GW1--07341_Well Construction - GW1_20231113

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• . WELL CONSTRUCTION RECORD (GW-1) I For Internal Use Only:
I.Well Contractor Information: -
RUSSeiI Taylor •i 14.WATER ZONES 1
Well CoaaaciarNsma • I FROM I TO I I 1 DESCRIPTION
2187-A `• I l
ft
NC Well Contractor Ca euion Number
I5.Qa PER CASING Mon maletaudwdlsl OSL1rtElt Of
Heiden Brothers Weil Drilling, InG ! PROM I TO 1 I DIAMETER I T+aaeRss MATERIAL
ft: ! f1 im. 1
Compsay Name w p`, /� 116.LiN£R CASING OR TUBING(geatamsl dcNd4aoR) •
I.Well Coastractibn Permit#: Q RO'Ileino-- �'I IA45 1 FROM I TO i : DIAMETER I TffiCK'V1133 MATTIRW.L
UM all appfeable aril c anion pamrts gr.c WC,Colony,State,Variance,etc.) i• 0 It 13 8 '• L Ito. ' PVC,
1,
3.Well Use(eheckwcti um); LI 38 I 10, to i'• • 188 tSTaG
•
WaterWaterWept 17.SCREEN
Supply • FROM I TO DIAMETER SLOTSl7R T 1LERS I MATERIAL
.
UIvltmlatpaUPublic ft. I ft. 1 in.
Gwtisormel(l3ilng/Ceo�&Supply) aOResidentsal Water Supply(single) g, I fa to• I
Indu iaVCommereial DResideetial Water Supply(shared) {{, lti GRacT
lrTield= 1 FROM 1 TO ! MATERIAL 1 BAIttAcorwrMtnt$ODs&AMMOtec
Non Water Supply Well: tic i 0 ft zo iL �nsesso I otanwd
&Jo:Rarisng R:cove*, I` .ft ; ' ft
jection Well: r
1 ft. ft I
offer Recharge 0 GroundwaterRcmcdiation
19.SAM/GRAVEL PACK tifa°aTimble) .
Storage and Recovery Salinity Barrier FROM 1 TO I MATERIAL ( FsrrLACEMinT MRTSIOD
idle'Test OStennwater Drainage ft. ` I 2 I I+
Experimental Technology OSubsideace Conto1 I I ft. ft
Geothermal(Closed Loop) Orraeac i' ZtT./D�RiLLLICzLOCl(stseeb additional sheets iiaeeornry)
Geothermal(&atinplCooling Reniai) nother(c 1ain unt=_al Remans) ff I FROMft' I TO !{ DESCRIPTION cee7oa tia�am,seltr.eensa rile sla.l eel
I clay a sand
4.Date Well(s)Completed: ib/cZO/a7Dr Welt.ti 30 it. 406 r_ paste
Sa.Well Location:
E*S 1.0DGRPC,LLC- )tt.sti,Be14 •
ft I I f ;— . _ —Cif I. A.-:.;: .il;,a`` i '
15 Rla�etoex, gulls ( flsbiedl ISM'7 ` I I LI-
ft.
< NOV (�
Ph ieal Addles.C lty.and Zip [��( Q � �Q n ! fr. Ii v 2 V 23
r./j .18- lona�G zi.REN RTLC .....':: ..
„sty Patecl ideatifreatiow No.(FLU m
DRy vJ ,:�,: --
5b.Latitude mad longitude in degrees/minutes/seconds or decimal degrees:
(if aeli Held.one i5Nfo0g is sufficient) 33.Certification:
35° ao. 85r/ N 083° OS.343 w ,D/-s_1-�6,Q� to :
Sigamta of Cz:tified Walt Cantrsco: (t
6.1s(are)the welts} Permanent or OTemporary })O}
pN. 3y stzriag:ids ferry.hereby ern'that iedir,, Owe)eaosavaed ire more
1.Is this a repair to as existing well: E2Yes or ,+:d:1Sri NCAC 02C.0100 ar IS.4 NC/IC 02C.0100 Well Coartritafsi Staniar&and t
lid*Ls a repair,J l awl Many mg caasarretton fnfarme:fancptair:the.surrs of the =PS'of this record i r beet pravzdrd to eke Breit aWnet
repairrmder521 remarisssciah aresrhe bad of-ritt:farm. 13.Site diagram or additional well details:
You may use the back of this page to provide tdditional well site details or
8.For t;eapro or Closed-Loop Geothermal WellsWellsBEP.. the same const ued=details. You may also attach additional pages if unwary.constriction,only ly I GW-I is needed. Indicate TOTAL NURSER of hells
drilled: I FF qqMM susAir rAL TNSTRUCTTONS
9.Total well depth belowLand surface: IdW (fL} 24a, For All delis: Substit this for within 30 days of cosaptetion of
Far multtplr wells tat all depths it'd-Cerny frsample.3(D300'cad 2 l00'} co retraction to the following:
1 q
10.Steele water level below top of casing: 0C�t 00 A (ft.) Dif-s ton'of Water Resources,Information Processing Utttt,
fluster level it abode cash=rur*1. I617 Main Service Center,Raleigh,NC 176994611
11.borehole dtaasarer. Lo (fa) :4b.For Intee:iori Wells:. In addition to sending the fora:to the address i
l� ^ above,also sebii-t ors copy or this form"villain DO days of completion of
IS.Well constractiod method: "tut. J�,1 ZJ`� .or.st:ae:;oe to t'l:e'fclloscia
Cam,alga mtyir ablz,d'tiect push.esa) 4 1
Division of Water Resources,Underground luieetion Control Provo
FOR WATER SUPPLY WELLS ONLY: ���, I 1535 Mail Service Center,Raleigh,NC 27699 1636
13a.Yield(gpm) 0 Method of test: i iM stti i �.a.For Water Suoeh g Intention Weill In addltion to sending the 5
(� } I the address(es)i above. also sabmiit one copy of this foam within 30 d
I3b.Disinfection type: ` + ;3moanc 1.�Q D`ii, I contpicton of'velI consttaction to the county health department of the i
I. where c*Ostuot
Form OW.1 te .^ ' -ie:ri _ii<_ s l:s.-Rcseu.-co= .1 : RCy6Cd 2ti
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