GW1--02177_Well Construction - GW1_20240408

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• WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
I.Weil Contractor Inforroatfon: - 1
Russell Taylor ; 14,WAIN&ZONES i "'
FROM TO ! ! I a6C Ft1019
Wall Connector Nta
2187-A Ia?8.2t` I a82•tt i
'a9onA4.6ft' I
•
NO Well Conutcme Ctat�ettica Numberi I5,OUTER CASING(for male wells)OREINER(S eDiel
Redden Brothers Well Drilling, Inc FROM TO . ; DIAMETER TOCIO s IAI.
}_ m I I ft' In.
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CompanyName �p I Id.WRERCASINO OR TUBING(geottu�aldosed-t000l -
2.Weil Construction Permit#; ( 7 I443-f ! FROM t TO I. . DIAMETER I TIOCIOrESs. ffitATIRTAI.
WI art appiteablr well eva rorBoc paa (r.ets c.WC County,Stars Variance,eta) �- 0 90. i• 1, hi. .I PVC
3.Weil The(check u ); i-qo .tt i GJ? I Ls 'a' 188 STEL
wawacppIyWeil: 1-SCREE( '
FROM •t To DIAMETER SLOTSIZE TKIEIMffi alATIOUJI
,MAgzitpalmnl QMunicipal/Public ft. I 1. ft. I is
M al des Supply) stResideatial Water Supply(ogle) ft I it. I ie. I
lEduattialiCoammcciat Residential Water Supply(shared) '
-18.GROLT '
on - FROM t To' t MATERIAL 1 E+IFLAccum T attracts a*aid
Non-Water Supply Well: j 0 ft ! 20 It a.=m.ro.rs ) Outromi
bloaitoresQ ©Recovery ! • ft.
: ft.
jection Well:
i ffiI ft-
Aquff=Rahargc IG:roundwatar Romediation
19.SAY/GRAVEL PACK(if appEeable)
Storms wad Resovvey EllSalinity Barrier FROM ! To t MATERL 1. tEtn iat_v'
.t� rx87Ron'
oiler Test MStorsrivraterDrainage ft ` fa. i I .
Expetir>iental Technology Subsidence Control I fr. I It I
II I
Geothermal(Closed Loop) OTracer . ' go.IIRILLI:1iGLOGfamehaddltionsi sheets ifnecessary)
FROM TG I DES;:RIPTIONtmler.eo�tet.seo4aek"1.Eels
Geothcmal(HeadalrlCoolioft Return) I�Other(explain twin 21 Remarks/ 1 A. i � �
112.
l 0 1 R I am a sane
4.Datc Well(s)Completed; I o�O o 4,24wc l ID= Sa rt I a ft-
granite
"
SoI.LWell Locratioli: .ft. I It.
floUII 1 rennM 4nr► ft. ► rft. ' l o h_k
.. f of g l e
. ,G. t_
l� i
fuaitytov -Nemo Facility IDd cif appleable) f4 ft' ���
t,/41 ii.4iDn Lang. Fani!J n1 c2873414
fc. i ;t APR 1�
dd Physical Anas.City and Zip I . . Ir)`.:;..... °^ � -...
. .- ,-,.. ;17ar.
• �ACor� L'awri • 1o5r13�38151a 21.REMeur� ..,
• County Parcel Ideat9frearim No.(?IN)
51%Latitude and Longitude in degrees/minutes/seconds or decimal degrees: •
(ifwali geld,one la:/iong is sufficient) 12.Certificatian: •
‘f5° 08. )1+7 ri O83° I2.-.39 8 w . 7?..a4.4LeLgpa.t- 1.2iiat,,
Sigaatutc of Certified Welt Cc atrarar
6.Is(are)the well(s) m eraneat or E'Temparary d ,I
3y signing:Ids form.I senor cont that well(s1 uta(Were)'carer t;et!ra.ass
7.Is this a repair to ao Misting well: DYes orpN. .7::tie is,,N.02,C.0100 or 1S4:CAC 02C.0200 Well Caasa�artlar r teaIfthir1r:rrpoir.filloutktonairrllewswuctianirrformc:ioa =plaisrkercur:plane coPy OH;record haTbemprm dmthetrelltmae'
repair mtdrreZ/ntaan(ssavion once the back cfrlrirfrrm. 23.Site diagram or additional well details:
8.Far Go:prabe/DPT or Closed-Loop Geothermal Welt having the same You may use the hack of this page to provide additional well site Wallis:
coneruetio4 only I GR-i is needed. Indicate TOTAL NUMBER of wells constructionif details. You may also attach additional pages nece eiy.•`'
drilled: I SUBMITTAI:INSTRUCTIONS
9.Total well depth belt»Laud surface; .9.2 5 (ft) 24a. Per 411 IWeils_ Submit this form within 30 days of completion
For e:Mapir well;far ail deptkr if-derma teaaarptr-3( 200'and 2C;c 100') construction to the followin
10.Stade water lard casing:
below top of sing: 1 bo (ft.? DivSian of Water Resources,Information Processing Unit,
glance lave it abate t tore-=" j,i 617 Mail Service Center,Raleigh,NC Z76994627
11.aare:ale diaasetar:
Q fin) 13b.For Infection Wells: In addition to sending the form to the addles
, ,, �L abate,also sprats one copy of this farm•n isbIn 30 days of caropletlan
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32.Well eossstsvesioa method: C�'�. t Li l�C[ conot•Or4on to the fellotcia
Cu.wrier,sway,tonic,:rasa push,etc}
Division of Water Resources,Underground Injection Control Pros
&
I6Mail Service Center,Raleigh,NC Z7699 1636
FOR WATER SUPPLY WELLS
QWELLS ONLY: jt� I i �63
23a.Yield(gpm) V 0 Method of(Oct w� j 24c.For Water Suonl &Infection Welts: In addition to lender the
FF I the address(es))above. also submit one copy of this for within 30
I3b.Disinfection t..pe: S R ;.=aunt. t LQ 1 co:tpiedon Of Well construction to Me county health department of M
where c* .sir feted.
Fe O��-1 Nord%Carolina Departmont ofEnvirono=n QI-ai:r'-Disisi
n1 .a o:l:aier R6CRT.Y
Rctiised: