WI0100622_Geothermal Well Construction Record (GW1)_20210810

Feb 1519 05;43p Clearwater Well Drilling
828-622-7241 P.1
WELL CO1,T R 7 TION RECORA GW a. For inicmni Use Only;
1.WrllfAntr•actorInformation:
1-5h lYl 1 11 1 11J1 t
T
14.WAT ZONES
TO nlsrRn't)ON
Wdl Cothtraclof Name tt fy,
t• It.
vt:Well C'mmclor redificalinn Nomber 0T1 fER CA4IIVti for tna10-cased vralht tDR LtVFdt n e
CO3 1s n l L trBOM m PIAMETLR r1tCKNBaS MATERIAL
tr. et, in.
Cnmpnrw Nnmc
r(' 16.LNNBR CASING OR TltRiHG thermal cMlatlaca
2.Well Conntruetion Permit#: WT •-D 1 yv U a M -tn nuMCTnt rntctav ss MAtFJUAL
h p, in.
i•Lv/all np(alimh(r welt cnncrrurrinlr parat(1.c(l.c.f/1C;,C,mrrxy,Sm1 lrarla»ce,cr;,)
n•, k. in-
3.WrlI Ilse(rhetk well list)_
Water Supp y I+
I Well:FROM
8RN
7A n AM7i'RR '..SLOT 9Q6 Tma"
AgriculhtratMrmicipollPuhlic p, tt in.
Crcaherntal(1•leating/Cooling Supply) Residential Water Supply(singic) ft. fL in.
lndustrial/Commercia) Residential Water Supply(shared) •18 GROIff
ifrl°alion NROIM TO MATERIAL BM"AC kW M nI&AMDUNT
ft,Non WnterSupplywril: t+,
Monitoring Recovery o• fu
injection Well:ft. R-
Aquirer Recharge E3Qroundwatcr Remcdialien 19-SANISlGitAVBLPACK ifa ble
AquifL'rStorage and Rccovery E)Snlilllty Barrier ON TO MAT IAL attrU CCMSLV7MLihton
Aquifer Test StnrmwatcrDrainage
Lxpefte>ntal Technology jSubsidenec Control f+ n•
i Geothermal(Closed Lwp) 13TtacrA 20,p1Lti.T.l[VC LOG IxUaeb additionsidmialfwaismUl
PROM To lira RlrTM rcX7.larrilam mWro14t olrtetrpaet -_
Geothermal McatingpCooling Return) 0ther(ex lain under N2.1 Remarks) re. to
i-hate Wells)Completed: Well IDtI
fr- 2a5uWellLocation:
P:+cilih:'flxmcrMamc Facility iDii(ifMpnc:tBlr.) M ft.
N17 r On fr,
Physical Address,City,qnd 7'0 h
21.REMARKS
County Parcel Identification No.Q N)
Sh-Latitude and longitude in degrees/minutes/seconds or decimal degrees:
01 well ficld,one lat+lang is xufiieicntl O + 2,Ce1'ti fAtinn: PitNP SECTION
035 ao.Qy 0a e Io W
l r iflilH`(":,;(less T
F.Is(arc)mewell(s) crmnnent or ©ITempnrary 4 6n;fc iinaWallContractor Drnc
I?v ojLming rh+.v,.nrw,I herrhv vailljy that Ar tw:l/(.j was fxroz)crmsrmOM h?accnrAryce
ly this a repairtm an existing well: OVes or (*No r:tlr 1.SA.'VY_'Af.7 o1(7.0100 ar i5A NCAC 01C•'.0100 Wi tt Cnnslnrrrirar SlaadarA.%rmrl that a
fr'thh L.n rrlaoiC fi)!ourkrtaum urlf.oasrractimr i>:farvnalinn rn+d rsp£oin the rxrmr'c r Irhu caPv r!f!lris rervrrd hag hem proMed to the well nMtex,
mwir Under i,2(remark.%seritan or rm the had afth0ffnrn+.
23.Site diagram or additional well detaits:
R.Par Genprohr/DP1 or Gloved Loop Geothermal Well.having thr came fort may LISP,the back.of this page to provide additional well site details or well
Lxm!tlniction,o k•I C. '-t is ceded. l'ad'^ c TOTAL NUMBER of,vrlls cormnrclion details. You may also attach additional pages ifnecemary.
aril{,ttl_
ji la mEaAI..)<TMy^{'R1117 TONS
9.Totat well depth NOW land surfacc: ft-) 24a. For Al) WO1s; Submit this form within 30 days of completion of wellFarnnhiplrw.Nl.o fi,r a/id:plla ifdi,irrnr(esamnlu-3(all!!P'ondi00
ennstrnrtiorl to the fd101sing:
1u•Rtntic water level below top of rasing: ft.) Division o(Water Resources,Information Processing Unit,
awler•r evr.!!s Bhdty casing,me..'-1617 Mall Service Center,Raleigh.NC 27699-1617
rehole diameter: in.) UK For lillieetiog}'GIs: In addition to sending the form to the addmm in 24a
t2 Well ennstrnel[nR metdrtd:
alcove,also submit one copy of this form within 30 days of completion of well
0c.mL c••, on rank construction to the following:tf• *3 ,¢irwt push,ctc,l
i'OR WATER tCt:PP1.4'WF,LLS ONLY:
Division of Water IReacurceS,Underground injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
13s.Yield(gpta) Method of test: 24c. For Witter Supply&inlet Hon Wellt: In addition to sending the form to
the nddress(cs) above; also submit one ccpy of this form within 30 days of
13h.Dtsinfecnnn type: Amormf:completion of well construction to the cormty health department of the county
where constructed.
I°+mnGVt'-I NorthCnrolinnDep rimentofvi-ionmcntalquailty-Divisionof water Pewoareac Revfsed2-22-2016