GW1-2022-03478_Well Construction - GW1_20220323

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WELL CONSTRUCTION RECORD fGW 1) For irdernet Usa ortlly:
is 1.Well CQntraetOrinformation:
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V� TIJti 1r6 WATBRZOM
wau Coft t tame FROM 1n DRSMU M
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NC Wall Contrmeor^�^ .•_ i�� I . �. .
/A 0 702 rtd S FROM To I MUMMM Ttl?c�taesa
CompanyNama
1G.7NN$RCAS MORMMG&eolhermuldend-lowl
2.WeII Const melon Permits'!: Meto>ot �o Mual lgreR � MATMAL
List atlapplia&ewdi cerium edon pvWts(i.e.UIC.Comgy.State;Ya(mse,etc) R. ZID
Lf t. im
3.WeII Use(checkwell leek ft. @.
Water Supply WcM 17.9CMEM
Agricaltural ElMunicip*Wblio O fr. ft. �, MurAMRnul
Geothermal(Heating/Cooling Supply) Residential Water Supply(single)
hiduattiaUCommerciai [3Residential Water Supply(shared) 1&GROtiT
ltrl 0A FROM TO MATEMMI, M9MOD&AMOUIr
[Aquilfer
waterftffly WeII: ft. t3.
nitoring
ion WeII:
ft: fL
iferRecharge DGmsmdwa6arRsnediatiaa sf�rIDlc,RsvBr.
lferStvrageandRecovery �5alinityBarri� teto>K To MATI3RIA1, tmrei,► erMarsoD
Test OStonmvaterDrainage D- it:erimental Technology SubsidenceControlthermal(GYoselLaap) Tracer 20.DRII,I3hIGLOG aftacbadditionala6�ifthermal Co • Retum Other(ccplain uader#21 Remedss) MMM M VWCRWnON Wbr wW;a
ft. ft.
'.• kDate Wells)Campieteda 3 1- 22,WeIIM#
5A.WeII Location: R`
I R. ft. MAR 2
facillty/OwnerNsme Fac•HtyM9(tfapplicsble) ft. ft
- -7100 PArl;noycN1 P,� • fd- %W ft. �. P � uIxi
Bhysicd Addrem.thy,wud ft rc, F "i
PP � 21.REMEARES
E cou* PatcelIdeatificationNo(PII� Pat F To'1 MaXiiaClr
3b.Latifnde and Iongltade in degrees/tmrinnteslsecoads or decimal degrees:
Of wall field.one latflong is sufficient) 22.Certification:
i W
6.is(are)the weU(s)&Permanent or DTempoM7 sigubm of Weu Casaaotor Daze
t�G. BY Agrlfng I Eby'GW45'drat tht MRS)war(tire)nvrsnitaed fit omondmroe
7.Is this a repair fro)an ex s�sctingwell- es or ETp with ISANCAC 02C 9I00 orISAMAC 02C MW Welf CoawwftStandards and dwra
Ifrhtrtsa repair,fit out Anown well canarucrIN-Infornration and eaplafaftnarreofdw copy offtrawrd has beenproddedsodr v"oimw.
repairunder#21 remarkrsecuon gran the backofd4 firm
23.Site tliagtmm or additional well details:
8.For Geopt:obe/DPT or Closed-Loup Geothermal welts having the same You may use Ike back of this page to provide additional well site details Or well
construction,only 1 GW-1 is needed. indicam WrALNUU BER of wells eonsttM edon detailL You mey also attach additional pages ifuecessmy.
drilled: � � D1T;it'RfJ('TInNC�
9.Total well depth below land sarfacm )6 O OQ 24a.For An wells: Submit ibis form within 30 days of letion of wen
For multiple tvdIs list all depths ffdff-Aw(er:ample-3Qa 200'mid2@100) I p
construction laths following:II
16.Static water level below top of tmaingt-J.� (ft.} DttdaIoa of Water'Resources Information Pimcessing 1},voter tevet fsabove Dosing,use"�° 1b17 Melt Service Center,Rateigb,NC 27O Q�
t
11.Borehole dlameber: 206 f+br Inlecdan Werra; In addition to sending the form m the address in 24a
12.WeIleonstncfien method: above,also submit one copy of,this form within 30 days of completion of well
(tax.auger rotary,caW duectpudi.eta.) -7'— constnMctionto IIMo following 1
FOR WATER St MY WMM ONLY: Dlvlalon of Water2e9omba.UnderawandDdecitm Coast pmog,an,,
1635AU$ta OOOmter MOW NC1769NUM
13a.Yield OM) Method of Ustt 24c.Bour Srmnly&Lni Wens In addition to sending fire form to
N-Tthe add[ea(es) abom also submit one copy of this form within 30 days of
13b.Dismnfecfion type: f! Amount: t0.S"d � completion of wall construction to the country heath departmcat of the comity
where consuacted•
Fottntwit-1 NorthCuobasDepamm aafBmdtnmantdQmhty_Divi mofWawResontees
Revised2-22-2016