WI0100604_Geothermal Well Construction Record (GW1)_20201229

))I c+
Print Fom
R'EL L C()YS fR[ t " ] CO" G%V-1 `�
L I /
1. Weit Cani tacmr fororma nia ' , FEB Z Z Zp21
Clint J Babbitt
Sidi Coa.1h r]amc
NC-3556-A Water Quality Regional Operations
NC'Wcll ('en,cWorr:=nifiurtiuv .,,,.,,,.,Asheville Regional Office
AAA Sweetwater Well & Pump, tnc.
C'nnrryny Nana
2. Well fDusirnction Prrmit 4l: V V' 01 W tY D4
List all nppLcahfe nadl ronuru, lion permits (i.e. UIL'. ( o.i, San, Parionce, ..
3. Well Use (check well use):
E)Municipal/Pubiic
(Neating!Crmliog Supply) OResidential Water Supply(singlc)
3mmercial OResidential Water Supply (shared)
Recharge
OGmundwater Remediadon
Storage and Recovery
DSalinnyBamer
rest
OStomtwater Drainage
ental Technology
OSubsidence Control
nal (Closed Loop)
❑Tracer
4. Date Well(s) Completed: JQ L.-II Lt/ well RM
S Will,eocation:
Fnn"s�wn♦JL.
aScility OwnerYamc /F�Fpacility TIM(if appliccabblle)
DL
Physical Nchanx. City, nd p
AtAAAELf, 0.0Z, 9'?r21Z3�3����7rxaf
C'numy P.M identification No. (PIN)
Ns. Latitude and longitude in degrees/mjnates•'sEcands ordecisual degrees:
I ifwell field. one Iatlong is officison
6, Is(are) the svell(s)'ermanenl or ®Tempura-
7. is this a repair to an existing well: ®Yes or [R o
II thl, 1, a rrpoir,, lilt out known u'dl mruoarfiaa info, ciwinn and esplairr the mauve of the
npairam+4r -21 nano,, sofa- Oran ke hark of
S. For Geaprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: � (�/
9. Total well depth below land surface: �! -0 (ft.)
fi. mah ple awl/ hm oil dep1A, iif hj)e,cw /erample-J n 1110'am11
10. Static water level below top of rasing:
IJ :curer local is alwve <nsing. the"' t�� (J,,.
It. Borehole diawwter: 6
12. W.R omstrucilon method: Drilled -
(i c. Hoge,, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Me o tesC Timed
13b. IHsittfecdon h'pet CCH t:
IB. OPTER CASINGrosrmulti-[asedxelis ORLINERfar4anumbdil-
I FROM TO DIAMETER TRICR.NMs M.eTER
16. INNER CASING OR TCRIN [hermaidwed4
Milo TA AIAMF.TER MA'IFRI:Ii.
R(t. � In,A. Tf1OEtMET1A SLOTSIZE THICKNTSS MAT[RLSi,
R. in.
ft In.
i Bentonite �IuDg2eW # 2
rt.
rt. rt.I i —I
R,
Grouted On:
22. CerOR if
¢ r a OVW
,groa. cofC/fiificaWeRC.Vlracto, pate
Br signing Ihis f rn,, I h¢..In rerffr that the yelllrl a., (o,,,e) ron,irurrrd in uraor'danae
xith 154 :VC.4C 02C.0100 or I5.4 VC4C #2C.0Z6V flail Consmm,ion Sai,idar,( and Ihra a
r pr ol'/his mrnrd lms Aeen pnnided to sh¢ xrf! owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SURMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
C slrutlion to the foltowing:
us, Divlslon of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
lib. For Injection Wells: In addition to sending the torso to [be address in 24a
above, also submit one copy of this farm within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the fomt to
the address(es) above, also submit one copy of this farm within 30 days of
completion of well construction to the county health department of die county
where constructed.
1 rum Gw-1 North Carolina Uepanmcat ofEnviro,nwnml (Duality - Division of Water Resources Rnhcd 2-22-2016