GW1-2023-02100_Well Construction - GW1_20230307

WELL CONSTRUCTION RECORD(GW 11 For internal Use Only: !_'__.,
1.Well Contractor Information
J a.M iSrn �7Li Occh i4.WATER ZONE
Wall CoturactarNamo ROM ' TOC I SEMPTION
146q'3_ C i air ft- 34o ylb (All 1-611e:)
N WefContrarterCettideatiaaHumber ' 29t R' .3tea
�/� �-� 1S vgTBR Ce!&Mfrormuld weal°RUINER Mohave)
(2k_4.-Q ) See tit•C S i I h C . PROM „ TO DL M ER !ffiCHNESS MAMMAL
fL rt. in. 1
Comp any Name '16.I NERC1 SING°BRIBING(geothermalclosed•002)_ .
2.Well CClletru (}11i1 Permit I DO S.3 PROM TO DIA M111 I,THICIpitia9 MATERIAL
Lill all applicable all conslructioapermits fi.e WC.Canny.Stale.Varian etcl b fi. 1 g6 tt• it,.2.' ill. S•)gZ2I P V C. .
3.well Use(cheek well use): ft. FL in. '
Water Soppy Welk IT.titF
gtleultural -FROM To DL1MMER morst� Trilei Ess MATERIAL� II1ctpaNPablio It: It, in. - '
ft.
.
Gcatltcrmnl(Heatin JCootingSupply) Residcatial�YatcrSttppip(single) .
Industriel/Cotnmereint °Residential Water Supply(shared) :l&GSoir
ii11 &loll PROM To- NIAT RlAt, E�teI.AC.is�.IL�T11�ixoDdc.umU7r
1Vou•WaterSuppiy well: CD Da �• efein tk r�oL4 K _
Monitoring Oftecovcry ft.Infection Well:: sat
'fur Recharge DGroundwaterRcmcdiaiion Ft. ft -
quiferStomge and Recovery 0/SalinityBarrier eno nmP atnttahiel
Aquifer Test OSttoln1watcrDtainage It ft. taw >?net act tt>�rrderrnoD
perimentat Technology ()Subsidence Control 1't. It.
Gcothclmal(Closed Loop) • Grunter ZD.DIiff.I.II�IGLONfathtcl�addittotmlr fttne tney� _. - _. __......_
Ctcothetmal(Hcatiag(CoolingRelum) Oiher(explainunder lRemarIts) `FROM i- TO o aeltrnrloN(caleLattlsns.curtorkniet�insize.ara
. a 1 ara f3• ►eu l lye ____d.,eh
4.Date Well(s)Completed: 2-1 22 well wit I dD ft' NZS R'_ G rq n! }'-�
5a.Well Location; Et. ft.
•
Rot►A101 Far►ioy+t"fi cc.
PncllityfoweerName WO* le- FacMtylD@(aapplIcable) ft.
14 4 Cater Creek ROI i Lth,on *ills _28 t(,1 tt: _
Physical Address,City,undZip SC It. 4g—i; �--��
_Alt.1 ^erf.fYCk. lt,5,1-18 in al.aatls
County Parcel Identil'icati4aNe.(PJ
5b.Latitudeand longitude is degrees(minnteafseconds or decimal degte
(If well field.one Womb suEficteat) n:
3 S° 361 MI."43 6.1,L tN Ti't %' ri.lst airU 'I l Or
"`.:, D—Q- 23
&Is(ere)the well(s) manent or CilTempararg Signanito°Mollified Well Contractor Date
9y slgihing thirform.I hereby cen((F thin the weft)was(were)cwwsarted in aerardonee
Y.Is this a repair to an existing well: Yea or No kith ISANCACO2C m000r ISANCAC 02C.MZao Well Caaseruaisa Standards and ter a
trails iv a roper-fill orn knoe...e.1I r rya m,t.,fmmartoa m rapc.fa rlre rmrmrof he cu O'edi"[wrdMc been Prrn hd fw the..en"Knee-
repair underii21
remark sseetlonaronthebark rldrjohln_
23.Situctinarmnoradditional well&toast
(Lifer Caoprobe/D1YP or Closed-Loop Cc' olhaerosot WelsBaviog Thu moo Yoe row use the back or this page to provide additional well abe demons or wen
conauuullon,play 1 OY1-IIsneedcd.Indic=TOTALIIIMIRER oi'wells aoacnucsioadenne.You zany also math additional moo ifaeeewery.
drilled:
t Stnalva rAL�CTRUCI7ONe
9 Total well depth belovrlan$sorFat:et "1'Z
Formal:IA wells-Ha all depths{('�fenatt(.•.nmr►„3 l2pp, pp1 t ') con. nt Welts: Submit this foie within 30 days of completion of well
construction
10.Smile water level below top of casing: I CAD (ft.) Dlpis treaterlkvrl is abase erasing,use"+ ian of all WaterService Resources,Information Pa�oeessiag Unit,
ILBoreholediameten co 0 Z� (to.)
1617 Center.Raleipb,NC276994617
n 24b.�r Tl_eetion Wells: In,addition to sending the form to the address in 24a
.wen construction method:
G C O�-01 Y`/ about.aloo submit nnc copy of Ms IOIm Within 3D days of completion of well
12
( augtr.ro[ery,cabl�daoctpush,txt) I - CDDSIIIICli011MUMrelining:
FOR WATER SUPPLY WELis ONLY: Division of Water Resources,Underground Ittjeclion Control Program,
16365fall SalibaConter,Rateigh,NC276994.636
13a.Yield(gpm) Method of tesfi et I, C niel in u2 24e. 9 ly&Id et lis;
J ��----�---�� In addition to sending the form to
136.nisit:€cction type: C.411 Or i it�Q Amatmq s the address(es) above,also submit one Copy of this form within 3D days of
CtIflICiCtiOII oven iJttttlrnetinrt m dui n.a,.,,,,t.d,rti t—_-___..