GW1--07336_Well Construction - GW1_20231113

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WELL CONSTRUCTION RECORD (GW-1) i For Internal Use Only:
r
I.Well Contractor Information: I 4
Russell Taylor ; Ia,WATER ZONES
i FROM I TO I II DFsciurnQF
Well CctiaaetortName Ile m 18 3 ei 19a-9 7
2187-A -
•
1445 n laa0 fr. 1'1
NCWdICttattxmeCttrtifaaoaNtimber I15.OUTER CASING(for malChased wells)DELMERttf septhsblel •
Hedden Brothers Well Drilling, Inc ; FROM I TO i I DIAMETER I TRICIMESS MATERIAL
ft. fu 1 -
CoatpanyMatte 116.D'NER CASING OR TUBING i¢eotheaaal elewd4OOO) •
2.Well Construction Permit#: 050q, 1-P I FROM t To I I DLLMEtER t =COM aMATt<RL1L
rltt au applteabtr well ears artlanpamits!:.a WC.County.State,✓erecee,etc) 1. 0 ft. 1 47 111. I tp tn. Pve.
3.Well Use(dais RdI use): L it I st. i LD 'fl. I . 18 8 STEM L
W4ur. We 17 SCREEN I '
► QI}' ll: f FROM I TO DIAMETER SLOTStZE ,T'R1C MATERIAL
Agsiettlturdl • UMtmicipal/?ublic i ft. ( ft.I , im
Geothermal aleating/Cooling Supply) EResideasisI Water Supply(single) ft. +I ft.III M.
InduattialIComaaeial DResidcwsial Water Supply(shared) I ig.GRODT
Irsistatiaa • f FROM I TO I MATERLII. 1 tMPLACL EDir5ItTHOD a AMoing
Not-Water Supply Well: - - I 0 et- I zo It. I �us� sewed s s
Monitoring oBaoovery It. I ft. 1
jechon Well: I ft. I ft i
AquiferRochatga DCsouadvratarRcmediztion I
19.SAND/GRAVEL PACK(ff=enable)
• Storage and Recovery •S¢Imiy Battier FROM t TO I MATER= I ESIPLAGEMEtTMETROD
uiferTest ] Sto=waterDrainage ( ft. I +ft 1
EatpeeimeutaI Teehaalogy • DSubsidence Control I ft. I fr. i I
Geothermal(Closed Loop) r3Tracer
Z0.1:1RIi.LI:1iG LOG fauaeb additional sheets if accessary)
FROM I TO I I DESCRIPTION ce'4""tnrde�.ssaaseknsw wade eta.a a)
4.Date Weil(s)Completed: IA
Geothermal(Fie¢daitlCaoliaft Rana) E'�Othor(asptaia cadet ill RemaQsl 0 ft I 7p +'ft I a mine
Wets 1D# i �7 1 f` I�3Q01 1 gr....
Well Location: I 1, fL
eedore_ gba-t . I' r, r. { _;
4aeHry(Owaa�j=me Facility i a(if appgeablc) ft I ft: t ';c�,k..^Fs .r; k ii
ail zadv,.y RA..—��b E. ' u NOV 1 Zoz3
lniris, e�R74-I
Pbysieal Address.City.and Zip d I.
t
N1 �r 75"loa ss ra .I�R=�r"asS
t tACp1 l euN N I. I s - Ur...?
Crawl ?creel Identifreatim No.(?lx) I _.,u,
I
5b.Lausnde cad longitude is degrees/miautes/seeoads or decimal degrees: ,
(ifwell geld.one i sag is sufficient) 1�cation: ;,
35° 44. ► N 083° Ia. 170 W e .z„idea_ &0I43e
Sigatahc a:Ce:tified Well Can �`"` i
6.Is(are)the wdU(s} Permanent or DTemporar;• h
3).signing this fovea:hengr a ei jy that is iaII(ej Mere) *++said ire amua
7. cabling Dyes „la::sd NCte ONCI.0100 er 1S.4 VCAC 02C.0200 IFell CenstnieWen Staniar*cad t
If a le a a to¢it construction
or ropy oftrrs record ha,ben prawarrd ro the ire!!asrrier.
ljtbirlrarrpairjrAorrta6tvn>smlleoastruetioreirtfarma:ionesplair.:iraatur_vjtkv
repair anger it21 remarksmatiwr orotr the bad ajttatjarm. 13:Site diagram or additional well details:
You may use Ice back of this page to provide additional well site details or
S.For Geoo.only I G or Closed-Loop Geothermal Wells having the wells
const ueoa details.You may also attach additional pages if necessary.
eonstmetion,only I,OW-I is needed. Indicate TOTAL NUMBER of?yells
drilled: I SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 3O° (ft-) 24a. For AIS Wells: SOb=tit this font within 30 days of completion of
Far malttplr urafr l tt all deptkt ifdtffirent fesainp1r-3Q300'and 2Q1001 contuses on,to ice foUowinm
I
10.Static water level below top of casing: 35 (ft.) •
Division of Water Resources,Information Processing Unit,
limner/eoel iratmmet*mr 1617:Matt Service Center,Raleigh,NC:76994Wt7
11.borenale dsasacter• 6 •l i
34b.+or iniecaon'WeI1s:. In addition to seadmg the form to the address I
aboc-e,also scbrs-t�ace Bogy of this fovea..sd+'sa 30 deya of aonplWoa e:
IZ Well caasVacrtoti mctLaGc + con-c.:cSo=m t,a follow3v
as.sager,rotary,cable,Cow ptah.ere]
Division of Water Resources:Underground Injection Control Progre
• FOR WATER SUPPLY WELLS ONLY: j_ I 1636 Mail Service Center,Raleigh.NC 27699-1636
ja y Yield( m) Method of test: l 3� t'J� i 2.4c ?or Water Sssnoly&Inieetion Wells In addition to amdtng the A>� + rr l I the address(m)1 above. also submit one copy of this fors within 30 di
13b.Disinfection type: I.-
1_Amount: 1 I cmr..piedon of well consnuction to the'county health department of the 1
—j where N0sat:med.
I
form OW-i Nord:Camlina>epa:ra^it x-=Er tan..r$nai 2�•iity-Oi,s'orof acrR.zcuc Rcviacdly
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