GW1-2021-01476_Well Construction - GW1_20210429

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WELL CONSTRUCTION RECORD{lG'W il.. -Far Intamol Use nly:
I:VY 11Cmntraelor IArormatlon: vS®
A- 2 4.W ZONES
9 xn to
Well
lCatdaga Name n U p 2 P. A.
Sglng (ftL_ IL
Nc writ Cemraporcetffm1fon manner ` �" ,3,tpron Froce S ovrBR
t I
Company Name t '`'lQ� 6.tNNSR CASING T1lHING eftq:rat
2.Well Constr action permit r� 1 Q 0 `7" '— t M Te nt""IKFAAC
Usr dot my liaaAla'vddf mnrr»rm/on panniers(Lit Utr,CPMIY,57ak Yarramx,00 H-
I lYtll the(then:&two ustt)_
n•. 4. iu.
water Sapp(yWen. u• m s rtlt MIAL
Agricultural [:)Municipel/Public IR. f1. +�
Gwmcr m]weatitig/Coming supph_� �Residentiat Water Supply(single) Q it. in.
[ndusiriallC.ommercatl r3fteswerwalWater.Supply(shwted) 1�CRt}Ifl
Irrl (Rion t<aoM ra MJt L trMn7a tt &Mum
twon-wattr supply V1dl:
b4orritoitng Recovery tr. fa
injection .
ff. R
Aquifer Rerharlyc DGrwindwatcr Rcracdiation I9 S Nfl/GitAVBL PAC H !e
Aquifer Storug�tvtd ltosovcty E]snlittity Barrier str v ioo
Aquifer Test C)SturmweterDrainaw °- „'
iaperirneittal Tecimnlogy [5ubal trace Comml (L a•
Creothermal(Closed Loop) DTcacrt !.t)G tdtadt
eothermal Hcetia Rearm) iher( is under#21 Rcmwks)
tt p tt. �
G r
4.Hatt Wetl(a)Completed:I a-a b-a� Weil iAfl � R• 14 t
�,.Well Location-
n_ esPA YiU
Inv. UL_
Fxil(t/-0wI rr Hume . Faeilrly IM(ifaltplicalk)
�°f �rlGtti Sn ( . 1�C
Cautuy Pmcel idemificatimt No.(PIN)
.rib.i,gtitttde And lanpjtnee in degree lmimrtedsetonds or decimal degrees:
W%vol)fidd.o i 0mgisxufrrclad) o e cation:
- 8tn a m �1 r a -9 a CND
d.ls(xm)the well'i-430 ta119ru or DTearporary a efOentfiat Well Canttaater Me
l v alpettag rhf8.iarro,I herrhv tw1ify sitar the nrWx)mac Afam GOIrd7/adlrl As orrohdp!rcr
i_is this a repair tb an existing tvdl Yes or o with I.SA NCAC a2C_B100 or
13A,YCAC.(IIC.IIX/0 WrIi Cnnslrnrxinn 59andaraG ant chat�r
if&ITitn-wrr.•Jll/curt"w"tivall.waamufiw thr..owu,gftha utpydfdttsrrxnalhathPt'd(11IDl�EAIpl/k'we(/nwltrr.
n:xatrrmde►h2f M=ifa sailer won tIr bar.Ynfthfsfdmt.
2.3.Site diagtnua or addltlennt well dMtils:
S.For Geoprobe/IWT or Closed-lAnp Geothermal Welis having thcsaene I,ou may use tits lack of this page to provide additional well site dgmils or well
unnatruction,00R I C,W 1 in rmcded. Indiam TOTAL NUMBER araclls cOri MwAinn drtaiis. YaLl m4y also attach additional pops iftsaxsuiry.
drilled-___. _. §1 MAL RMUMM
s.Total wall depth 04low land aurlt►ca:, 3 HE VP 1f. for Ail VII_Rits: Submit this fluor within 30 days of complaion of weii
I nr rAulNplc mrlJ.�l�st alld.!j tlu fdJ�anenr(attmpk-3 r�i T00'and stela lQ�1 con9li=iOn 10 the W(Wft:
Ill.Static wetter ltvrl below tap of using: (tt:) Dividon of water Raettrms,Information Prveming Unit,
/rxrotar hm:f ft t*w rWng.we i4;17 Mal Setrotee Center,Rsteigb.NC2709-1617
1
ii.Roreholtdiamt eel; �(ie.) 2+ttt.Far exiec sin]Wls: in additio0 to sending the Ebro to die uddrom in 249
above,also submit one copy of this form wilhin 30 days of cotnpladw of well
12.Well a nttreetlam metbad: T'-"^ I omshncdon to the following:
(i c•-ITS.noun.mble.hilt%push,etc,) I
Division ofWater Reath rm%Underground Injection Coalral Program,
MR WATER St.M V WEi,LS ONLY: Ib36 moo seroiec Ces ier,Rateigh,NC"094636
13st.Yield Igpm) 15 Method of IC4k ?:tG Iron Wuer 3oaQtt &faiee8on iNd InaddiflonlawadftflKlitnitto
the sddless(cs) above, also submit one copy of this form within 30 days of
13b.01sinfectim type: .Amount Gtaplction of%vdi constsuc on to the county health deparmott of the county
whare comnucteA
I'ornt C1t+-I Wrth CAar*m Drpnmmont of einvIrdnmLMml Quality-tAvrsmn of Werner ROVOure s Reviwi!2 22 2af b