GW1--02035_Well Construction - GW1_20240401

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WELL CONSTRUJCTION RECO (GW 1) ' ' O •
. ;•, .,•,. . . For Internal Use Only ' - . , .- .
1.;Well C !racier.. rma
• ��d ` I
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14.wwTERzoNss
Well Contn c orNime' • PROM
TO DYat10lrION •
3..5.5•S. ,••• • • �.0� n' �lYrO �
. NC well Contractor Cmtification Number"
• .. . .15.OUTER CASING(for Multi-wed wells OR L1NER Of■p Gable) .
a'ti^ ���, PROMTO . ' DIAMILTZR MEEKNESS MATERIAL`.
l� 1 1 V� 16.INNER CASING OR TUBING(ieethermal dosed-loep).2•.Well Construction Permit#: CD O •J' •)• "OM TO DIAMirtn TS cia'izss • MATiEWU. ' •
List all appliaobla we11 cmnt►ucuon parader Ai.t7IC,Cur%,State ya►iance,eta) ) .It 9/ 4'
. 3.Well Use(check well use):• f .'
fG in
Water Supply Well: . 47.SCREEN .
• °Agncultuml OMwucipallPubhc PROM • TO DIAMnYIIt SLOT SIZE THICKNESS MATERIAL
• ft ft. m:
°Geothermal(Heating/Cooling Supply) °Residential Water Supply(single)
OlndustrieUCommeroial • in.'
.ORecidentird7ater'Supply(shared) • �,' •�
Olrri ha 1P.GROUT •
ga n • °Wells>100.000 GPD: PROM• TO MATERIAL-• • LMPlacrauKrmemoir&AMowfr
Noo Water Supply Welt — tt LL
OManitoring °Recovery l� a 7` r, An/_ A.., +�
Injection Well: _ - ,Cb r-i 1 /.iVa.. ,
., DAquiferRecharge . : °Groundwater Retnediation R tt: f
OAquiferStotageandRecoyery OSalittityBetrier 1..SAIVD/GRAVELPACK(if■ppliceble) ' • . . • . . • . ,
PROM - TO
°Aquifer Test s• OStomwater,Drainage ' •• ft • ft MATrRreL • , EMPLACEMENT. .•
METHOD
['Experimental Technology °Subsidence •
Control R
°Geothermal(Closed Loop) • ' '°Tracer ' •• ' • _
20.DRILLING LOG(.Mad,additional sbeeb if nemsap)
°Geothermal(Heating/CoolingReturn) °Other(explain under•21Remadm) EOM='n TO D�Q�IION(obr.hordaea,p0/nekyrye.credovia,der)
d Date Wells)Cotupleted. Well)D# ft. tt i•'
Sa Well Location � : ft , •.: . ;. ,(,i
S IL Facility/OrmerN Facility 1DN(if$pplica6le) 1t ft.
Pbysial Addmee;(Sty,and Zip 'ft ft. i. :i 6••ir' f'•,T ak •
:a/l/ La R
'l t,.� 21.REIVIARI(3% AP.. •� t O24
Gallery , „: Pacal Ideetifiwtiaa No.(PIN)
5b.Latitude and longitude in degrees/minntea/secords or decimal degrees: • � ; g'Qr3OG' �"` U�'R ' '
(ifwell fif_eld,one latilong is Sufficient) /
`� , 3 1 15 t, t /' 22.Certitiation: ! I y' .. •
'N T ''
W erg
•6.Is(are)the well(s): ermanent or OTem ore �2/•-•_ p ry _. 1` .7 Sisoatum o Well Contractor _
-. Dace"
7.Is this a repair to an existing well: °Yet or, 15ANCn;ihlijorm,Ihmebycert that the m0(i)was torero)eon trusted In'accordance o, -
Ithis tsar e• ISANGlC 0IC:0100 or•'714NCAC Dwell ow 0 Krell ConarvctIon Standards and that a copy
f repair, out brown well contrrirclion information captain Ihe'natau ojthe ,` of this record has bearprovided to the Oa owner.
repair under#21 remark sectionoron the.baekojthisjomi.
' ; 23.Site diagram or additional well details
8.For Geoprobe/APT or Closed-Loop Geothermal Wells having the same • :• You may use the back of this page to provide additional..
ell constmetion info`;
construction,Only 1 GW I is needed. Indicate TOTAL NUMBER of wells (add'Sec Over in Rdaiarb Box).You may also•attach additional pages ifnecessary•
drilled: •
9.Total well depth below land surface: �'Si1B1VJ1TTAI.INS1TtUCTIONS
Formultiiple wells fist all depths ljdlfjenni(eiampla-3@200•arid 2@JOO) (fL) Submit this OW-1 within 30 days of well completion per the following: : •. '.•• '
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10.Static Water level below fop of casing: f� a. For All Wells
If water revel Is ab, .ove •., ((Y:) Original form to Division of Water Resources (DWR)0 acid&:"!e"#' Information Processing Unit,l617 MSC,Raleigh;NC 27699-1617
'11 Borehole diameter A t�' L(In) 24b.For Injection Wells.+Copy Underground Injection Control
to DyPR,
�j Program,1636,MSC,Raleigh,NC 27699-1636' (RUC)
`' ",12.We1F eoaetruehoa method: '� K D F il. u � /A^ '
..Cr.e.sut so*able dneetpwb,etc.) ., . ,, c.For Water So °
- - and O eo hoo Geofherbwl Return Wells.:Copy,to the
FOR WATER • county e°vlropu°ed �` tepttrtorent o the county ere.s. SUPPLY WELLS ONLY: . • Ft'
, , • • •
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pen For Water Wells roduela over 100 000 GPD:Copy to DWG t,CpCUA
13e,Yield(gpmj '/ D o Method oreeatr 'LLf,. • Penni. gram71011,MSC; erg N02769971 11
• • 136.Disinfection type: * 'Amount ' /2-✓, • •
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Form(3W-t !' c