GW1-2022-07188_Well Construction - GW1_20220729

828-622-7241 ' p,1
Feb 161905:43p C1i38rwaterWel1Drilling
WEU CONSTRUCTION g>u�co (GW-)L) or lnlcrnni Use Only:
weltCnntraetorl information.. �• _
i Q' fI`p�,i .�•�{(� - ^. -•PAN •r�ES DBSCRItTION
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'Yell Vonlraclot Warne— ----"'"""`--^'
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11�-�ii1l/'1,1O1TrF.R CASING Par matli•eaiw weth OR It If il e
0 ell Cnnnaaor i f Cenlil ati Numler 1 D1AM1 ttrR n)I[atIY88S ATGtuL
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C.ompnnv Name 1•y�� l��J--��a -16,tNNER C ING Olt TI im dwepat sliced t NA EFJUAL
TO DUIHETEA s TAICKMS5
In.
2.well Construction Permit#: lt• ft.
-
ow aD opplicnh6r writ Cnnrmrcrldn pmmir.t(f.e.tile,.C.naary,Stale,Variance,eft..) in.
3.WON ifse(check well use)_ "17.$CRBRN
•�� TO n A1148T1R Sr4T B 7'ntClrtlfr8a MATB.hfAL
Water Supply WO: fr. ft, m
Agricultural �MtmicipollFtthiic ()
Geothermal(Heating/Cooling Supply) midential Water Supply(single) ft.
lndusttial/Commercutl Residential Water Supply(Shared) ti G OUT &AMOU
tt TOMKI•EIttAL tiMrLAC6M YC:N ODNT
Irricntlon - ft. ` &
VortWater Supply W e:ll- fc
Recovery p.
R4rntitoring .---.--- -
injection Well. ff. R
AquiferRcebat c OGroundwatcrRcrnediatitin -19 gaty RAVRILPACK fo 1 tde ®VrrLIC MSNZMCTnan
Calinity Barrier FROM T MA AL �---------
.Aquifer Storage and RerMn' [) - ft.
Aquifer Tc�t �Stnrunwetcr Drainage
TO ta
Experimental Teehnohlgy �Suhsidencc Control
A. ft.
l..f -Tit.
Geothermal(Closed Loop) DRli.L1NG LtIG dtach ■1 kt rslrro6e etc,
Tracer pttllM Ma lur/a wM/roe ,/ -�---1--;
lot
Cienthcnnal IHcatin Doling Ren,m) Other eX l lin under k21 Rcmarks) ir• tt
I,Date Wetl(s)Connpletedi Z-�2q -a weit iou t.
ft
SW Well).nratlon:
I"neilih:' naretMame atility[DO H01)le
���111111���smnl Addres,,City, Zk N
' /I 1 A`_ �i� � 2t.REMARKS t/y\t1mty �R-rU-1J pnreet identification No.(PIN) ` fyAyjCi1
51).Latitude and longitude.in degreesfminates/seconds or decimal degrees:
(ii well freed one latflnng in Rufricient) i z2.Ce CAflnn:
i D W
V
6.ls(arc)the wells) Permanent or DTcmpnrary
Siennl re of erlifitxa We11 Ctmtraetor DMe
FmIng,r/ns'fi)M.I Aerrhv CTM)5r[Aar 1hr lwdl(.)war f rm)rmrona..•1ed in ocshrdanCt,
7.is this it rrpair to an existing well: r3vas or No t,;r 13A tit. ..'nT.C.I110U nr I3A NC iIC 111t'.o10D Wrf!C.urvsrrnrrirrrr Slalydarr�r mid rhm a
lyd is is.)repair.fill oorrknnwn it-ill em.V11aclinrr i>ifonnalinrr arrt Uptnin the immure.orthc enplr nflhle rrcnrrl hoc been pMtddead In rhr wrr!nwrecr.
mWir under t,21 remrarkc,t'actlan gran tic hnrk ofihf.0am, 2,3_Site diagram or additional well detaits:
ll Site details or well
A.Cttr GeoproheMPT or Closed-heap Geothermal Wells having the same )'Oil May use:llic tutclt of the page to provide additional we
txnsmtctinn,only I GW1 is needed. indicate TOTAL NUMBER❑f wrtls
camtrtiction details, You may alst attach additional pages if flOceMaty.
9,Tatal well depth tmiaw land surface: (p! 21a. Iron Aq Wells: Submit this form within 30 days of completion of well
f%nr ntnhiplc wrN.c fis�nli d tpl7cv ifAiJfarrnt(cramnh-9(nT7p(!•m+d a 100� CongMlelinn 10 the f011Ming:
l0.Stotic water level below top of east rig:r _(ft.) Division o(Water Resources,Information Processing Unit,
!f mler Ame!is Aborre rodng•me'• 1617 ping Service Center,Raleigh.NC 276"4617
tl_BoreholediamaMr: � (in•) Mb.For IRiectiop Wells: In addition to rending the form to the oddrm in 24a
abnve,also submit one copy of thWform within 30 days of completion of welt
Ix,Welt construction method: � ^�t cnnstructimt to the following:
(i c.mrgc^,tong•.artrlC,direct posit,etc,) 1 �
Division ofWater Reeattt'¢et,,Undergronnd injection Contral Program,
i- R WATER Sl.PPI V FLL3 ONLY: 1 r,36 Mail Service centff,Raleigh,NC 27679-1636
13%.Yield(gpm) Method of test: bte. For Water Canoty&FRUCtion Well to addition to sanding the roan to
Me oddress(es) above; also subtait one copy of lhiv form within 30 days of
13h.Dkinfection type: _, Amormr. ec)mptetion of wdl construction to the county health department of the centnty
where coiLoructed.
Form Gw-I North Cnmlinnthpnttment of f:n.ironmcnral Quality-1xvismn nYwater Rasmtra�l ReviReA 2 22 201 b
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