WI0100654_Geothermal Well Construction Records_20220622

82M22 7241
1 P.1
Feb 16 19 05-Ap Cl,arwater Well Drilling
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WELL C N TRU TION I2ECO . GW 1 For in(emal Use Only:
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70 DIAMCCEtt TAIC1tN6S5
2.Well Conetrnctien permit
Lht rill a iicnblrr wall ewiriteddn pt<n+ttrt p a till'.Canary Srarg Yartrotcv etc)rr
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S.Well lice(check well ust:):
17.5 EN
n AMrt'r6 t ArAqfflm 'ntrCKN 83 u7&Rur.
Water Supply Well.FROM to
AgricuiRlrnl MunicipnVPubec p •
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Geothermal(1•Ieating(Conling Supply) [311rsidential Water Suppiy(sfigic)
rndusifiallCommercialResidential Water Supply(shared) 8 OUT
t, TO MA'r6AtAL 1LMt7AC &•iT t sr77tOr1&A<•rO11NT
Irrigation ft, fr
iVnn 1 ntt;rSapplyYiell:
Recove U, fc
Adanitatin
tnlN:ttcn Wncchell: f4 R•
Aquiferar a E30roundwater Remcdiation6C..+ 19.SAM1It;itAVELFkCit ifa ble
Aquifer Storage and Recover}' 3,winitg Barrier FROM To
n,
nrK MAL 1rt lAC8M11• BtiT>titCflrOa
Strttmwater ranag
ft
Aquifer Test Die
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Experimental Teehcology DSubsidcnw Control
Geothermal(Closed Loop)Tateet 2&DRILLING LgtC atlJoe
TO DPS mkrr• rras•drHasktFPa Aratn siu,qc,1
C:cothermal(tleatio Cooling Return) Other( lain under 921 Rcmprics}
PROM
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A,Date W41(s)Completed:,_,___---_.__._._.Well 11)11
Su.WellLncntlon: r It.
1%aci{ih'!()nnctilamn F i Y lf)H(LfaMlicablc)
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Physica{1 ddr cs,City,Zr
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d f rt•I Vil i+l f irk:74'e:r..Jl tirNl
Caunty Poteelldentiifcafion No.MMI
Sh-Latitude and fong tude in degrmimhntteS/secondsor(lceimnl degreem
ffwelificll,onalaMongiasuilieicni) 6 t 12,CE fiCAti ,
loll
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41 5lO ova •g W tr t 22'ZZ
signora . rc Will cantraetor Date
fi.15(arc)the well(s) ('crmaDent or ©IlempnrAry
LiP Btf.7lia$rtt1A'i%r'm.!
anurraertvt/n au»rrinnce
11%thlt:a repair to an existing wen: riYes or 191No u rJr 15a tiG'aC a2f..4lDD ar 15A XCAC 42r:.P200 W!l[Catts/rnetinrr Siatniardr rmr!char rr
J'ddr isv rcpafr fill nutl fnrvn till coastruuJmt irnnnaliaa mill crploin the.atria nrdta copy nf11r.+.c rccnrcl has ht+9t pMldderf In rite a Cif mv77er.
1-:pair under A21 rdmnr$r attar ornatltc lark-of riots farm. 23-Site diagram or ndtiidonal Wall details:
R.For GeoprobelllPT or(Iresad Lrutp Geothermal WOW having this same ),
ou may use Ilic black of this pegs:to iwovide additionad well site detl&M or wet)
nmsiniation,only I GW-1 is needed. radieato TOTA.)NUMBER of Uurlls
construction details. You may also aitaoh additional pages if nt cessety.
J Cnnwi /l( 11 11f 1115`
9.Total welt depth below land surface: 121•L BOr Ail Welts: Submit this form within 30 days of completion of well
l%nenrrrlrlpfcwrtlslixralidtprlurfdrllcrrnr(rsmrmh-d 70'and tnA)cnnxmrctiontothefelloteing:
In.Static water level below top of easing. ft.) DiViSinn of Water Resources,lafnrtaation Processing Unit,
IfrraterAm!!isatvrretaxing,me"-"161711ail Service CeatcnRaleigh.NC27699-1617
11_%reholedinmeter: in•) Zjh.Fnr lrrtect;On WOlirr. In addition to heading the form to the address in 240
ngove,also submit one copy of this form within 30 days of COmplatitm Of well
Ix.Welt construction method: construction to the following:
fie.auger,sitars.table,direct plait,tdc.)Division of WAter Reataltoe.9.Underground irjeztioA Control Program,
ir(51%WATER SUPPLY WFLLS ONLY:1636 Mail Service Center,Ralclgll,NC 2709-1636
131.Yield(gpm) Method of test: 24c. I r Water Sandv&1akcHon Welk- In addition to sanding the form to
Me addresses) above, also subatit one COPY of this fort within 30 days of
13b.MOnfeetion type: Amount:completion of well construction to the county health department of the county
whore constmcted.
Form Glt;-I rfnrrl,l.atnlinuAcpnrtmene ot'i;n.-7ccinmcotal 4nali tg-T>i•nsrnn at'Water Ravann c Revised 2 22 2a{tS