GW1--06419_Well Construction - GW1_20231009

•
. WELL CONSTRUCTION RECORD (GAY-1) E For Internal Use,Only.
I 1
1.Well Contractor Infer nation: .
�
Russell Taylor ? I4.WATERzoNES I
- I PROM I TO 1 I I PESCRIFTIOr
Well CoaaacauNum fa } Ir. ,
2187-A •
i ft I Eft,
NC well Counselor CentEenionlNmaher I IS.OUTER CASK G(for maitbased wells)DRLMER fifu�ublel •
Nedden Brothers Weil Drilling, Inc 1 FROM I TO ' ; I DIAMETER I THICIChiSti ► .TWRUL
Company Nome 1I I6. 1VF.R CASING QRTtIBIh'G 1 eotbermal eloaed•ioo>s) •
I.Well Coatt:rlcthcn Pamhti9: �q O�a3 P 'I FROM I TO mtrllAMEPER l - 36ATaaut,
II 0 It. - 1 `ft.
I In, I
Ltrta!(oppfienblr coaaaeCon permits(i.e.(t c WC,Cocauy,Stara?erica' me am) . p 1
I ! ty I . , ice. 1
3.Well Use(check well ms}: I. I 1
Water StiPPiq We: I 17.SCRE 't FROM I TO DIAMETERSLOTS= TiIICIOlP.S4 MATERIAL
icDltitrat �Mtsaicipal/Pstbltc ft I 1 it' la
Geothermal(ftIatMg/Coa&ag Supply) Resdeadal Water Supply(single) ft.
I i fir i la.
Indu raisl/Comaaeiai I Rest'deatial Water Supply(shared) 1{ 18.GROOT I !
Initiation I - I FROM 1 To r ; I MATERIAL I IRMFLACOLVITalusotr c.*MO(!
Non-Water Supply Well: I j 0 r_ 1 Zo' • 1 ........t s 1 mowed
Monitoring ORaeovery 1I. tc I rt.
fection Weil: to I it
Aquifer Re large ElCeromdvvatortZcmediation
IS.SAND/GRAVEL PACK(if apnrxesbiel
Storage and Recavey OSalinity Barrie , FROM I TO I MATERIAL 1 tmslr tCFsttrvratanlOD
;Lifer Test I 0StoanvaterDrainags 1 ft' ft' I 1
Experimental Technology DSubsidesce Control III I fa I , It.
Geothetmal(Closed Loop) farmer ! 20.ORILI.LNG LOG fattaeb additionaI sheets if awmtY)
FROM I"S'CI, I DfSGR[PTfO,\lm]er.Aariam.sDhoektt4mtr+resistie�
Geothermal($eatintricockmg setura) (other(explain undo#Z1 Remarks) 1 i ft, I I. f•. II O 3 sand
1, ft 1 creme
4.Date Well(s)Completed: 7�°���oQ� wail Mt' t}' 1
I ft. I it. I �..
52.Wall Location: j • I } Y - :,,_... ,,
Joanna_L. ire Dow e I I ft. ! _ .,OCT
�,.,,.S. ' "-' .
Peclity/Owac�Taae t Facility ID�cif appiicablei f4 I I 1 Ol, I {� 2023
90g 8i►r �bM 2d. �i hhaths SB 4o I :t.
I t
PbysialAddress.t's�y.andzip i tt. � IfF,Jra' n fir•^^p.-,,.�,::-., r„�.
'�11 e_f r' 7511-oo8 5 at.R , ' }� Ln ,,,!,-.�w:,....: •' 1....
1,IAC.pr� t_fN M►�I Y I O � OR A D IJE .P VF C%-w,-f` o `
Cody I Parcel idcadfreztiac�a(PEN)
5b.Latitude r ad long/tads in dogreestrainntes/secoads or decimal degrees:
(if well Se1d,one lit/long is oiffieicatl 12.Certification: ,
35° o4.µalai •i 0 83° IS. 7.99 w ,3 Lea_ *k.g.
I Sigmtatals of CGtifithAVcll Coanator.
6.Is(ere)the well(s) Permanent or OTemporary I I.•
I 33.-signingthis fo;m,t aerie"certify that : wrd(s!mu Nerd oea*traaed la area7.Is this a repairto an esisth well: Yes
,utir!Sal NC6CO3C.0100 or 15.4 ACr4C 02C.02e01fell Coastivether Madera au
Ifthis it a repair,fill oat Anoint i,rIt ll eatstruction information
'mplair.the rsatur of the coPS orfris record leas beer.Provided ro the well omen
repair war e31 remarks section or ea the bad.'of this farm
13.Site diagraa!or additional well deta7s:
1 You may use the back of this page to provide additional well she details t
8.For Geopro ly I O or Closed-Lang Geothermal tI having the wells
construccon details.You may also attach additional pages if atesssnty.
constriction,Daly I GW-I is needed. Indicate TOTAL NUMBER of tiiells
drilled: I + SUBMITTAL INSTRUCTIONS
9.Total well depth below lased surface: 1000 at') 24a. For A11 Shells: Submit:his fort within 30 days of completion i
For taaltipir wells-tat all depths;(different lesaarple-3Qr 200'and 2(4100'1 corsrrretior,to Ithe following
10.Static water level below top of casimg: (ft.) Diviiion of Water Resources,Information Processtssi'ng Unit,
"waterlesel is above=Val use - j617 Mail Service Center,Raleigh,NC 27699-I6I7
U.isarefole disinterest:I EA (ter.) .4b.For Iniecaon Writs: In addition to sending the form to the adds
above,also sr:bnaix one copy o£this form within 30 days of completion
lei.Well construction mi erbad: 42./...2 . I /V consL-acnon to the following:
Cis auger,tory5:obis,direct plait etc.} I i
Division of Water Underground Injection Control Profit
FOR WATER SUPPLY WELLS ONLY: ,f� I �16i 6 Mail Service Center,Raleigh.NC 27699-1636
Sae.Yield.(gpm) - I 0 Method of test V.i�% 124c.For WarIeel Suera&Iracetion Welts: In addtooa le smdig the
t i 4 I the address(m) above. also submit one copy of this form within-30
13b.Disiafecooa type: ‘..1/ E _amount S t I
Li
1 completion o;r well commotion to the county health department of the
' where eonsalet-d
I
v:s.er R�eu:e.a Revised Form o1V.l � to:dt Carolina Decor...-. of E.n wantcm:ta:tie•-=i: -7?iiso�u o:
_ _ --___
• � 1