GW1-2021-03220_Well Construction - GW1_20210624

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dJG Well Coi?t ice t ertif�cat+on Number IS.OUTt!ft CASING for multliasd*00.10 OR LINER fif a krlrle
Barefoors W611 Drilling&Nino Service:,LLC "UM TO I plAl sup THICKNESS MATT IA1.
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2.Vi'c11 Comitruction Perfnit NPh TO M f 0d 9 1r6R NNFR CASING t7R TU nrNMETYA�r I THICKNESS I MATERIAL;
I,isi ON appplimble Nr11 ca.atntafon permits#.e VIa Cawt)s Stan Yarfa+tet ek) O
3.Well Use(chetk well rite):
W!w Supply Well: MSCREEd
20M To I ®IAM R I 640T6I7y: 'THICKNUfS 1.44AMIAL
Agricultoral 13Municipal/Public10
tt. in
Geothermal(Heating1cooling Supply) Rtsidaifia)Water Supply(single) 0 R In
fndustrial:rAxmmcrcial 131kcsidential Water Supply(sh") `VGROUt
Irri a4ron i'RO?t "to MATERIAL EmnAcrm"mMETNOD6 sIOUAT
ikon-Water Supply Well: � 0 I L
Aloniioring Recovery
Injection WellE
Aquifer Recharge 0 droundwater Remed laiion
CK fa lleable '
Aquifer Storage rf95ANDIGR and Recovery Salinity Barrier MINI AYELTA.To I MATFRIAr: aM»Ae�r�r+r�t+un
AquifcrTest E$tortnwaterbraindgt iI. a f� tt. i
iixpctimcntal Technology E)Subsiderm-Control tt, ft.
Geo hernial(Closed Loop] ['Tracer 10.DRILUNG LOG Ottrsrb addl8oeal ab"Irm tkno .
FROM To nFSC�II ITION ache bsrda wiYrM"r c to else see t
Geothermal(HeatioglCoolin Return). f Other(e lain under`821 Remarks)
4.bate wells)Completed: well IbN
Sa."Well Lotatio : •R. rt, a oL
Facility/Owncr•Phme facility ION(ifs,pplicabk) RE Ell
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Physical dd. City.aril Zip "T h ft.
21:^RERlAR1CS-",
County Tercel ldcmrrtcation Na.(PIN)
In l)t111
Sb:Latitude and longitude In degreW"nutes/seconds or decimal degrees: ! 0 " VVR spcil,011
(ifunellfel .aft lationgissuffickw) 22,c0tifiration;
1Y01
d
,6.Is(ort)Ibe wells) Permanent. or O7emporar} S' ofOcitificd 1Ve11 ttratror
By igtiins this fwrn,] rbr test fi•Ihot.rhe�arl!(s)cone(covets)opnstn+ctnd In aocordoner
7.Is this a repair to an txlsting well: QYea or U3No Kith/Set NCACW.0100 or ISA NCAiCA?C.071V Well Construction Standards and Aaro
I/Ass is a rcirwir,fil/oru linage WINconsrrartion information and explain the nature of ibe +�pl'a�lhis rYt p►d Iats bernpro>#derltoeite r<elloH�ei.
rrpoirunder.'21 nwaiki section err on the Batt of ibis form, 23•Site dlo#am or additional well details:
8.For Gcoprobe/DPT or Closed-Loop Geothermal Wells having the some You may use the back of this page to provide ndditional will site details Or wellconstruction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also ztlech additional pages if necessary.
drilled, SUBMITTAL INST tUCTIONS
9.Total well depth below landsurtaee: r�(-�" IR.) 24a,For All Wells: Submit this form within 30 dejrs of comptelion of'weil
nor Multiple NWfs 14t all depths ifd errnt(example-$@200'and 2QI0Vj
cobstruction lathe foNoµ9ng:
10.-Staiie water level below top otcasing:� (ft,) Division of Water Reso rees,Informailon Processing Unit,
If%wer noel is obow casiaa use" 1617 Atoll Service Center,Raleigh,INC 27699-1617
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11.Borehole diameter: (in) 24b.For Injection Wells: In addition to striding the farm to the address in 24a
12.Well construction method: ydli r( above,also submit alit Copy of this form within 30 days of completion of well
(it.mu*,ruler),cable,dircei pus4etc.) construct ion to the following:
Division of Water Resou",6ndergr6und Injeedon Control Program.
FQR 1Vr1'!BR SUPPLY WELLS O\'LY; 16361Nall Service Center,Rnlclgb,NC 27699.1636
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13a.Yield i(gpm} V Method of test4-i lilt 24c�adodress(es) above,valisolsubmirt brieee : In addition to•sending the form to
6py of this form within 30 days of
13b.pisinlection type: (a:yl Amount: ��� completion of well construction tb the county hw1th department of the.county
_ - 1,where constructed,