WI0100694_Geothermal Well Construction Record_20231204

51 RUCTION RECORD (G-W-
Print Foal
cos tntema! Use Only.
1- �!'cll Contractor Information:
Clint J Babbitt
t.: C.:::r . N,,,,
NC-3556-A
NC Wet C,,- _its"(-caifi, odn \souse
AAA Sweetwater Well & pump, Inc.
I.
2. Well ConsW18C.? tlK!>I Permit =: V� I Q(� e
lal ai! tt,'+pTti nh?c veil t UVSir4rt10A'errll" !,
t• Srt:e• 11A7[IT.(p, [YLI
3` R'ell Use (check well use):
•.
.. -z , Wpq sell -
(Bearing —'Cooling supply)
Tndu:trial,'Ctunmerc iai
\on -!Eater Supph !!'ell:
Stosgeand Rtxo%ery
Tes,
d Tahnolog)
(Closed Loop)
❑\funicipaliPublic
DRcsidcntial !hater Sttppiy (single)
[311esidcntial Water Supply (shared)
[]Growidw'alcr Remediatio n
QBaluut_y Barrier
[:)Stottriwater Drainage
Subsidence Control
Tracer
under =2I
i- Daft ll rWs) Completed Well ID#
Sam IN ev Location:
Sae a C^ rimuan
" - _ zz +Ge--cv. C "* —Ln' t T,a
'61
FaciI4 W=
97.5-03V3 01076ZL
i'rr�l Teentific:ation No. (Plti )
-%. Isa itudr and longitude in degreesrminutes/seconds or decimal degrees:
,;t r.k fs--s,:. rc LA , g t, Wlticictrl
6 (s(=tj�rser(sj Ytrmaornt or OTemporary.
22. Certift ation:
2- - 23 .
•gnutlre of C if ed N.-II ('. can t>i:e
� 1t1• sigaini+ A& Jntrr, l herehr eer/ih that the neHfs) sea.. (tsirre) c»acrraned inttrrardatrcY
7. Is this a repair to an s ydWng well: Yes Or I f7"o nith /54,VC.447 03C.OAK) or l i.(.VCAC 02C.eQ(Ai Nell Constrtnnon Standard. an l %bat a
/i// ,n.r )rso. n k, Lr on,tau, non lnfwaattos, and explain the rtatare of the copy oil this reensd lac been pnnJe t ro the hell otcnen
rrp,Vr Oder -1 / remarks wrt,.,r or Uri )br iaocl "fib" (arm
23. Site diagram or additional null details:
1. For GeWilibe/LTf or C'losad-Lary Geutheratud Wells having the aamc You "nay use the hack of this page to provide additional %cell site details of w'elI
constrsction."nly J 4yl/- needed. IndicateTOTALNUMBER ofwetls
t onsttuetion details. You may also attach additional pages if nazessary.
drilled: — -'- ( SUBMITTAL INSTRUCTION
4. TatIA we! below land Ittllr/tsee: (G.) 242. For All Wells: Submit this Jinn) within 30 da%s of completion f owr11
utld,/.tli dINI",nt lr,wwp/r-Jul M� unr/i , lttli)
consnudi"n to [Ile 1i111uwn1g;
I(I. mai ie »tiler lit -SA Lrltrw WP of calsisw
!I a.,t, r lr.r:,.,do,r rn.,w; Ole
1 I . ita,r ebole diaawicr: 6
Drilled
12. Will uarstraAirw asetlwl0: _
„m,W rawy u . OarJ p•s:)- cu I
F()'lt M'A7 ilt 7+1 !'lm1.Y V/"i 13 ti f1�1.Y:
I is. Ykld Wail)
136. rnthotms ►f'101r: GCH
W
UisWon of Water Resources, Information Processing IInit,
1617 sllall Service Center, Raleigh, \C 27699-1617
(b.) 24b. Fo► Iuleclbljt_Wellst In addiusn to sending the funn to LLte address in 34u
above, also ,ulwoit one Copy of this Lunn within 30 days of completion of %%'ell
cun►huctiun to the following:
Timed
I►Islsluu Of Water Resources, Cudergruund Injection Control Program,
1636 !%fall Service ('ewer, Ralduh, X(' 27699-1636
22r. tier Nater 5uonly gt lnitcl(u Welly. In addition ts% selldmg the tilmt to
the addrtss(tr) alote, ale" submit one COPY of Ibis linen within .lot days of
l`11111111clion o well con+lluclnal 1" the county heallh depadntent of the manly
where clmslrut trd.
1,4,0 614-1 %, O,(oa)ulrl)(tolu'k nl us l nl siu,u,k ""AI 1)Will) Ih�aion now •1 Hsynwcrs RcU,.•,t2iI ZIIIA