GW1-2022-06482_Well Construction - GW1_20220706

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LPrint Form
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Onlv�—•
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1.Well Contractor Information:
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11'ell Cunhachn Name
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NC Well Conuacun'Celli fication Nuuthel
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15.OIITF EA-SINCLjIi)r multi-cased wells)OR LINER if�licahlel
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racsn.. -ti
ft.Company Mums m. nt;rient,Ci.
16.INNER CASING OR TUBING
UBINU eothermal closed-bur r —
2.Well ConstructionPermit#. Y.. + a.� vLt Fltr)nl 70 IrlAni r'rF It rllf('K Yr Cr MA h:ItLU.
l re till appbrahle r,cdl comb m Ilan prrurils 6" WC,('ouun..S(a!r I;,r7nur fl• fl. In.
..Well Use(check well use): ft. I'r. in. •
W'afcr Supply 4Ve11: 17.SCREP;V�- '----- - —. -_
rnunt 1�(i- -_ u%laih'rtat t_o�'sli_ �ritici: hs; �rnrefi%i�;AIp'iculutl'nl 0 Milli icil,aUptillIic ft. -- -
Geothermal(Ileatjng%(:'ooJjng Supply) Dltesidential
-- fr• I't. in.
htdusu'ialiC'anuttercial OResidential Weser Supply(share(f)
18.GROUT
Irrit;auO° rrtuw ru vinIi•.iit:\t. - t:.n`rrinctau•�^rjnntrnoncnMi�i i
Nun-61%atcr Supply W'cIL ft, ft.
- Q KcCove'ry ff. tt:
Injection M'ell:
Ae oil r Bechar r ft. fr.
R Ciroeuul\valzr Rctomiation
-ry lAe uifer Stena" In(Icuvcn 19 SAND/G_I_7AVE.1--P-AK(If a) liCahle)©ISalinit Barrier
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rHUN fU \L\I'fHt\I. I•:M I'L:\(.'1•:n1 P:Y"1'kl li l'HOU
Ayuifer'fes( DSt wolwaler'1.)rainaue ft. fr.
C':.eperimeu(al I'ee'hnt)Iugy1SuhsidenceControl
.Geothermal(Closed Loop) ------- -------- ---13I Tracer 20.1)RII�I,I:VC LOG r attnc)add_itinoal sheets oifr, mm .. _r_e_._n. .(eothermnllFlentin ratn rt) ,coQter(exilajuunder1121Remarks) t._.
,�-..'_2 — l—J--- --__-- �'GY.�uc. 71_C��fI�L•1�rG:v,\_.�e:�'Fa�fF
4.Dale Wens)cmnpleted: ' L 2 well m#. � / w o�
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:+a.Well Location: E--••4' n. ) U ft. ��� '.
c�'rsMP✓ t.Jca. ¢'v' l i`-' ft. I't. 'el
MY
facility/p\vnc`"N:uue' Iacr6ly IWI inapplicably) fi. ft.
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- - ft.-- -- —-- _...—_._.—.......sical Ad .-, hv.and 7q, Ivr
('euutry 14ircil Idrnliiieati.,n\o.II'INI t`. +( -W• �- G`d"e Ai�G' d..0�• t�.•'�\+
Sb.Latitude And Inn rifulde in degrees/minutes/seconds tor(Jerimal de,lees:
tf
Uf.\ell licld.,rn:tat/hyne r,4uffictcnt) ,.q_7tb'e-,4°�'l 22.C'crfificatinn:
6.Wave)(he well(goPermanent or C'I'empnr•ar•y S10-latutt of Crnifiv(I Well Conuartor Dale —
1{t'ci,t'uru,;IGcv jurn,. l hr•rt•hr rrrlili'rltrrr r6r urllial uo.c Itvvrry rnactrrrrrrd b,ur,.rrdu<trr .
7.Is this it repair to an existing well: oyes or MNo Will,/5;1:1Y',li'07C.olrm or 15,1 N(JC 02 .rr duo Well<'.,r,, nr lir.,r.erarr,l,urt,,r„d d,.;:
/1 dra,c. I repau.1i/1 ear!'rm.rn,n 1l nrn.rlrtn:'rinn in/nrnuuiau anr/rrp!ain dlr nann'r of fhe rape of-lhtc rPCru'(//leis A-ell prm ided In der nrl/inner.
rrpui•'alder 421+rrrrar/.,'larding nv lit lh,•hoc1 o/7hu form.
23.Site diagram or additional well details:
8.I•ot GcoprolneMPT or Closed-Loop Geothermal Wells holm the's:nm You mad use;the back of this page In provide additju <I '
construciion.()Illy I G1V I Is needed. Indicme TOl-AI NUM131'.It Ill wells Constr'nction details. You utav also atiarh additional 1);c.
drilled:
- uI.BMITTALINSTRU(TION's JUL Q �3 zQ22
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9.7btal well depth below land stir f Ice _ y�
�f (ft.) 24a. For All Wells: Submit this 1111n within 30 days of con)plclion of\vc l
�a�unnpL•„•r l/ L.r�,(/J./Nr. x h/b r,ra/c orary�h� jar?tt!/ w('ai/OU'1 !
construction to IBC 161lowin ' I E{}�jyj (•(}jm��`(E2t3ir�Urlj4
10-Static water level bt Inw top of casing:. it.) t� ��•��{/°
If loner lerrl re,lAu rc•rrau,,r�.,a. .
( Division of Water Resources,Information Proces.W.LV pqG
1617 Mail Service Center.Raleigh,NC 27699-1617
IL Borehole diainetcr: Ull.) 241). For Injection Wells: In addition io sending the form to the address in 2•'At
12.Well construction method:_
JO A/ above, also submit line copy oi'lhis horm %vithm 30 days of complefjon of well
n.a,uugor.rotary.r:d,lc,dirccl push,ete.l - '—"—•._-- (:on.tiIRIC ion to the lullu\\'jnc:
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636;Mail Service('miter,Raleigh,NC 27699-1636
1.3a.Yield(gPr)r1 _ Vlollod of test:. 24c. For Wrlter.Sti) iv& Iniccl.ion �4'clls: In addilion w sending the limn i,,
the addresste:s) above, also subn)it imc copy of this form \011in 30 days of
136.Disinfection tv c:-_�p Amount: cnnlplotion of well ccatatructitm lu IIr cntull�,hcallh dep:u1n)cnt of the count.
where constructed.
Nwill t nI I n,unun:rutu;t?I;;�hl,-L)n I_..rot o1%\;Ilcr R.r.,,tu�;. Ii Hr•.I,rd_',"-.'..%!r
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