GW1-2021-01615_Well Construction - GW1_20210215

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WELL COriMUCTION RECORD(�-4) For Iiitemal Use Ow.
I.Wen Contactor Iol armation:
Gary.ThOmpSOn :14MATSR •M
�slYollComiaetorName FROM TO: n
". 4418-A i��s 11 IL >✓-
fR %
NC welt C0e4eameC9ftV1=d*R1;=a1er IS:OIITERCASIIVG ilhralaitlsaudwdb RLII�SR ""IIeable .:`.:::..:
Aqua Dill, Inc. : 1 -. KATARIM
CbmperryNatne• 0 n ,o o• te. PU.C-
161NNERCASINGOR•TUBING thermal :1':; n.;
L Well Construction Permit#: I m n �Fss MAz�:
LW ag applicable ue Commordonparo to(Le:WC Cmmry.Soft tradaim etej ft. t6 (a.
3.Well Use(cheek well use): R % 6L
Water Supply Wdl: 178Ctt8BlY::. .. r.:
Agiicultural MON TO 1ABIRM Mar
�MuaicipsUPu6lie.
Geothermal(Heating/Cooling supply) ffKaddential Water supply(Single) ft.. rc
industrwoommetcial DResidentiai Water Supply(shared) 3&GROUP.. :.
"Ibrigation FROM afAOn�,tpi0
Non-Water SupplyWellt. & 72-57 ft - a
:- Monitoring mitecovery R f
Y ec on. .
• fa !t
lrAqufferTest
qi»ferlteeharge E3GroundwaterRemediation
quitter Storageand Recovery 13Saliuity Harrier SANDlGRAVELPACI
• on
OStotmwaterDminege &
erimental Tectmology SubsidenceControl fG ft.
eothermal(ClosedLoop) OTrac r 2LDRILLiNGLOG bunchaddidood'sbemueothermal(Heating/Cooling Return) 00ther(explain under#21 Remarim) FROM TO DESCRUPnrloN
rCc9 c' p-,
4.Date Well(s)Completed: �"�-'21 Wail M#
So..Well Location. "n L( 5-L fi C
I'
FdotGtylOwoarNnam Faciti4ylD#Cifapplicabto) R' f ~1
° ReShi t,�Zl t hoc 'a"�v 145 ft. ft.
pbpWd Addrwe Cary.and Zip' ft IL
ly M
REDEMM
C Ar of identificatiouNo.M"
SL Latitude and longitude in degradminuteslseeonds or decimal degrees:
rftvell field.am[Mang is soMent) 22.Cerdlitadon:
t � i . �z W MS ' � .rs►r��CJ1/ --1-�r. 2
6 Is(are)the wells ermartent or E3Temporary S9gnsnne of eu6e4 WeD Ccntaeto. Data
� BY sigNng do fom�I hereby Cent dmt die m t(#I r(irony Cansaoaed m acaotdwae
7.Is this a repair to an et le ft well: E3Yes or BG ft o frith]SA NCW 02C.0100 or lSANCAC 02C.0200 Wdf Conrvvwan Sya&dtdrand that o
{(ddstsatepalr.JNl ooritrohrn trailootatnicrlon mjotrtmuonand erplabt thertattae ojdie copyofdt&xewdhar been prm7dadtodntrcJi onvtsr.
"pafrwrdar 82)reamrbsradon open the baekgftblsjorm
311 j" or additional well details:
�,� '
8.For GooprebeM T or Closed-Loop Geothermal Wells hafttli c,kj r-'Nn may' the back of this pope to provide additional well site details or well
consuac Lion,only LOW-1 is neoded. Indicate TOTAL NUMBER of►velis construction detals You may also attach additional pages ifnecessary .
drilled: - j 1 &MU&AL 1NSTRUc—no-M
9.Total well depth below land sarface: „� :nE51+F Submit this form within 30 days of completion of well
rornmk(pla,ra!!sllstaitdePderffdlBemnr(aooipfo-9(a�2�•andl(a)!oo =,ory t t�
�S�i3C1+' `. . Istrttctionto the following:
It Static water level below top of casing: (tt) Division of Water Resources;Information Processing Unit,
Ijmaterlevel&above carlti&are"� 1617 Man Service Ceate',Raleigh,NC 2789-1617
IL Borehole diameter: (io). ?sib.For Iniaction Webs: In addition to sending the fora[to the address in 24a
12.Well construction method: i't�-wc V All., above,also submit one copy of this form within 30 days of completion of wail
(ix. .-my.aWN�tpush.am) Zconstruction to the following
DtvLslon of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1 1636 Man Service Canto' Raleigh,NC 27699-1636
13L Yield(gpm) S Method of test:Ct-44 f j h•. 24c.For Watar Sannly A Infection Wells: In addition to sending the form to
a/ the address(es)above, also submit one copy of this form within 30 days of
.13b.Didetiection type: 0r Amount: b�Z completion of A%tull construction to the cotmty health department of the county
where constructed.
FocmGW t NothtorolinaDepauentofEmdromneatdQualdy-DivinonorAvaterltemurm Rovirad2,22.2016