GW1--01325_Well Construction - GW1_20240304

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WELL CONSTRUCTION'RECORD For flFor ititcrita1i4cDNLY:
This form can be used for single or nu ltipk wells
1.Weil Contractor Information: l
-1 ',WATLR ZON ES I
Tyler Brown . IrnoM TO DEtC twllt)N ! ' •
Well Coiiraclor.Name R. ft,
4625A - ft. rt.
NC Well Contra tarCertification Windier EIS OUTER CASiNO tear ttulti-casedfnctlsl OR LiNER Miff Riable): - - •I
FROM 1•TO ' • DIAMETER,I THICI i<T SS• MATERIAL
SAF.DA000 0 ft.••I 18 ft.: 2 hi. SCB-40 - PVC
I
Company Noma 16.7NNERCASINGOR.TUBING(geothermal doxcd-lotip).;' r
"FROM - TO DIAMETER I TUtCGA'ESS MATERIAL
2.Well Construction Permit#: -ft. • ft; • 'in: '
List ail eppilirable well permit:(ix.County;Stute..Variamre.Infatic!I eta,i
:' -- - - .- •I
4 ft. • .in.• I.
f
3.Well;Use(check Well use): 11.sCR[EN
- Water Supply Well: • -- '- tmoat. TO . 'DIAMETER stOTsinf; TtuCKNI I MATERIAI. • i• . •
DAgticultinal I7MunlcipaliPublic' 18 ft. 38 ft. 2 in ;.010 SCH=40 PVC
OGeotheitnal(HeatingiCooling Supply) ®Residential Water Supply(single) • ' . rt. ft to • i
0IndustriallConmtcrcial ClRes[denftal Water Supply(shared) IA:CROUi
,
FROM. " TO . MATERIAL ; EMPLACEMENT METIROD.D AMOUNT'
Ohtipation . - 0 'ft. 12 ft. Bentonite c 5teethie
Nou-WJter Supply Whit:- . . .
ft.. ft.
I✓�Monitoring Elfccoyely . ,
• ' lnjeciion'Wdt: - ft.' ft. •
' DAquiferRecfiarge [7Gtoundii:licrRciicdiation -,t9•'SANDIGRAVELtACK(if alyllictDtca= ._ , -
PROM - ' TO' !LA•rRRCAI. , • ESIPI-ACI:Arr:VT Mr:TnOn I -
PAiptifcr.Stoagc and Recovety' glSalinity Ranier 16 R.. 38 ft. Gravel pack #2
❑AgtiifcrTcst i75tonmtiateri ratoage • ft. (L .
Olir petimcntal Technology DSubsidcncc Control : - . . • .' • . ..
-'2u DRILLING'LOG(atlsch.addilioriatdicelsifioccessarYl
CGeotitenual(Closed Loop) . l7Tracer. .FROM ' TO DESCRIPTION;Dolor.Itanlnea+,wiTnicl lyttt.orAin,itudc:I.
OGeodietmal(Hearing/Cooling Return) DOtlter(explain under#21 Rettnnbs) R- ft. i
ft. 'ft.
:I.— r•--a .....,,,. ..
• 4.Date Wells)Completed 2-13-24' Well®11MW-1 ft. tL _, �
Sa.WellLocation: .rt.' . ft,. MAR 0 .1• 20Z4
Kayser Roth ft. ft. ' . -
Faclitg+mivncrNaruc. Facility IDk(if appli able) - "
ft. i''" Ifts%r r i�isi4eri OrGC:NEO:f:'g Uvril
719 I-40, Graham; NC, 27253 .ft. ft. • I iArt)l�bk.n.
Physical Address City.and Zip• 2I.REMARKS •
Alamance Bentonite seal 12'-16' I
County Parcel Idcnhifwallon No,(PIN) •
51i.I atitiide'and Longitude in degrees/minutcs/secrinds or dcciliral-degrees: 22.CettiSeatIon:
(Knell field,one la>along lr'softlekaly
r.
N W r ~ 2/15/2024 .
• ' Si ofCeni3ed Well Cannactar- •• Dame
6.is(are)the uvcll(s):.%Permanent .or DTempnora
Fy•signing rhir farm.!hereby certify that the'veils)mt.(were)constructed is accordance
twit I SA NCAC 02C.0100 or 15.4 NCAC 02C.0200{Veil Co,rstriet(e,Staiulards and klin:a '
7.Is this a repair to ait_existiugwell; DYcv or IDNu rro�ir'ofMit recordhasb cti'prorufrd raahe'l rli owner,
. lf,Wrs'ds a r:Falr.fill on:knouir well eoos;rucr(aa hrfarmrrlon andriplahi the aortae oldie i
repair tinder02l remarks'sreliun or on the back of this form.. • 23.Site diagram or additional well details: . •
You may use the back of this page to.provide additional well site details or Well
8.Number of wells constntcted: 1 - •• •• •• ' cettstmetimi.details. You May also atta,c[t udditioilal pages if necessary.
For srnlrlpte lydeeilon or non-tearer snpplr•wells ONLY Oh the sortie cani ruelion,yogi con I
submit one fano. . SUBMITTAL iNSTUCTiONS .
9.Total well depth below land surface: 38 ' . ((1J,) 24a. Far AU Wells: Submit this'faint within-30 days of completion of well •
For•rnaittpl1K'relr list all ATMs(fd(fli•rem;(cranople-.l@20lr'arud209100) construction tolhc follow ing: 1' •
10.Static water level below top of easing: .(ft.) Division of Water Resou�es;'Information Paneessing Unit,
If unto,leval.ly above casing;uu-"+'• - . 16.17 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter:6"' (ta.) 24h.For Mimeon Welk ONLY: in(addition to sending the coml.to the address in
24a above,also.submit a copy of this faint within 30 days-of completion,of well
12.Well consttttetion method:Rote-sonic constmction to the following:' f
(i.e.auger.fetal)•,cable,direct pink etc.) I '
'Division of Water Resources;Undetound Injection Control Program;
FOR WATER SUPPLY WELLS ONLY: -- 1636 Mall Service Cent r.'Raleigh.NC27699-1636
13a Yield(1 pm) Method of test: 24c.For-Water Supply:St Infection Welts:
Also submit one copy.of this form Within 30•days of completion of
13h.Ditinteetiun type: Amount: well construction to the county health department of'the.county.where
constructed.
.Form GW-1 Nor&L CarmIlna Depnnment of Eniironrucril and Natural Resources-Division of Melt'Rmaurom Revised August NIA
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