WI0100593_Geothermal Well Construction Record (GW1)_20200918

For Intemal Use Only:
1. WeB Cwlrwcmr WormaHon:
�a Ls �n Gfi 6mn
Win Con;nnor Nome
zq; -A-
NC Well CommMr Cadifimlien Number
Sa r-ixcP C I I
Company Neme
2. Well tbmtraction Permit in I Qi 01 C10 5 9 �
dal mlaFpapem wanronsnarnnx2tern,n, case. we. aa,Rr, saN, vaemxe., ete4
3. Wall Use fah«k well use);
❑Mmucipal/public
(Heating/Cooling Supply) ❑Rasidensial Water Supply(single)
a .... let ❑Residential Water Sapp ly(shmed)
Rechmge
❑Groundwnrer Remediaticn
Storage and Recovery
❑Salinity Barrier
Test
❑Stonnwater Drairege
ental Technology
[3Subsidence Control
a.] (Closed Loop)
❑Tm«r
4. Dam WeRG) Complestath 1111112A Well 1D6
6a. Well Location;
DonB.td KirauS
Feci1i,1Owner Namv Facility ID# (ifapplieablvl
42. rool-wD I CA AshevilleINc z8sal
Phynviml Address, Cib. and Zip
C3trr13:i:1 q 'PgITb5.' 00000
Counry Parcel ldentiflcatian No. (PIN)
St. Latltude and longitude in degrae/ealmder/s«onde or detlmal degrees:
Iifooll field, one lWitingn eoffinNo)
35"A'z•124 N Rid 35' 12.27(1'f w
6. hums) the weh(s)aanent or ❑TempormU
7.Isthisarepaistaanexuakagwdl; ❑Yes .,El-'-"
(fmLG n"I"fi6 sm krown aen,.nnenuanm hµnn a so eow.fire sour,'gme
.eyahxaliol2/reniarb.v«rinn- or Is, hack ef1h.fi n,
8. For Gmprobe/DPT or Closd l oup Geothermal Wells having the same
constmmion,m IGW-1isncded. Indicate TOTAL NUMBER ofwells
drilled: R2W ZE GP
9. Total well depth below land surface: a 31.J �+ iR,)
F„rmul6ple wells 24raNJepO,x jfd�rem (esamy43@200w2ss/00y
10.Shticweterlevelbelowmpofordng; 01"L (R.)
l{wln lose/ie'ahore rmin6. me'•.•
II.BorxhDle dhmeter: .r1 IIZp (in.)
12. Wall construction method; 0. sups. one'. Sabo. area puts.
puts, ems) 7
FOR WATER SUPPLY WRY LS ONLY;
13a. Yield(gpm) _ Method oft«tl
13b. Didnf«fins. Wpe; A.m.,:
TO
DESCRIP1ION
n.
R11WATMMICES
ASING ear mulRnmd rods OR LINER a
iNICKNEa3MA'1'RR
doM
h.
Is,ASING
OR TUBING Normal clawd.
i0
DIAMBTTR INICENias
MATERIAL
32 "•
0 "•
.t x2l"' DC tI
Mq
315 "'
O "'
1.25AI R' S 211
I NOPF_
If. SCREEN
PROM To
rehaliddilk
I BLOTPIEE
I THICKNESS
NATURAL
n. h.
In.
18. GROUT
PROM
I TO
I MATERIAL
EMPLACEMENT METHODS AMOUNT
ft
fie
315 "•
O "'rtherm
fn
n.
n.
EAND/GRAVBL
PACK
Ra
.
FROM
1 TOI
MATERIALn.], I
EMpLACEMBNTMRTNOO
n.
h.
24, DRILLING
LOG andanaddmond
Nave®
PROA1
TO
pNeb
DESCRIPTION oo LNn ra1V
In, µcal
n.
h.
7 1,
n.
n.
n.
n
NREMA--.-.
erQ
11shovilli,na10
.
22. Cart 'r etiom n�D CO
nnure."emmaill Conrteeror DNo
81.lood R this I-. / h.veh,;' [oIRI that or. ,nx6vl Wa r-) rnnfol¢I.d In ace-du[e
.111, ISANCACOSCtrionor ISA NCACO:CO210 Well Co-mr,l-Swr0000 -drool.
, n/ Ih. -1d bus hem Pro, &W m lot neo owner.
23. Sim chairman or additional well details.
You may use the back of this page to provide additional well site details or well
Irmennctiondehils. You may also attach additional pages ifnecessary.
SUBMITTAL INSTRUCTION$
2". For All Wells; Submit this to. within 30 days of completion of well
construction to the following:
Division of Water Resouro«, Information Processing Urdt,
1617 Mail Service Cent«, Raleigh, NO 276".1617
24b. For Induction Wells; In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of complation of well
construction to the following:
Division of Water Be., Ured«ground Iodation Control pra®am,
1636 Mail Service Center, Raleigh, NC 27699.1636
29c. For Water Su"ole & Ini«Sinn Wells; In addition to sending the form to
I
address(esl above, also submit one copy of this forth within 30 days of
amIllation of well conatmetion to the county health department of the county
where.ansbucted.
Fonn GW-I \WhCarolina Depa.lmntat Em,i nmertaiQminl Dorionef WAea Rncwxr Roised:...016