GW1--07337_Well Construction - GW1_20231113

• WELL CONSTRUCTION RECORD (GW-1) i For Internal Use Only.
1.Well Contractor lnformadon: ! - I
i ,
Russell Taylor ; 14.WArlssZONES 1 1
• i FROM t TO I I DESCRIPTION
Well Cowmen Name 'Rl ail % I"8 e10
24 87-A n Ist. I
NCWc11 Connor CmtsftodOaNumber 1 15.017TERCAS Geformalei•asedwalls}ORLiN.RtRf
•
FROM TO i I DIAMETER I' C 111 MATERIAL
Haddon Brothers Well Drilling, Inc ft. 1 In. 1
Wpm Name /�� Q 116.DINER.CASING OR TUBING(¢ea'thamal eleteerLicap) -
V '07 /1�1 I FROM I TO DLLMMER l TRIL7@Vm5 MAMMAL
I.Well Contraction Permit t�: d V-L 1 I �, � n. M. C
. Lust all applies:OW nett eaa�metfanpermits(i.e.WC,County:state,Yarnnee,cu.) I• 0 138
3.Well Use(duds well use): 13 8 R. I 14'0 P. I Cn ley . 188 STEE L.
Water.
17.SCRZEN 1 Supply Well: I� FROM t Ta DIAMETER SLOTS!za (T MATERIAL
QMuiicipanblic I fa 1 ft.! us. `
Gcotis6mal(Megan/Cooling Supply) OResidentsal Water.Supply(single) fa I ft:, I ie. I,
IadusniaVComaccial DResidersial Water Supply @bared) I i .GROL•7' '
tailutian
FROM ! TO • { MATERIAL I r?iCCtckTMLTdoo&amotd
�
Noa Water Supply wens . f I 0 fa I 40 ft. seem � k s � ocresed
MoaiWresg t��cliecovery 1► ft- I rt. I i jection Well: Ili fa f. I {i
ggtsifer g 0 C�toutadwatcr iemediatiaa 19.SAND/GRAVEL PACK of ap arable)
' Storage and every oSaiiniy Barrier 1 molt I To I MATERIAL ` EMPL, ERS T=TROD
{ is "--
Ii
alter Test EIStsurawater Drainage ft !I
F.xgetitasatal Technology IDSubsidenee Canrrol I I f:. I I ft. I
Geothermal(Closed loop) DTracer 20. Q.L1NG LOG<atraeh additlansl sheer K tsc }
FROKDR I TD P I DFSGRIPt'tO.\Im1CT.Uit♦elQ.7aalr�et�`�stze•de:
Geothermal(Beadag/CoolingReturn) IFt Other(explain under#2.1Runnels) O g, I 45 I, itI asand
4.Date Well(s)Completed: ID 14 Well i a6 i` i�� fL• I yra,ite T} ^
lt. I;.It'Sal.Well Location: i { %^
Facility/OwaVsmc r
c Facility IDs(ifapplicable) I 202^
rr.
Physical Address.Wy.saF _ t',•`I , ••., •✓.•
ryM
ti
maeo� Crauary r5400gD OA 31.RFL4R1C _
Guiars ?areal Identifeetio No_(PLC) —Parisi et (_0MMini Well ov Ltdje 4 }-lpt Ei .;
I'
Sb.Latitude aad loagitude in degrees/minutes/seconds or decimal degrees:
(if well field.ate(at/long is sufficient) 22.Certification:; J
, "..
35° off.�,a rt 083° W. •w l'C —. �P - ig
Sigatuuc ofCm'tf,teti Well Ccatac or
, 6.Is(are)the well(s} ertaanent or OTemporarp 1, t,
���+++ 3y signing gisfor;•lantf-:•eer.,that wars)use Mrrel worn:zed is exa
7.15 tin a repair to an existing well: E d
Yes or tto „Jlt l54 N 6C 03e.0`!00 ar 1S.,t�CAC 03C.0200 DWI Coartractloa&reads cad
___ - Iftkis 1r a rrpac.711 qm'know:writ eartttruuion i nne:don epicto the re:vr_of the rope of fhb record iiaw beer pra,idrd to the writ owner-
repoir render R31 rcmanEr scalar area the bad•oftlurfcri r. a.Site diagram or additional well details•.
Ye;may use the back of this page to provide additional well site details.
S.For GeoprabdDP'I'or Closed-Loop Geothermal Wells having the some d his. You may also attach additional pages if necessary.construction,only I GW-I is needed_ Indicate TOTAL NUMBER of wells
drilled: 1 -YAL susylr INSTRUCTIONS
4.Total mil depth below land surface: tarn (ft-) 24a_ Far .&I1 Wells- Scestit this font within 30 days of completioa-t
Far multiple w rlir fat all*pas sfdarereat Ccsempir-3Q300'cud 3Qa/00? construction to the followin=
10.Static water level below top of easing: 1110 (ft.) Division of Water Resources,Information Processing Unit,
Iftratsr heal Is ab014,axing.rsr_-_ 1517 Stan Service Center.Raleigh,NC 27699-16I7
it.Eorshale dlamcrer. (ia: 2•4b.For Injection Wells: In addition to sending the feats to the address
•n , � ^ ��� . above,aLro=brae one copy of this form misbio 30 days o£eo+eplstlea
134 Welt wrisavcueu mewed: • 1�'" nt-resoa to the feiloccia - _
[f`augc,mury;chin.discnr P: :etc] v — Division of Water Resources,Underground Injection Control Profit
FOR WATER SUPPLY WELLS ONLY: j NC 27699 3636
I.1 r 16330 14ail Service Center,Raleigh..
l/� Method of test: &A.Cir•�+ j 2*c For Water Suool&Infection SVolk: Ia,addition t0 3eodiap,'thy
13a.Yield(pas) // ! I the addrss(es)above. also submit one copy of this form within 3Q,
Amount: I[Q 1 co:tpiedon of Iwcll conscuetion to the county health depattateat of tiie
13b.Disinfection type: i'i where eonssttcte�
v
I' Rcvited:
Form OW-i Vast Carolina Dc;a.tnao t of Far.iron r. Qt=itr-Division of Wafer 3 ur mcc0 .
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