GW1--05941_Well Construction - GW1_20241009

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. .WELL CONSTRUCTION RECORD (GW-1 .
For Irmetal Use Only: . ,
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T.Well casospator Information: .
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Russell Taylor ...
i 14.WATIMZ0329 ,
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. WeS Conatoor Pismo • • - i EROM 1: TO I DESCRIPIION ,
•' ., 2187-A . . . . 1 Pf,5 II ii5o.
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NC Weil Coatactor Catirsonicutiomber 1 b15%II 650 It I ..',
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. isturyzat CASING rformalit.mselyells)egazaater '. . Hodder!Brothers Well Drilling,Inc . I most • ! TO I DIAMETER MOO=
' ' i f4 1 • C. 1 lit.
-. Compaq Max . • • I •
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' A a jan 0,a a . i Id.L17911LCASING ORTE1BINGfireethumaltiosoi•lool •
,Well Coll/latetiOls Permit* vv1-f'9‘,-Y-I , • I FROM (I TO • DIAMETER i TMCIONSI mum
an t:4*ovgeozersegoo parnitie At WC.CosowY.SO2I4 ivoriczre•eg=1 ' 0it.1 114 ft• 1ft '2'1 PVC
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I.Well Use(checking use): . - r -94,.'1,9.5 u. I to '12- 1 .188 STEEL
• Atter SOppti WO .'
. . . 17.SCREC(
• • ,.... ' 1 FROM t'TO. I ousrETER SLOTS= =MEG ati. RI Agtieultgal 1 LI MUnicipalatariic ' • fr' II I 'ft I to.
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1111 —- ---, atleasiniprozorms Simply) Mites!di:rattail Waft-Supply Csaave) 11 fr. p !• ft. I in. .
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ktdairtelalfCcommecial D.Resid=tati Wet=Supply(slustsi) '1 . ' '•
- I; IL FROM Erl• TO IsiATERzA.T. 1 Emitz.ActoinTatiNEOD A
Not-Water Supply Well: ,
., 11 0 ft. I zo ft emete.rarrea 1 osacord ,..:
lit bionitotios • itccoveiY :, ft. 1 • : a. i
•'mon Weil: i l•
, )11 • : Rcolsamo . .„: 0 Clitiociveatcr R.cmediador. 11 • f". I IT. 1 . •!
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1 IRSatMUM PACK tif artseeablel
-....- Storage sod Reeovorz Salioiry,Barricr 1, FROM •I To SLLTERIAL I ESOLUSAftqistie
NI -•:•,- Test '• " . i ,. OSIOnnwator Drab:lap ft.;1 m
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. • VII Expetitiscal Technolome OSIthsteme Control • •- i I ' '
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. eo =ams Clesstinolinliturn thor mco " •e u i W.I DR IE.T.D,eigja tfascach aDdEdSiCtiRoInP:T1I3O1N=gaUg iefr.=larme1l vaesnk"s dEpodeDImile
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. I Ghal( oed Lop) • ' • ,
. . GeohalCblsCooge ) nOt la = ReaddFmTr
. 0 '11145 ft-- "ilium: . - ''.•
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4.Date Wits)Completed:, 9/0 ja?aR 4. Well 1Dt• . .• ' i 85 *-1i4o ". g-te •
.52.Well Location:. ' • I r1-.11 ft- . r.... ,..._ • . ..
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• an afTiLk Itilr • ' k.-k..... k ...L ' - k •• !",•••• :
V ' fQ:; ft•
TesdlitylOsmseNsa .
Fealty 1l3t-:(ifappEteaBle) .. ; :.!.'r-
11.th5Olk2.- kai t
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. . 110 ( tr :j r 'S74 • .0 9 & 024 '
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,nve=1Add,..s.car.void=p :
;P I '. it. I ft 1:'.:7.V..
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PliielP C0(1...Yr4 66/4%9338 ; 2.Rsza4p.xs,
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Camay ?mac: da:remade: EM) :: .
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5b.Latitude sad losigitude irt degreesizoinutesisecoadv.or decimal degrees: ' .• - '''••
' ‘ Lifivr.li field.tam Wog is sea-foal -•
21 Certifiealion: '
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. •36° o5.614 • N 083° j3.676 w.
. . • Sits=of CmillaiWel Constar
Is(sr thll(sytikPertnanent or areasparary . ....,
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3.;sigang:I*foraz.I herritr err4:hat wars,/vas Oren)mattrasitt:f-a
1.is this 8 repair to an Massing' wa: Dyes or No 0 . • , . war:LTA Itr.h.0 03C.0100 or IS.4 ATC4C 02C.0200 Ira Coogrocriaglaristani
. Pei ir it apex;fillout ka von mil constraotion isrforinvion' atspica::he 4ciunr.opize roes 0.0); "ad hax be=Pi-award m riselnelamm
reprint:lap at rerztork r:mien arca the bock oftlesionn.
'7.3.Sire diagram Or additional well detaBst
. I.Far Gesprobe/DPT or Closed.LoOp Geothermal Welts haVinz the mom . Y°u 20Y a5;The.baCk Pf tbla Pag6 ca ral.s.T*
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eoastrueden r .t You may also attach eau:anal pages eneeessary:consensetion,only IIGW is-I needed..Indicate TOTAL NUMBER of was iro1s
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Millet
SDIRenTTAI;MISTRUCTIONS •••- -
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' , F9t=otRalo mte;iwl&ar M&ba blle dleorwal alo raedc tsreurrrfnat ctietr:a ndp,?©ma @fo,
ol • ' Citl'•.2..4.a yor'All Welts; Submit;kis fewat within 30 days of eoami0
cgzscr.ccon to,cht f011OwitiF . !.,
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10.Static water level below top 9f=shag: .45 • (It) • iyision of Water Resourc es,Information Processing TAU
Yinger lord ir eon.easos&DLIT"4-.. 1: 1 1617.Mall Service Center,Raleigh,NC 2769-1617L-
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11,Somme alasserer: .t„.0 Om; .
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IQ:.For inieccion Wenn. In addilitto so sending the itato to dm ad:
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• .—1 above,also subraft one copy of this far=wish%30 days of totiOplit.Welt auastruccloti rambost: .lwijr • J\114-4-k....1-4A1. consmedere M the followins .
OA mice:Mom:able.Qat posts.eta) ', '. ...- .....
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- Division'of WomrResources,Undergrouta Injection Cootrel P
sva WATER SUPPLY WELLS ONLY: ' 1636 Man Service Center,Raleigh.91C Z709-2636_
616,43 • i -
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13a.Yield Wm) 4 Method af tesm - i 24-;.Far svarer suopiv 4'refection cvtp= la adtPaion to00 tenfezt.
- : me aor...-gs(es) above. :Ise cobra; one copy of this Sam vain
13b,Oftri'f"rims Gl7= Irk I H . compledOts of well coasru. aloe to me=may head*depostertent.oi
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Faso OW..i . . Norm Cmo",tes Deomar.mr.af.317.-noammiai Q:-:..1::,.-Di;visior:of Va cc:R.m,c was . • 1).V.i:
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