GW1-2022-09998_Well Construction - GW1_20221104

WELL CONSTIAUCTI ONRECORD �' �' 'Internal Use Onty; .!1.Well Contra'ctorInformadon:
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CompmYName G t FROM TO ID IAMETER! g e hie x:�?i;.7,
CrOYESS 1VrAT8RiAL .
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2.WellCons, cdonPermit#: I� 7p 2� `15•'�R'CASINGORT[TBnvG '
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tLei alelo`iEd=Iod' ? ?,;rt;;�t,•:i�i:�^ .�'e;
pernrTRs(LG flJ�County,Start Yariaac4 etas ft DIAIHE7ER TffiCtOVESs MATFdtrgL
3.Well Use'(checkwell use): t°• ie
WaterSuppl3nWe11:
Agnculdrrat 0Mwrici ai/Pub �FRobi�EEt�i�:wa: ?D /` V":r's:Z:'�<u?`!l�'f':i.?.'a:4�?psi." �•• •te:+' s:.".:'S"'ram?
P li0 TO IA11II7SR SLUT SIZE s? +t)su.t 1 :{} •13u
Geothermal(seating/CoolingSupply) raftidentialWaterSu I sia a l) ft ft :ta. ! Trucravess Mn
lndushiaUCo 1lonmercial Supply( gl)
13Residentrial Water Supply(shared) f t
DR OrTT�.'-�?.Y•31B;.�t�.artS:r�. .• .5,•:a •r,�ti-
Non- -terSupP�yWeII: FROM TQ) :�{,l.in,V9+ itip�YS
MATERIAL• EarPI.A ' �Sa 5:11:�•ASet:NwS
Monitoring' !t Menron� ouNr
lglecd Well �Rewvery
iG fG y
AquiferRecharge Ground it
ulferSto and pp0--�� vterRemediation ft
!1 tyBarriet RAVEtiPAQC ifL'"lieirble :r 0.1 •;.
AquiferTes Recovery �Salha Drainage �Fao s � aL� wL r`a•°,F►r&�cEni `? "�`:L":���
Stonnwater M>.raoD- >3asperimental Technology ft
tt
DSubsidence Control ft Geothermal(Closed Loop) OTracer
Geothermal IGG
satiai/Caoling Return) nOther(explain under#21 Remadrs) voMINTo attaci,DFs dta�io ta'ieiiFees;a' '*"+Q,,
4.Date fr: N eabr.EaedEets.,etVme& "'
Wells)�ompleted: 2^ �j Z?/
5a,Well Locattbn: Well ID#
raeiaq�/pryaerNa�e; _'�`• �` ft, `•ram t4-/► � '
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Cotmq� y •Parcelld �21: .+iS • 631R1. �y u
• � enti6esUonNo.(Pndi '� .,.d^^'•
511,Latitude and longitude in deiceesJmfnutes/secottds or decimal degrees; a
(ifweUHold,onelainangfssuMcfeat) . ,
N Certification: s
6 Is(are)the welt s 1-•� S!�/ •� S''-" , �, 'J; • • . , ., ', ,
() l'rmaaeat! of OTemporary Si�at er
U ^.ncu{:Onwjctw. Date 7.lstblsarepairtoaaeulstingWeil: yes or •ByjTpjngthlsloma rherebya � _
'�ftDanpah%J1qoutktorvn rveUe vlth15ANCtCOTC:0100orL£4=C4 C•OIS,IPeJlCfotu on ��onfi�omiattonaadesplalntye-ft-gftha RJWII hl rmrdharbeedPmd*dtotherveUmaner. ondit a
rePairemdert3Tlr adareetlonoronIn
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8,For Geop Only,I pT or Closed Loop Geothermal Wells having the same YOU imay useetthe bacor k of tliis page to pro�trid!a additional weA alto
d nstmati only 1 GW-1 is need ed.Indicate TOTAL '
dn'lled: NEMMER afwelis construction details. You may also attach additional � •or well
pages ifnecessaW.
9,Total well depth belowland surface: r SFJBNIiT1`AL INSTRUCTIONS �' '
FormWUpla trd/r JTit b!ld�pths{ldt6hrent(esamplrr 3QI00•aredT
ta, or Ali WeTLs,�too7 (�) 24 '---__ Submit this form vidthin 30 days of.completion of well '
10.Staticwaterlejelbelowtopofcasing:_�d T coontothbfollcwiag: . i
lfwaterfevaibaboveeasln&'use"+"' (fit) DiylslonofWatetResotirces
3617 Ma11'ge ��*ation Processing Unit,
11.Borehotediamltra;.' ( ) lvtaeCmter Ra ei0,NC27699-1617
' 246.Por Iniectin
12.Welt construction method•. n Welts; Ia tiddition to sending the form to the a
(la aul a mtacY,tab data r., above,also submit one co address in 24a
pussy etc.) copy.of this Sinn within 30 days of completioa'of well
construction to the following:
FOR WATERS PLY WELLS ONLY; Division of Water l2eso
1636MallS ,Ujul igroundWectionCowtolPmgram,
13a.Yield(gpm) arvlce Center,Ralei'
Method of test. ,�t' ; � g1r,NC 27699=1636
24c,I?or Water SuIniee_ 6_ -orVysiiss�1A addition sending the form 13b.DLsiniection 4;a:� Amount:' � the aanress(p) ebotrq also submit o?re'lls: k addis film w completion Of* construction t0 rile wan °30 day3 of `
where Constmctai. health,iieparhaent.of the,cot!sty
FormGW-1 ;! � � f �
• NotthCamtivaDepartrnenEofFovironmeatalQualitv�ntdete�..ew_.J_.•__._ ! 1 ,