GW1--05480_Well Construction - GW1_20240912

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.--33E01,11,CONSTRUCTION RECORD (GW4) ' ''For ItternanThe'Only:
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" ---''''''.1ell Contractor Information: •
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- - DESCRIPTION 174:414 rY‘U k‘3 y FROM LT . ,
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Well Contractor N -t'
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NC Well Contractor Certification Number '.: 'ZTVOUTER:OTSINOVolatiiiiiireis,44erOXMLIZTERAianiMlli.V,771":„%tilt.t!'„;:.^•,t., -- Lz
Yadkin Well Company, Inc. , 1 FROM ___ ;TOI__ ,_ .DLLMETER . ...THICKNESS. 'MATERIAL
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Company Name
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kinMERIGARING:ORUMBINagtelitlieTairiligiga;16Wi-'::::a7:::;i7,-1-a-C- --f--:‘'•-•'.."' 1- - .
-2..5 'f'1°4/5,'2.Well Construction Permit II: 1.7..-it.._ . - . ; : .., _ _ , FROM '-TG- .- - - , mAKEIT11,- Tificlatess' ;MATERIAL
Lin all applicable well consiraction pennits(L a rfiC,CO*,State;Vittkrhee,eld) -' ' - it.
' I ft.' 33 f4 0. !'.i° i tl: 1 i:la li" WI'
' 3.-.Well Use(check well use): t fil,_ ', ._
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Water Supply Well: , ., . - 1 ELV,S.tillitlibt;;&Z.'.7..r...,ik7i..ia'f-aareZ:l'ilarL1,,:?-;:*_'.... ifffanil:i.g..-;;Cri..7(,....7.i .',.e c;It
„ ' ' 'FROM ,TO .._ DIAMETER t SLOT SIZE :THICKNESS MATERIAL ' '•
OAgricultural OMMiinipalfPliblic, it. : ft: i'll 1 .
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OGeothenaal(Heating/Cooling Supply) OResidetitial Water S,applY,.(aingle); , ft., .
OIndustdal/Commemial i den- tialW....ater-SuPIRY(ahead), ,,1,adnatittr., ,. a)
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Olnigation ElWella>,100,001i.OPDI _ _ ,_ , FROM .__TO.' ...,„ _.. bUTEDIAL_ _EMPLACERDINT METHOD&AMOUNT_n ,
Non-Water Supply Well: ..!-'' ! oftb ft; - ft: , .
'1' ,..; ' ,.?. 150 4:01:)9' i Petle4rd
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I:Monitoring ORebbvety ft - ': , / -
_r_ft.. [5.0. . ,ei„sior(-1
Injection Well: '
ft. ft • ;: 1'
1.
.CLAquifer Recharge OGrcalartviatet Reinediatict,
, '11;19:iaiii5.71:411X- At70-6011i31r4ial'ir,::.-:''..11,:iV.41..?..W1I'2;:ti:',7':*1:%`.-.7"..;itie'4-:''•: .
• DAqinfer Storage and Recovery ElSalinity Battier , i'_FROM._ ;TO ____ MATERIAL ._ .1qPLA.CIIME2TM=OD ' • -
i- t 11114 - ,
DAquifer Test OSMUtwater.Dranage • !'
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ORagerimental Technology ' OSulisicience Control 'ft. ' ft. . I a:::'!;.E:4;c1,''. ,:l-/'•,..1-..•‘''",..li tikk- '
' EIGeothetmal(Closed LoOp) . OTrtie er . ' f,'"=„20103RIEMOBOOlittlialiiliaditiiialliailifiteraisTIFY)D,...Y.F.S.etit.,33:::1. ,,f......: I, i': '...FROM ;TO S DESCRIPTION:(eolok,harrbietsisafllinek graMily.4- del
0 Geothemaal(Heating/Cooling Return) O Other(mrigainancler gl_RematitS) :'- -.2----• . ....
Dat?Well Started fr-- iv --,f 1 c e (fL-- _.c.,--f " , .....Sei.1_._ _ _ _ _______-_____. ,
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Alet‘f 2P 3' ' e1-7;
4.Date Well(s)Com2leted: 9.%:,916,•.).tif 'Well133# , : 0-7 - 'r .r74._
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1/70- 0.,,>4,0 ft.- i,.),) ,00e ti--,45 -_. ,
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, bei,evutorme..,c,i-i.k3 -.•_, .9., - - . !,,, , _ft: ,,,,..,...-- ft, I,Z, ! ,o 2, . . .
;010v 7,1 Lr' .fir ,,. „foi.7..re. ' ...
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Facilit/OvenetNameg I iFatilitkpiOanipplicable) itS Oft' 'ItioAP ft. -Od,
fw,,,,s0„ ir-- • -...-or-'.
. D, ek .L • , W42C.115 ' ft'' 1• )0 ft
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PhysicalAddresCity;ani4ip 0 .1 ' 1/A3Lfl ;A i
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g <y it- ' ,---0 ,A= - ' --
, , - d u s--412 greet -
.County '-.. ;putelidtho-catio' ci,(pj,N) . _, _ :. _ .- . . . ,_ _ , _=.._ _ __ __ _
iX 9.15 .5 ---
. 5b.Latitude and longitude in degrees/minutesiaacoudeOn decimal degrees: -f - ''"- - '- --- -----l'-,: '..---,--.)511-eek, --- ------- - --- '- - -'--- rti,
(if well 5eld,one kat/long is sufficient) " 11 Certification:' VV ' •
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3z- G.i s 937 N a i, 716,6,41',.°_ _. .. .._w p - k 2 4
S .+.0 - ,.-- :,,„4,37:7e.ithintittecbz ir, - Date .
6.is(are)the well(s): EiKrinanent or OTemporary - .-r-
7 of
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.8 i)stng thiefOrntIliereln!&rah that the.Will(s)WaS(WarS)Oonstriscte4in accordance with -- ?,•
7.Is this a repair to an existing well: OYes,'or ei , I54 NCAC 02C.0100,or ISANCAO'020.0200'Well COnsthia Elba StandisitiS coultlitit O copy ' -
If this is a repair,fill out brown well con on ird-ormatIon.Muteaplain the nature of the °Phil'recordluzg'beenProvidothe'rlhilvaer• , ,
repair ander 01 remarks section or on the back of this for*:
23:.Sitediagram-or additionetwell details: .
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8.For GeoprobeJDPT or Closed-Loop Geothermal'Wells haVing,the same You MAY'lige the back Of thitPais,to provide adilitionalWellcontinictiOninfo: '
also box)(ieltl'See OVeeiii RRemarksRemarks :Youpaay. attachadditicirialpitget if nedeit4z'
construction,only 1 GW..is needed. Indicate TOTAL N% 'UMBER&Walla
drilled:- ,. Y------------ --- 24..S AL UBMTINSIRUCIIONS: -, . . ,
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9.Total well depth below land surface: 2 O
/g3 ( ' - Submit this ON.V4..within 30 days of well emnplettonper the fallawmgr - ,
For mult4sle wells list all depths V clgjerent(example-3@ 'cazd.? Or-
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34a,-,For All Wells: Original font te Division ofWater Resources (MR); -, ,:
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10.Static water level below top of casing: :,.._ if(.5.6.: a, _ fft.Y,
--4 Information Processing-Unit,1.617'h;ISC'Raleigh,NC 27699 1617.
If water level is above casing,use"+" ,k
'24b.For IiiiectlialiWells!Copytn:15W11., nder'grotindliijention Ceara(IUC)-
11..Borehole diameter: '4 o3i"
(in)Bit Off,-: :. _ 3kb - - - - - - - ---' -'-' - ' '' 00.
,-. gram',1636.MSP;Raleigh,NC27,699.4636
12.Well construction method: „4i- 4.47071 __. .__ . . ..., .246.For Watataupply and OPeLionGeothermatRetaittWells:Copy to the
(ie auger,rotary,cable,'direct push,etc.) ,•
county environmental health department of the county*here its-tailed , ,-•et:,,,..,..„___'
FOR WATER SUPPLY"WELLS ONLY: ',-:-
24d4j3tWatet.Weirs'13rodbeing Otret,100,000 OPD:,Copy to'DWR,CCPCUA.
A '13a.Yield(gpm) 7-!--- Methodaf test: . _oir.__g i> _ ,_.:„,, '-Permit Progra 4.1611 MSC,,Italeiali„-,NC276994 611 ..'-i3e4.,.4,.....,5 ii.
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DateSiteVMted:2:7 z`l;7'24- , ..
13b.Disinfection type: . 70% hth
Ailiount: 1.'2:..r-°z ': 8iteVialteclay:, _13 i,3-Ki_..: ' . _ . ' ' .
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___Form..MV-1 North Catniiitallapartraent Of Eroiront algal Q(inlity‘ Dieisibir Of Water Reaburden - Revised 6-6-2018' •. ,- '
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