GW1--02393_Well Construction - GW1_20240423

\Vr1:L CONS l•Rt,c:L Lt f Llht, !Lhu i(kr\\-11
1.Writ t'anh a:tot Infimmetian: -__ -
Landon Phillips 14,WATRIt WPMli
_ _ __—_.------ ------- MOM II) 111Lirlt tin met
Weil C t,le,[lro Name ft. It.
.111 A — o. ft. -- -
va'Well. -nu.,cnn.rn.f,:nbun Nnmhr• 1 S.U1I TEQ e:.ESSrG(Mr mnnF ea,niwwellc) I tin tt�(i.npu•„w. •
V4l�' Poole Welt and PumpCompany _f_nom-- r° DL`•`rni'r T171fIWIYS MArEaff4 ,
p y • ft. I ft. in.
.„nl.,u.Mame 16.IINNERR CASING OR TUQtNi;(grolheemnl Anred-Ma
r ' I I25(j •7 I'l10s1 t TO DIAMETER ToozwNess MAtilmuL
Z.F\ell imtstrne6on Ns mil q: W f�/✓`� ( _�C" tl, th in.
int aprii-aNe well rrmuru:fhnr NOW,I(i.e.UIC,Caunla,Stale.rarrahee.ale)
ft. ft. in.
3.Well esc(check well use): - ------17.SCREEN
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R:Der Supply Well: ---- F110D1 TO nMvlKrs:Xin. S'— IT s1LE TT1ICtArESS •,ram'
'�1:\gricuautDl ❑It1unictp:rlll'uhlic R. fa - --_ .
OI.3e lrennal(Heating/Cooling Supply) )(Residential Water Supply(single) ft. ft. in.
Clndustriat/Co ninercial ❑Residential Water Supply(shared) taw GROUT
C ITigauon ❑Wells>100,000 GPD FltOh1 TO MATERIAL EsiPt.ACEsiENT 3I7.1-11001 AWRIST
1 Non-\Yalcr Supply Well: ft. ft. - _.- .
OMomto:ing ORccovcry ft. ft. _
)njcctinu Well: n, ft.
GA.luilcr Recharge OGroundwelcr Remcdiation `-
I9.SAND/GRAVEL PACK(if applicabfc)
❑A,uifcrStorageand Recovery ❑Salinity Barrier mom in vTATEAIAL :P ACEs1ENTstEliMr. _.,
❑AqulfcrTest ❑SlormwaterDrainogc D. fr. --
OLxperimentul Technology ❑Subsidence Control fr. R•
OGeolhennal(Closed Loop) OTracer 20.DRILLING LOG(attach additional,heels if nee...aryl
mom TO DESCRIPTION!rain.•,hnrdnnr,sad/rack rvpe,,vale ere,ac._
OGeothermal(l lcat,ng/Cooling Return) DOther(explain under 1121 Remarks) lin n {�Q5 n q
fl `(Gn��
4.Date\\'ell(s)Completed: 1-73-Zit Well 1D/l ft, ft. (/
5a.Well Location: f rt. ft.ft.
E-r •i,,.,,i 'c. ).-,,'7.'�.
pm r ► ..octltlo fi. APR 2 ? 2024
Facility/Owner Name facility IOU(iIapplicable) .
ilif 61 crews f k(tr1[4,14..lc AA_ a iSY I f, n.
ft. Ti. ni.�,f•--.' ' .'' 4`:r:+
Physical Address.Ciiy,nil Zip '�- • . - 1
21.RF.MARKS f
��� Parcel Identification Na(P/N) Used hardened steel drive shoe.
County
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Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Of wail field,aim lal/long is sufficient) 22.Certificati
35.8313S N `7g, ud9n7(0 „' I—Z3-zY
G.is)ire)the srell(s): crnwoent or O fe 'pantry Signalnn:of Carotin Wall Cunimetor Date
fly roguing tier funs,I hereby errs/p that she u•rl!(r)ova(uwra/catun¢ted al aeim::a,A:
7.Is this a repair to an existing well: es or ONo 15d NGIC n!C.0100 or 15.1 NGIC 07C dorm If ell ConstructionSuuahurfr tom(att......„
if r/ra is o',purr,fill nut kissers,well cmmn,nma a fonunurul dud explain the Itamre of the of d,l r,card l.a.l,een pnndded m d.e"red°theta%
repair under ll?1 trawls t reunu ne nn the hack al this form
23.Site diagram or additional well details:
S.Far Ceuprobe/UPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to pravidc additional well cunstmcto.,i
construction,only I G'A-I is needed. Indicate TOTAL NUMBER of wells (add'Sec Once in Remarks Box)You may also attach uldntanal pages if ne.cr:
drilled:i 076 24.SUBMITTAL INSTRUCTIONS
`),Total well depth below food surface: (II.) Submit this GW-I within 30 days of well completion per the fultowieg:
Far urdnple treat list all depths f different(exams',!,:p200 and 0100•)
24a. For Alt Wells: Original farm to Division of Water Resm..cn tDt•.
10.Static water level below top of casing: (fL) Information Processing Unit,1617 MSC,Raleigh,NC 2/699-le i
If Water lurd a abort.cara,g,sae
241i.For Injection Wells:Copy to DWR,Undergtot,nd In:c.a-•.••-,-.. ,
11.13archolc diatnctcr. a (Ill.) Program,1636 MSC,Raleigh,NC 27699-16.16
Rotary
12.Well t oustructiuu method: 24c.For Water Supply and Open-Loop Geothermal acre:to\lrtAtc CAW am,:._
ri.e.au,;ef.rumly.cave.direct pods,etc.) county environmental health department tit me county mdiCAG rat I< •
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Hilt WATISII SUPPLY Wlil.)S ONLY: 24d.Far Water Wells producing laver 100 DOR GPU: Csry0u vica.[7Cf1CR-'i--
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'L BLOW Permit Program,1611 MSC,Raleigh,NC_'64,1 kit I
I3a.YFald(guns) Method of test:
lib.Disinfection type: HTH Amount: 1 lb.
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P•.,ui S./.1 Noah Carmine Fkpuatumnt of Eusuu,ttuenlal',Wilily•Otensal at WJIer tt_xLuiS3 ••• - -