GW1-2012-03833_Well Construction - GW1_20120823

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Geothermal(Clt+sed Loop) �7Yncrx • Tit
CicerittcrntAl(lteatiaptJCtiotlntt Realm) �pitler[ex 1p ain under 021-ttcmnrks) tr, i '� a. 3'
.1,hair.Well($)crMplcted. o__.. ! well IIN
.Su.Well Larpanor ���G� l Z< R. it.
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C.`annly Pnrxi Tdtatiticntbn No.(Pits►
Sb.Mfitnde Rail longlltude In degrm.IMIn!Utcslseconds or Qceimai dlgrace:
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:.It tfii.a repair to no cxisdag welt: �Xt a ar puNo xd+h i$A-v Ac 02C-#100 m'MA NCAC.11 r.0209 Well CumrrneMw ar+�a mvp+h°"r
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r:�r+ir ender r 7!rxdrAlsk�acdMtt oronl/rr bark nflAfy fern!. kX$f d or 1 wdl dalft:
R.for GcoprnAeMPT m•CImea-Lanp GentbermilI Wells hVing iha sArne You nwA use liteeta bock of Ibis page Lo Provide MMlli ii tvel)she de- crt Weil
IVIVNIn+clinn.onh I GW-I is needed. fndicMo TOTAL.NUMBER Of+-r.11c �+►•��i�tl�Ails. Yalt rR9y R160 RftBCh Adt1)�totlBt iA$��rt���l•
9.TOslI well depot beiow land snrimec; c `-r J —_--(R:) W �E.stp.,_.11 wNLt submit thla form'tvhltin 30 delis of rompl dion of welt
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Division of Worer amuve'v%tniy►rmation Proet Undl,
10.$teiir.tvatnr ltvcl hetntr tnp of cnsingr (11.} ,
1%mama Gmri la•tw,') ,taring,rrae"• 1617 Man Suvlce Center,Abldgh.NC,27"-1617
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f4Srt!fiole dipnretcr; IS, AR•) 7Ah.Ror I[tlectioB3Y.dl to addition to Sending the forte loft 111101 at in 240
+dtnYr,8t�,,ubtnit one copy of this form vullbin 30 days of txtto+pletlrnt or well
1�%Y¢ii conAtnietinn methnd: d-O lk I---- cnnstntclion to the MICR)ng:
(i c,nre0"rntttry.Oblr�dimst Milli,ctc.)
Dlvmon ofWater Rratol>UL Undergtnnnd iBjetfta CORMA Pragillm.
VOR WATCR St:P171i WELFA ONLY: t� 1636 Mott SUNI a Cc R'altdgir,WC 7-709-1636
I3a.Yfel01ltitm) ittlathfal ar lol! i(�C 24c for Wntcr an •&leierflon'W�t� to eddikltm to inning the ram to
- —^- the oddm.Ocs) abnvze also submit nne Dory of Ibis forts WIM 30 logy or
t9A.t)tstntretlon tY1re: .Mnatmt: eampk"On of W41 ix nSUMxioa to the cDanly'k8 tb dc(Mocrit of fba Murilp
vrh'arC coAstnrcttid,
!rxm C:tl•'.! Nmtl,Cnmllonrmpnrvnent nfthwtninnento lity-1N%4st navvmm Raeoa+"Qnn R+t.rise.l2 Z2-7n16