GW1--06016_Well Construction - GW1_20241011

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WELL CONSTRUCTION RECORD Per Interred UseON,LY:
Thi farm can be used for single tit tnultipk wells
1.Well Contractor Information:
• • "1l:W TER ZONES .- . . ;
' Rich.Lemire -. FROM. ' .T0 ' fFSCRIPr1ONi •
WWI Contractor Nang ft, R, .
•
f4 ff. . } ' •
2593A • •_`t5
' NC2593 1CaNmcttirCcniftcatiariNiiriircr • ".0UTERCASING'tforentd1 cised'AictIOOR•LINERRUM) Heat*);
FROM TO DIAMETER', THICKNESS- .� MATENTAL- •
SAEDACCO ft., ft.
' ' C0ngty ouNance . T6.INNER CASING OR.TUBING(geotbcrmal'eMsed-Ionp)' '
. •PRO\r •• TO ' DL%METCR THICKNESS ?JATERUAL.
f. 25:8. ft, 4" i at. SCH-40 PVC
2.Weil Construction I'el�ipit#: 0 •
Usr all appilicnbfe ttrl!pcm'ls(is.County,State :Vorioace.TrarEctia eJr)' -11,.
3.Well,lisa(cheel,well use): Cl SCRLEN
«'atcrSupplyWi4l: - - .. FROM. TO . .'Pt. MEUR St,OYt•SIM TnICICNKtS I MATF.RrAI,
• 25.8ft. 27.8'it; 4" ' -II.- 030 ' ' SCH40 I PVC
DAgucultntal . . . inhful;ictpaliPttb)ic_ . .
°Geothermal ealin 'Coolioft, IL in,
(R g, g 5trpply} l7Residential'�Yater Supply(siuille) '
•
Cilndusti(aUConuttercial °Residential Water Supply(shams) ' F1toGR®UT TO ar�T2Rut .• EMPLACEMENT METHOD AStouNr"
' °frtipation 0 iI, 23.2 it. PORTLAND TREMIE
lion-Water Suppl.Y Well: .
phtonftouing, . ElRecarct)_ •
Injection Welk, h, tt
°Aquifer Recharge . • G1Groundaatcr Rcmediation r9:S,NDIGRAVELLrPACKOf niiidicabtel-. - .- -
'FROM'- - TO' • ,1fAT1PRIAI .IsSIPI ACI:\IENT\IF7wwo
pAgni(crStortgc and itccovcl)' •°Salinityfirii¢r 25.2 ft.. 27.8 ft.. SAND „ #4
ElAgnfcrTest 'OStormnatcrDiaitia -ft. (t..
oEkperimental Tcolinotogv °Subsidence Control
120t DRILLING'G'LOG'(allach addilIonia!-hoots If necessary)
riGeolltennal(Closed Loop) . °Tracer, : . FROM-• TO DESCRIPTION(color.Imnlnceectoil'r+aek13tx'min!am4ee.I
°Geotitennal(IIeatingWCaoting Return) ElOtiter(e plain under#21 Retnaiks) 0 .:ft.,; .27.8- ft. PWR '
IL ff.-
4I.Date SVell(s)Coirtplcled:.9-17-2024 Well oft 1W-02 • ft. ft. o s,i--�C..,r 1.... y jf. . ,;
•
Sm Well Location:- :fl- ft.- OCT- 1 - (D%4
ECI it. . it, ' . '
Fac0it},QisttcrNanm Facility lDk(iCapplicablc) f.` ft, it k;',:;•,...... P,..c.•.w"t•:`:.-1? '.`7:r,
1239.Rock Creek Dairy Road, WHITSETT, NC, 27377 . rt. . rt ! `r:""'
i . -
. Plijiicul'AddressCity.aiuI2tp• a21.R.E.A4ARK.4 ' .
GUILFORD BENTONITE FROM 23.2 TO 25.2'
•
CoolyParcel tdenlificallan No,(PIN) .
•
•
Sb.Latityde arid Longitude in degrceslmintiteikecnnds or decimal degrees 22. •Ccrtificrtl•rn: . . . .
•
(.ureic field;en:•ltvlong is sttlllcictat)
36.053569 N' -.79598642 NV v- -.?1rh 9/21/2024
• SigmluzearCcn -:4cll i Contmeto ' ; 7- • .Dale
. 6.Is(are)the wells}:.$IPennanent of °Temporary 'signing that funtr 1 lrerebp rergry dud the hell{x)arts(earn.)c carrot ted trt accordance
. - ii'ith 15A NCAC 02C:0100 or IStt NCAC(12C.0200 Weil Coarstraide r Sratadards and Ma:a
7.Ls this a repair to as evicting well: OYew or 111thi 'fepy'of Mir reford hos been Provided to iha rrrll rnvner.
ifOfs•is a iepalr,fall our kraoiair;t-dl caosuarctloo.br[oroxrrlmr and explain rho tytrure of the
repair anderit21 rrnuerktart wn or on the bark of this form. 23.Site diagtram or additional well details: •
You may,use the back of this page to provide additional well site,details or well '
8.Number of wells constrticred: 1 t:oustmetiot%detaits: You may also aitacllaidriilional pages if necessary.
For arraaUlple lrJectlon or atui-rarer supply wells ONLY trlrh the some censtract'imr,you on
sahrmit Dare farm. ' SUBMITTAL iNSTUCTIONS.
9.Total well depth below land surface: 27.8 .. - (f},) -24u. Far-All Wells:. Submit this'faun within 30 days of completion of well
Far multiple wells list al1 depths ifdiOrrent(example-3e20fa"aru12e 10l) construction to the following: I
10:Stacie water level below top-of casing:-25 ((1y) Diyisiun of Water Rosaurceat,Information Plaieasing Unit, •
if w ater lee el is alcove costa::use"+" - 1617 Riail Scrt•ice Ccntcr,,ltaleigly NC 27699-1617 .
11,ilorchofrdiantetcr.10.,625" (ice) 24b.For Infection Wells ONLY: Lin addition to sending the form to the address in
.24eabove.also submit a copy of this faint within 30 days of completion of well
U.Well cotistitictiou Method:AUGER constmctiau to the following:
(ix:auger.rotary.'duple.direct posit eta:} • I .' -
Division of Water Rcsaurces,iUtuderground Injection.Control Program;
FOR WATER SUPPLY WELLS ONLY:' .1636 Mall Service Center.Raleigh;NC 27609-1636
13aa Yield(ant) Method of test:
14e.For-Water Supply&Injection'Wells:
Also submit one copy of this faith Within 30'day'sofcompletion.of
13b.Disinfection type: • • Amount: well construction to the county hcallh department of the.county.wlrere
constructed.
Fonti GW-t North Carolina Department of EmitaruugN and Nauarsl Resources-Division of Water ftra etc Revised August HOS