GW1--07809_Well Construction - GW1_20231201

. WELL CONSTRUCTION RECORD (GW-1): • Y •For Internal Use"Onl :• . t
1.Well Contractor information:,
ChriS,King 14.WATER ZONES. . ." :.. .
Well Contractor Name
FROM" TO DESCRIPTION. ''
. �C ft. g0 i ft' )0. i i 1```1 •
080-A ft. ft.
NC Well Cotnracior Ceniiication Number • 15:OUTER CASING(for multi-cased wells)OR LINER(if ap licable) '
Aqua Drill, Incl .. • FROM• • : -TO -ft �. - "DIAMETER • "THICKNESS• ..� MATERIAL • •
•
• l. '.ft `y 1° 1�2 1.� �'o.6.
Ceninany Name
16.INNER CASING ORTUBING(geothermal closed-loop)
.2,Well Construction Permit#• S I'I 0.`"(AJe�`.. .2 3. "FROM TO• -DIAMETER. THICKNESS .. MATERIAL ..
List oil applicable well unittruction permits(i.e.WC,Con,,!, Stole,Variance.etc) • . if!' ft: in, .:
3.WelI Use(cliee!well use): f(. ft.' • in. -
1
Water Supply Well:. .
• 17 SCREEN:
- • - • FROM • .TO . . 'DIAMETER' .SLOT SIZE. THICKNESS. '.MATERIAL ' '
A nic tlu:rat YIp)iicipal/Public , ft. •ft: • in. - -
G_o:'lcrntal(HoatiligiCoolin2 Supply) 4Slesidential Water.Supply(single)
'inti;istriai Commercial . lRcsidcntial Water Supply(shared) 18.GROUT
Ir i t.t or, FROM 1'O MATERIAL`- EMPLACEMENT METHOD&AMOUNT" .
itiar:.:n.-. Supp.pWellf '. ., ...0 ft. 2(J .ft. 1.3P1Q410i4 e... �1;,„"
!1Monitorm2 Rccovcry" . .
Iajecttoa Well: . .
.iii-quifi:r Recharge . I�L..'�Groundwater.Remediation t
f ft
- 19.S.4D1D/GRAVEL.PACK(if applicable)
J 0. ilir'e,Stor tgc arid Recover `Salini Barrier" •.
q 5. ty :FROM- .l TO' I biATF.RIA1, F.DiPLACEilIF,NT METHOD
r^c;.:te: ;est DStormwaterDrainage, -ft• 1 • ft iExcerimcntal technology • DSubsidence Control #. I ft, '
.._."Csec�'.nen•aitl'losed'Loop) - y]Traeer - • , 20 DRILLThC LOG(attach addItlo'sal sheets if necessary) ' .
• FROM• • 'I TO' - •.I •DFSCRIPTION(color.hardness.solIfratk type:°rain size;etc.)
L,Gceillert:lr,l;l fearing/Cooling Return) • (Other(explain_under#21 Remarks)-
�t r7_ � / ' %-7 /Z� �p fin.
-"..Bate'd'ell(r):Completed:/I'2 "23 Well ID#L. 4 . . 1� / . 12. .,t ,22 .ft: `�•�AiY�:�t.: sico-c
•,,:,.1Vc!?�l.y. :tit;r: j j 72 ft. 12257'. !7/uc 0-n� a'fc.. .
aso
F,.,.•:,:: N FacilitylDR(ifapplicable) ft, I ft. I ' •8 .-i .f I '"•''
1 q 3'7:_ge_A l;iiV' C-I- Z �1 •ft. • '1 t w. .
--" )e f Iic irAti r�q" rn •
PAy:y.,i...a acu:u:..City,:and Lip I• J
// �"1 j `! � . •- 21.REMARKS tar :- - -
'Coun v . T '.: D ti
Parcel identification No.(PII\) J`>0+7
Sc,.Lati.Ude ;itti lon itude fat degrees/mutinies/seconds or decimal degrees: .- - - - "
- -
(i7 w:I!ti;ad.our lat,long is sulTlcient) 22.Certification:
. W
• . • // -22 - 23
b.isu:3-,;.si trerlis;�/ rmanent or TeRlporar . - SignatureofCeniticd\NellContrac r . Date .
• Br signing this Ann.i hereby certi/i'that the.utill(s))ails(acre)carieu•ueted in acenrdtince
'i 1:.t-;i. 1..r,r.:.•to an misting hell: -Erf es or io lull:15:1?,'CIC 02C.0100 air 15.4 NC IC(PC:0200 Welt Camsn•action"Smrtt%ads and ihat a
,i:IL. ,e, •.yi.,n•. "'„pat kihaira roil amsa•rrclion hi/iirunatioa and explain the/iatia:e ofthc Coln Wilds rei•art/has helm p ti rodded to the cllonweit
r,l,ut• r,t,.: :',;vna•k.caei•tiam dr an the hack ii/'[hfsfoWr. -
2.3.Site diagram or additional well details:
S.Fe Gc ;;;:E�ciS)PT or Closed-Loop Geothermal Wells having,the same You may use the back of this page to:proside,additional well site details or well
c.tu•• ., (. I C\V-i is needed. Indicate-TOTAL NUMBER of wells construction details. You may also attach additional pages if accessary.
drilled ___—.-- SUBMITTAL INSTRUCTIONS
9.Totcl siel)�'enth helot land surface: • 0.2 e.2...57 (ft.) 34a. FM- All 'Wells. Subniit this form within 30 days of completion of well
F,/-a:'r 4. .II, t,r all depth i/'ililj;rein(exi°plc-30200'attl20,IQO') construction'to the following:
10. Si-:,:.:. ':ace 1z-•el below top of easing: . 3 Q • (ft.) Division of Water Resources,Information Processin;"Unit,
/r rr•• ,. • „n•,;; c:.•-;',e.ttse'• 1617 Mail Service Center,Raleigh,NC 27699-1617 •.
11.E,,,r?heir(Hz:meter: .(in:) • . 2d1b.nor Injection Wells: In addition to sending the form to the address in 24a
r �1� ,;J/� above,'also submit one copy of tl is-form within 30 days of completion'of well
F:,..:. .s:rt.etioit method: Cr construction to the following:
(i: .. _ :,. -}...,ale.,hrcctpush,etc.)
Division of h4tater Resources,Underground Injection Control Program;
' ist)hti, _ Sc, PLVWELLS-ONLY: ib36Ala;lSelvice Center,Raleigh,i�C27b99-1636
is _. i o ibtethod of test: ) h'} 24c.For Water Supply&Injection Wells: In addition to sending the form the address(es) above, also sformto
n it'one copy of this form within 30 days of
3b. _�_ h s^t: _ � Amount: l2. i� completion of well construction to the county health department of the county
where constructed.
i-.:. . North('amlina t)enartment of Fnvirnnmernnt(Inn lift,-Ilt.-a.,,,.,t ut..•,.,.u.,...... 7. n..a-_.,o 00'In.c