GW1--02407_Well Construction - GW1_20240422

WELL CONSTRUCTION RECORD(GW-11 For lnicnudl I IA!Only:
1.Well Contractor lnfolntltion:
Nick Young it.WATER ZONES
FROM TO nem:furt ION
Well C omrocton Name _.---`
4605-A A(:; R / 70 R , J.
.1/l 7 it ,Z ,? n- (L,
Ni'Weil Contractor Cntaicathm Numlrr IS OfTTF.R CASING(Perm.cssrd wells OR L1NOJ!lire IknDk
N.\AL Poole Well and Pump Co. 1_, �P
FROM TO DIAMETER TInCK�L'iS _� NAiFR1A4
t1 R I1_, R � (r• in' rf•17 I ('t..ti /
Comprily Name
16.INNER CASING OR TURIN!:(geothermal chased-loop)
L Well Can strut'Uon Penult#: ?-7 S J``_t7 FROM TO INA MET FIt 7HICIC Vl MA II PRIM.
List all applicable aril ermslrucnon pernn/s(I._e.UK.Cnannt Pah%r m an rr,ere) R rt. In.
3.Well Use(check well use): rt. R In. I I
Water Supply Well: 17,S(F2F.F.N
FROM TO DIAMETER SLOT 317.F. TRICICr FAS I MATERIAL
CAgricultural °Municipal/Public R r n. It
In t a ,Ge,,- k/V(...
❑Creothamal(heating/Cooling Supply) 9Ri.sidential Water Supply(single) R ' R In.
Dlndustrial'Commercial 0 Residential Waler Supply(shared) IS.GROUI _
°Irritation CWells>100.000 GPD FROM TO MAIFRIAt EMPLACEMENT METHOD 4 A,Mr,I NT
Non-Water Supply Well: , R (�• R 'G.!,-.4Cn.4C ;OCR- r-
❑Moniloring ❑Recovery R R
Injection Weil: R R
°Aquifer Recharge ❑Groundstater Remeediatian
19.SAND/GRAVEL PACK(If applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I TO MATERIAL EMPIACF:M02T MZ11P7O
❑Aquifer Test CStormwater Drainage 0 R , n'
CExperimental Technology ❑Subsidence Control R R
i
Geothermal(Closed Loop) °Tracer 20.DRILLING LOC(attach additional sheets If aecevaryi
FROM TO DESCRIPTION(color,banM.o;ol5reek type.ante Av.ere,
CGeothennal(Heating/Cooling Return) °Other(explain under 1121 Ranarics) C//�
R 4 n' Jn SdiA
S.hate Well(s)Completed: /-/sl i(1 Well ID# a 11 1 C_:c, n /�_,,G.,
5a.Well Location: l CUR ;Cj n- ('7 vet nr 1C 1' r
rVt<1:T /6“/C.rit<.:� R R APR 2 2 2024 -
Facility/Own Name l i''') ( Facility ON(if applicable) R. rt.
Physical Address.City,and Zip It R
21.RE\TARKS
'c 1.4�sa.1 Used steel hardened drive shoe
County Parcel Idenuicatron No.(PIN)
5b.Latitude and longitude in degrees/minu tes/seconds or decimal degrees:
(dwell field.one lay long is suffici,na) 122.Certification:
35.9-a 44'3 N - 7K,xac 3 w e-ko.‘7
i la-.4y
6.Is(are)the well(s): OPerm �cnt or CTcmporary Signors c of ell Contra r Dos
m
9•v.ngning this form.I Hereby ce 6,that the well(s)was(weeel eanrrscre:tin scceraane.r:.:
7.Is this a repair to an existing well: ❑Yes or tNo 15,1 NCAC 02C.0100 or 114 NCAC 02C.0200 Well Construction Stsnta.k sod:Ito:a:,:IR
if:1=s s a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owne,
repsrr under u21 remarks section or on the back of thus form
23.Site diagram or additional well details:
S For Geoprobe/DPf or Dosed-Loop Geothermal Wells having the same You may use the back of this page to provide additional Neil cower lion if:I.)
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of\tells (add'See Ova'in Remarks Box).Yeti may also anise:l eddit\ra:pa;.s if rc;cv.-i.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 3C (ft.)
For nalnpk wells list all depths rfdfferent(example-3(5.200'and 2(31003 Submit this GW-1 within 30 days of well eortrpleu.ut per the following:
O 2,4a. For All Well.: Original fern to Divide.of Wit r Raaxtrcea Magi
HE Static water level below top of easing: (IY.} btftmmition Processing Unit,1617 MSC.Rateidli„,br27il99-b6F
.7 outer k.t1 us above casing are"+"
6" 24).For Infection Wells:Cop) to DWR.Underground Injection CCsnRol IUC,
11.Borehole diameter: ist) Ito(ianu,1636 SISC,Ralneh.NC 2'70 7-lo30
Rotary
12.Well construction method: 24c.Fur Wafer Supply_and Open-loop l:euthrn,ul fiction Weeds:.espy leflic
r,, .,.gcr,tosry.,.alle.direct push,etc) count)a n'irtnnc ulttal lie.tlds.lepurbncat ci the..uIcs Absc m aai:A
FCJlt WATER SUPPLY WELLS ONLY: 24d.For N ater Wells ptturlucuig rater IIV.daIII tank Copy tODIM.CC,PCILIA
Blow PsnwPnigruill,tort MSC,RAl.•ig?t \i r.i•`.%Lill
lia.Yield(glum Method of test:
HTH
Jib.lhsiidertiun type: Amount:
,tr. i it I 1Jialb Carolina Ikpatunclil utHnvtioouw Mal t/tu6ly-Lii,Ua,nut tt tics k.,.w..., ttionto siStIq+