GW1-2021-07056_Well Construction - GW1_20211129

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R'A'1'F'R ZONESM� FRUN TO DF.SCRIPTION,
well Contractor Na::r b ft.
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FROM TU DIAMETERi Tt1IC1{NESS %IATERIAL
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Companc Name 16.INNER CASING OR TUBING(geothermal closed-tooit
�•i1•„� �'�Q'1 FR011 TO DI.AML-rElt TH[Ct:\ESS MATERIAL
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SOppl)'N�PSI: FRO>1 TO DIAMETER OT SIZF. THICKNESS
MATERIAL
u!turai ®Min pal/t'uhlic i ft. ft. ? in.
erma!11 t: ;a:_Cooling Sup pl)') sldenlial Water Supple[single) � r;. fz i" C i
tnal/CoI:'..:ar.•••• nResldenual Water Supph %shared% 18.GROt-T
FROM I TO MATERIAL' ' EMPLACEMEVTp1ETHOD&A?t01:!VT
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ter SturaL:.,:.., xcoven:cries[ QStoml\%aterDramagertmenta: Subsidenl a
Controlp �Traxr20.DRILLING L OG(attachadditionalsheetsifnecessaiwim.al l: i.•J ) : FROM TO DFSCRIPTtO\(color,hardnesr,sothermal I i cull^e Rc' �; �Uthertc�pluln under#21 Remarks) $ R. :C10.
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4.Date Well(s)(omoteted: 11-12.21 N'1-ell ID# �f 1 �C� ft.
5a.Well Locati. .,
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Facility Ouner N:: Pacili;y IDc nfapphcablel
o Ts;ah � Gb�ulrb>J.s,n�� $ as ft. ; �_ ,
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i�CA k NOV
Count, Parcel Identi licauon No.(PIN:
Sb.Latitude an a. tide in degr ces%minutes/seconds or decimal degrees: i3 I )i
tit\vell field.one , _, .:ultictrnt; 22.Certiticution: ` r r
35° 11\ •L it 81°591 t 44- 311�1� ° _��' �� I1' 12- 21
tna:urc.,s('enttied Well Comr aor Date
b.Is(are)the sty:.t,,j ertnaner., or 01emporat'}
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11thir,.r;epurr, uu;0,,„rv,urlrun:nlurnrmurrun;l.:r/J,rurrNcrnunr.•ujrh:
repair under ]I ...'r,re or urr rir:•h,,;k of du.,lurut 23.Site diagram or additional well details:
You Ina\ .Ise the nack of this page to proade additional tce!I site detaiis or well
S.For Geoprobe DP for Closed-Loop Geothermal Wells having the same construe'._I'•details. You may also attach additional pages if necessary.
construction.or t s needed indicate TOTAI.N. CMBER of%vells
drilled: tin'BSII,I"I AL INSTRUCTIONS
9.Total well det,ut^.:tan land sun lace: 3 0 5 (ft.l 24a, For .ill Wells: Sub"14 this Porn: within 3O days of completion of well
Formt,Url,l.•vell,; ?•br,:;Jr;r,'r,,,: r,nu/,/,•_t.li:_b0 ,urd_'u'!IdPI :bI1SVUl'I�..•Il:J tbC llllltn�'inL: .
10.Static water: below top of,asing: � (ft.) lltvision of Water Resources.information Processing Unit,
lft+tn:rr:,•1 r..,r. 1617 Wail Seri,ice Center,Raleigh,\C 27699-Ib17
1l.Borehole di:.:nrtrr:621- (in.1 2db. Fnr:niectinn \'ells: inuadiuon to sending the form to the address in 24a
ton above.a;:,,s.Ihnnt one cup. ni till's l nrnin 3U days of completion of well
12.Well constr.
rlrtnoG cnnstntc::,.:1 to follo tir: temg:
I i.e.auger,rotaq... .. _.:::pa<h.
Divisn,it of Water Resources,l hderground Injection Control Program,
FOR\N ATER",,`:'t.. WFLLS ON I A` 1636 Mail Service i(i'enter.Raleigh,`C 27699-I636
1• i i 24c. For V1 ater Sunni,B: lniec`tion��'ells: In addiaon to sending the form to
Method of test:
13a.field(gpn', _i_�_ 1 the addr,::;,Ls) above. also sU011111 one ion.% ill'this forill within 30 days of
CInAOY rQ__ Amount �IO�bS ..tmptet:,nt of wet) construction 'to the counp health deparlment of the county
13b.Disinfectio. -- %,here co,[::ruoted.
1
' Sep ised,"•2016
F,n'.UA- \,nh Cvo!:n:Deptcr.,cn:o` n+:nvurant-:+:, I:;.- :r.:<&,t:.,i A ntrr Rc :r,e.