date Well(s)Completed: "► 14LJ4?.4 Well IDT • £c 406"I. i �ni:°
I //(
6a.Well Location: i i tr. I I R. ! <" -
•
Mi)' •-�� 2.y fr •
::. V e'er.£,,'L 'i.i' h.""c
Patt311ry 13sm !Dec T Facility �(i:'agpCeablei ! fc. ! ft.' ( T ®
ale &Al ?ate, 'Rdt.. t` ! �` ' at ` t 2(�23
Physical Adders.Cry.and Zip £t. i :' £ it %fin-.
/t :S.R?.�ZARIG I L':•:�i,'I.:.r,� ':�is�,
JAest.Sim. e-�r l 7µ89- Afa-458 3 ..
Cater/ j ?once)ideati£tarity No.(PLC 1
5b.Latltsde and longitude in degreeslaaiauteslsecoads or decimal degrees: I '
Orwell field,one Wong is stiiff:clan:1 22.Certifications ; ,
36° O . orv4 i rf 083° 03. 8aa4 J „ Q •
6.Is(ere)the wells) ermanent or OTensparaary 5£�nuc ofc«tifrai wit Concaao
3y signing ads farm. herter certify that t well(s)was(»err)evauruaed aka acre
7.Is this a repair to as euistiag well: Dyes or pc-. »tilt 15d:1 Cr:C 02C.0100 at-1S.i VC.4C 02C.OZOO Well Coesa coon Staurdmels one
Phistra rrpvrr.frAaar kegler.wttl construction injarma:iorteplain:he cc:ur-ajthr
ropy ofrhrs rreoad haw bee,prodded to the srl on7ran
repair tinder CI+ramafs srmrwr area the bad aphisfeim. _ 23.Site diagram or additional well details:
1 You may use the back of this page to provide additional well site derails a
3.Far Grapratitdi?PT or Closed-Loop Geothermal Wells having the sateconstru cdon details.You may 4.50 3=11 addidena):ages if nemeary. .
eonstmcdan,only I i is needed_ Indicate TOTAL NUMBER of wells
Milled: 1 ll��' SUBMITTAL INSTRUCTIONS4.TotaI well depth below lard surface: 400 (fv) 34a. For All Wells: Subatit:his fo zt within 30 days of completion e
For mtdiiple wells Its all drptla if-ere-Frew(rsatplr-3Q200'wad 2 100) constriction to the following:
tt'' ^^ I
10.Static water level below top of casing: "f'(,J (fa) TJiXISioa of Water Resources,Information Processing Unit,
limnerlavrl is above essmi tar dia "-- 1617 Mail Service Center,Rale».b,NC 27699.1617
11.Eortale meter.) 19 (ter.) 34b.For Iniection.Wells: In addition to sending the form to the address
n above,aLso=brats'ore copy of this form within 30 days of templatiea
1 Wen 2.We eoastraeaoti methods [^.,`_it jtratkruA, construe-Ala to the fallowing
(Le.saga misty,cable,QC=pest.ate) J
I Division.of Water Resources,Underground Injection Control Pzogt
FOR WATER SUPPLY WELLS ONLY: �t ,cut^✓� j 1636 Mail Service Center,Raleigh.NC Z7699 1636
I3a.Yield(gpm) 16 Method of test: t.. ! 2.4c•For Water SuoPh&Infection Welts: In add!tioa to sending the
ff ( the address(es) above also submit one copy of this foals within 30
13b.Disinfection type: 4x AMOOnr: L I ea ntpiedon of~veildepartment coconsumetioa to the comity health deparent of the
Q I where eonsaltecad.
I ( Renard 2
Form CW.I North Caeoltna Deoarsi'nt of En t onmy ci Q�.itt:-Division otlR•zc.r 2•ZCu:c�
I