GW1-2021-01688_Well Construction - GW1_20210322

PriniF�m
WELL CONSTRUCTION RECORD (GW-1) 1'or Internal tisoOnh:
I.\fell Contractor Information:
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l r7 rY I CrhSV l�7 f �JSU� 1:.N vrf:R ZONES
' EROM To oex'Rlvno\
N'dl('ontrvnnr\and O ft L ft. lO(.J
ft.
NC\xdl('ontmaor CzCLcr./i�:.n\\allt'n-� I5.(1C)'ER CASING(for multi-cased wells)OR LINER ifa Geable)
�'l4�\ ) ._�JC_A V\ `rC C r I \ 1�• IA(l\t o 10 I. Nll L. THICA\E$S ptATERIAL
ft. in. '
Conlpn,\Dive
16.1\NIRCASING ORTI RING eothennal closed:oo 1
2.11 ell Construction Permit#: tIiOH TO mxVEfER TMICRSEses xLxTER1AL
l.I,n,Ill upp6.nh4 ll •Irl..o,n/ ,,.•,.e. !'lr',I.en,m..vnL. .u.,,.oc, ft. B. •29- in. 's-_M,2 f VG
3.11 ell Ise(check N r11 use): ft. ft in. ✓✓��^^
Water Supply Hello 1' G.SCREF.N
FROV To DL\S1 f:TER 5L(ll N!: TRI('6\t:<S MArER1AL
Acr.l luml �Mm spot:i; ft. ft. in
Geothermal nil ' in`Cooling 9r.ni.lc l btl IA eer SLpph ISIIICIC �' tY. fr. u
."austriaVComrncrc::L [DResldenLal Nmzr Jupply(sharad l I� 19.GROI I
Irm,auoll tROM TO MArLRIAL Ext LA('Exl Ep\TMETMODSAMOGfiT
Son-N'ater Supply\\eII: 1 ft.
Momtonrm Rcco,en
Injection Well: r ft 1
Aq.liler Reenar: nGr1LMJ1IZaer RClne(Ila11011
19.5>VNCRA\F.I.PAC 61ifa dieablel
Aquifer Storm -.nu Reco,er. QSalit gHarrle. I; rl:Ox �To xuT[al.u. eMVLAceM[si'METHOD
Aq,.ifei Test 13Siorn,Nmer i)ramage R. ft.
Fypenmental see[ii, o_, E]Suhside^CC COM101 ft. 1 ft.
Gcothemial up) II ace r 20.DRI1.1.IN mc G LOG Iath addi rional sheets if necesearvl
Geothermal ll.-.❑ c:online Rr.r.r:l, Oil`.er l e\pa w.,nd,,a2 l Sent at _ K0%1 ro 1 DE/s�('//RIPTIO\Ir.do,I,<,a ,octN <.ere.
p 10 ❑. O fr. l..lQ ✓C'.1' UJ
4.Date N'e14s1(nnydeh•d: J 2 N ell Iba O '` rdSan
&Or-° G� f
n.
Sn.Nell Lofutir it '
ft I
7Tess�c4 (-fc�t�onxbe
Firs:his O,ner Sr.;•-r I �dhl, I ppl..,,b11' fr. ft. .•
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-I c��rxt2.0 Qr. P,�arnaYcllS\j.112t VCAK
Phs' AIL.....:11,.,.,a/q, C p�Z D11�I , 1� it. ft.
o,Y\C.0CY\b /e- f T OS—O'�— Vi LAV '-I.Rf\i\Rl:l
ce,111. Parse:Idennvi:noon Aa t pl\I
5b.Latitude ane lortantude in deg,i es/minutes/seconds or decimal degrees:
(ifwcll bold.one.a:r.,;_.,adniaenl 22�Ozorri:
350 to ' 12. 805 UV/ RZ0 .2S) 53 .Lir.9OL11 g
6.1slarelthe N ermanent or ['Temporar, 'XI
.-':(amticd Ncll Conlnener Gard 1
-'I."Il l hel I ;. Il, a 1-u / �r I •u¢,✓a1 it ocuvdance
7.Is this a reps:-tD:In existing Nell: Wes or uh l t ICI .ulna 1.,�\f a( o I II_po Weil r t m v .,,&mulur(l,and thm a
/1thin Ir.IrynurI ?I.......u.unll n. .nun.., u1A, •r vIh,I.. nAcJr I nI,,• ..,u.
rclwv uu;hr :l„.lxv..,;,uu„,n ul ,., I,,,F nl rlu.toms • I n
23.Site diagram or additional Nell details:
S.For Geoprobe/t)PI or Closed-Loop Geotherm:d AA elin ii.v n_the same A or; a , the bun(o dii,pa_e to procidz Wdition3 Iwil site details or well
corStvftlnn,0III, i J.-I isneeded Indicate R)IALS( Y:HLR of weld "11111U . ,.dcad5 toamu, a'soatmeh additional pastl necessary.
drilled' Sl 111111 !AL INSTRL("Ii IONS
9.Total well deem beloN land xm'face: //>70 (D-1 24a. For all Afells: SLie:cit thu tor,; aith,n 3n �axs of completion of we]I
/...oIdl,pl.,,r,11,:n I,,lr,6pll,.IPl111, u,I,., u u,i plr-3a"If ,In,I',I;
n.anon to the follow crc.
Ill.Static water lest below top of;asi mg: .Jb (ft.) Dix ision of Water Resources,Information Processing I-nit,
11„emr0,111 n _ o.m,.-. '111_ ..- ' 1617 Mail Se-,ice(enter.Raleigh,SC 27699-1617
11.Borehole cis nwo,o : 401 Ls- (in.) tab. Fur Injection Wells: In eadmor. :o sending:he arm to the address in 24a
I�(� r, anode. n1,,,>oomlt one cop, of this roan wehin 30 daes of emnplenon of well
12.AA ell constr u.,,. method: ,01;ar:.:::.,a:o:he foj.wrlg
Dix isicn of Nater Resources.I nderground Injection Control Program,
FOR II Al ER S,PI'1'f W EIA S ON LA: ,,,,,,..1 1636 Mail See,ice Center.Raleigh,A('2'699-1636
Ida.1 ield(gpml 1 Method of test:�QI• �ToLl notF 24c. Pm N:Iter Supph S Injection ll clis: In add.twei to sending the form to
Cs ad di" ._ sl ahox tls ahrl t ane Co",, o' th]: tarsi mid—in 10 days of
136.Disinfeetim.tvz: n� amount. (O � C illrl. o:ecil to .I1C1:L 1 to tile avunx Health depanmem of the county
what C,a,.0 ocled