WI0100586_Geothermal Well Construction Record (GW1)_20200708

WELL CONSTRUCTION RECORD (GW-1)
1. Well ConireMr IMormation:
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Wnll Cnvnu:m Neme
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NC Well Conmmor Cenificetivn Number,
y1/��1�P(]���_1�_ Qy,< Ir%
`om4gY Nate'° V
3.Well Use(eheckwelluse):
aublic ('
WetefSupply (single)
wale/Sr{af (sllprep)
Rechmge
UUmundweter Krone
Storage and Recovery
❑Salinity Ranier
Test
QSearmwamr Dmimt
canal Twhnoloav
[I Subsidence Control
(Closed Loop)
4. Dale Welge) Completed: I ( (G© Wen roe
Set Well Location:
i QasP� beta
facility/Owver Neme ���.� FuilirylDN (ifapplicebla)
(naf 2eei�c Ut-t'k oftacxu'llelfx °
Phydral Address. Cary, and Zip n,
County Parttlwantificetivn No. (PIN)
Sir. Latitude and Ion®lude in deseestminums/6econda or deelmal degrees:
(ifteellsaid, one lePlmg is suffide.) cr /' �,�/ 22.0e eaiRm
O 1 • I) 2- /f N D Zd�190' 4101 �w'! ff W
6I N lk)M a nent or yTemporary Si nofCmified We mot
For Internal Use Only: 7r
Y622-
11 WATER%N7BS
PROM SO
DESCRIPTION
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I6. OUTER CASING ff.,mrld.ured
PROM tax
wells OR
DIAMETER
LINRR. a Beetile:
TRICRN6ss ta,rDnAL
n. n.
16.INNBR CASINGOR
PROM 'r0
TUBING e9d:nmaldleand.
DIAMeTBR
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MAl2R1AL
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SPRIT
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IN n•
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I
114
DPE
.19. CReeN
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ID
DIAM6'IY0.
6LOT 5128
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MAIBRIAL
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In.
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i0
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885
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1) n.
10115 n.
Tj R.
tt.
19. SAND/GRAVEL
FROM
PACK
'r0
Ke barns.
MATERIAL
EMPLACEM6 TMn'PROD
n.
ft.
n.
n.
2M DRILLING
PROM
LOG adaebaE4lRorml
'PO
sheets nneaeMa
DPBCRIPTION eabn M1a:tlna.ealMvek nln pv ek.l
n.
n.
n
ft.
u
ft.
n.
h.
tt.
h.
n.
Injg,;lDa11qu 2r riffislEfilUlllt
ft.
ft.
DNR Section
21.REMARKS
Date T
. a(ere) ewe a
p.ti'15A this joint 1 heresy certNCACl rna war (x¢rel eamxrarlW Imes d,Wl.
Well Conmuprimr Smveardr and rhmu
9.Ia U elfngreapp ❑Yea or No
.02M)
coop I6ANrawrdh.OloOmoiidMoCd2L02W
Ijrhu' npvinpilnwkm�wn well mnavunlon 4Fmnia and explain Me nature Jme
is,p not kmrw
onpr Jrhtrrecnrd Laeheen pmridedmrbe wegnwner.
repair under as revmrae secure or au the hack ojOnx/irni�
23. Site diagrem or oddidimad Well detects:
You may use the back of this page to provide additional well site details or Well
8. For GeoprobaMPT or Closed -Loop Geothermal Wells having the same
construction details. You may also much additional pages ifnecestary.
contraction, only l GW-1 is needed. Indicate TOTAL NUMBER of Wells
drilled: :]- pCC;
SUBMITTAL INSTRUCTIONS
C
9. Total well depth below lend surface: r.2 \'^' �J A)
yy, For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depde rjdlagrear oramp/e. 3Q200 and2@1110)
Construction to the fallowing:
10. Sta", wamr level below cop of<aeing: Q`�IP, (ft.)
DivTon of Water Resources, Inforep ation Processing UrdL
Ijwmer level is vbma e-i,. to, "� "
617 filed! Service Center, Raleigh, NC 27699-16 V
11. Borehole diameter: I Z (in.)
24b. For Induction Wells: In addition to sending the form to the address in 24n
t,
cayCI
above, also submit one copy of this form Within 30 days of completion of well
12. Well construction method:
',,
construction to the following:
(i.a..n6er, mMty, cable, eeaatpmn. am.)
Division oPWater Service, INIC27 Central Progress,
FOR WATER SUPPLY WELTS ONLY:
endergrelM
1636 Mail Service Cedler, Aeleigh,NC P699-1636
it
ISO. Yield (gpm) Method oP test:
2hk. For Water Supply ba Injection Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form Within 30 days of
•
romilefem of wall connotation to the county health department of the county