GW1--02801_Well Construction - GW1_20240506

WELL CONSTRUCTION RECORD(GW 1) .:
For Intental Use Only:
• 1.Well Contractor Informationd
Reuben.W. Clayton;'ill- il ) y«�c.•��• 1•a.WAT•ER
•WeliContraciorNun .•
• • DBSCRIPriON - _
•:.2241 A
•-.-NC-Well Corittactor Ceiti6ce6on Number:: : -'.- -.. .�.:I
n fe
An ua Drill Inc, . MITER .
ar roolW�ed ae1W)ORINR(if ap teatime) •
. - .. I 1.DIAMETER: :I THICKNESS �MATERIAL:. :._ •
Company Name: — ' :8,: tn:
16.m177..CASINGOR TUBIIYG..(Weotheematddud-loop)
2:Weti ConstrircdDn Permit#: Od r� t) Zo3l!?5': :... "
. :. . tO1 all age l.eitMe well ilo FIfFic lonPf.renlfs(Re U!g SYaMTerimrce eta) M n f.: •
Te..ln.
. :.: . • -3:Well Use(cheek well tie);.' . ,:. . • . -.. . o•�R � .•• ft:. „ ia.� 7 - -
E
NIA
Water Su
.
. . PPIY'Well: : _ ... . :. . •17.SCREENw. '
' . Agucultural :, [jM ioipal/Pabl'
. :�; •' •� •. to .. : ... -
Geothermal eaten
l'+HOM TO .DIAMETER.... BIAT AD.tr TA[CIQ�II+ffi MATERIAL
. . glCool..Snpplyj; estdenUal Water Supply(single) .
R
- ft. lit
. . .ff, fi: 'tn:.
. .'..• : lnduslrial/Commercial. ... .' . '•' Residential Water Supply(shared) .
Irrigation .
Non-Water Su AMow r
- tocRvz•:_ - _: : -'
'. FROM TO ,MATEIrrAL EhfPLA�aO;NTMSIHODQ ;;
_ pply Well .. .. .
Monitoring..- •. - - ... . . • :- [jReeoverY . .. .
Injection Well; -. . '.. :
. • - :• Aquifer Recharge- • :- . .. OGroundwata Renrediation. : .'•'• ' .• • • - •
rfer Store a end. SAND/GRAVEL PACK(if sppliiabk) - '
. g itecovery : . SalmitY.Bard .
Aquifer Test ': . :
. 9.
I+aoM- ••To.
. �Stamiwaler Drainage'. • � ' :-.. L-. . ft• . .. rEiu AL ts1PLACEMENrD1I'MErHOD.~
'; Experimental Technology. .: .:'OSubsidence Control •. . . : : : : -- , ft ' • .
•.. Geothermal(Closed Lop) -•.- . -.•. •-. Taer : ': •' ` •' _ : ::
. � .- .� 2aDRILWNGLOGUtfsch'addiitonalckeetsHnronvey)_=
Geothermal(I1eating/Coohng Return) -IlOHxr(e plain under#21 Rdnaths)' FROM_ TO. • DESCRiP ION(color,auamr,soei od tne'lfreL+lr4 em)
4.Date Well(s)Completed:�1/)? -Well ID#' • -1. . ft.
SSaa,Wen Location:. : .':•" : • : . :-.: it: rw, . .. , . .. .
• Farlhty/Owner Name
. . . : ' FacOity:IDO(ifappUaable). . . f6• •r . .
: : .g..>•cso,..s044 es4.✓• z16 rov 9efi.: Z,. o7-..••' .'rt' n.• : 31 =2:24
Physical Adams,City,an-Ti •. '• : ' .. . ' ' : /. .. .: -tl. : • ft.. f ,
9Y
.... � y � 21:REMARKS - s��fv c -
� r
•
.. . County :•- ':. • • Puoei3 otifi}xtrtia Ido.(PRE.• .•
. ' : ITiistl"440 °l✓,rs�yQ,.?fell '+d'0•.PdW c.7J.
Sb::Latitude and longitude in degreea/minutes/seconda or decimal degrees Cs P'1 -. :
(ifweli 5eld,'one latlloag is sufficient)
:N Io•00
. •;.. • 6:Is(are)the,weU(s) ermanent•• :or r(^��.,,..em : . , •ofCmtified well Contrnctor - .....
. :•. .. . ... .CAP'. h?ort�' ;' • � � � .Date'..-. •�,. :
•
•1 By signing. sfnm, here y cerib5•.that ihe-weU(s)was(were).eonsiracted In aoca alma•:• 7,.r®thts a-repair to an.existing well: or.r3No iv(1h ISA NCAC 02C.0)00 or_1SAR AC 02C:0200 Well Coashucilon&imdm&red ihat a . ••'lfihls Isarepair,fell mrtlmoivn.well constraulon iq/ormallon andexplaln thenahae oflhe• .capy.Othis record hue been provlded►o Ire i9e11 aw►iei:- '' • • ' •
tepalr.unda�p2FtiemarkssaYlon oron Ihe'backoftlita form.•• ' .. ..
• : . • • ., ` •- 23.Site diagram-or additional well details
:. 8:For Geoprohe/DPT or©used-Loop Geotheraral Wells h'suing tho'same.. ; '' .matey use of this Page to prdyiik iadditiotial well site details or well -
construction;only 1 OW-1'is needed. Indicate.TOTAL NUMBER of wells. .' You may also attach additional pages.ifnecessary
You a ba
constru on details:'.
}SUBMITTAL IN3TRUCnONS .
. .•- 9:Total 1e w depth h depthshind surface -• • • - -O '(it.) .'24n *or-MI•Wells Submit this form within 30..d -of com letion of well :
Forwidiole.wellsllitall.depths,ffdfferant(e�rample 3@200'and 2®IOO)
co •nstruifion to the fallowing• I. p• '
10.Static meter laud 6dow to of cast - 1 : • ' - - 1
P ngi .• '... .. . -" ice) •Division of Water Resoa. . • tfxwlerlev.d is above casing use"4^ . • • rote Information Praoes46 Unit, .
ter,Raleigh,NC 276991617
li Borehole diameter: - :•6��' (io;) ce Center,
- 16I7 Mail Seivf . .. .
' 12:Well construction method.: ' •• : . . • . ' .
onjection Weis:P In Y
above;oels omit.on • ofdtlus form•with 0 days of completi of well
(ie auger;,iotaiy cable,duect push.etc,) - • construction to the following . .
.• FOIL WATER SUPPLY WELLS ONLY:
.. •• - • • • •• • rider R • d lnjec 27699 636 Program. •. :
- Dlvlston of�a6 Mail Seu�enter,Raleigh,NC 27699.163t1
' • a 'r'viceCc •
13a.Yield(gpm)- • Method of tom'-:'' _ •- . 24e.:#ar Water'Sunoiv&'Iniectlan eN:•In.addition to sending the form to• :
13b.Dislatectlori eel •, : the' dress( ..ove,_'also submit 'ne'copy of this rm within Of .
type: .Amount• .'• . •..- - :. • 'completions of�wel'construction to the•county health depailment of thieco con*
. . where co cted. .
Form GW-1 . North Caiolina Department Of Environmental Quality-.Division of Water Reimirces I ua•:..a e,,,ni . .