WI0100415_Geothermal Well Construction Records (GW1)_20160204

OP-0-THERMAL VVELL.CON' aRU 1Q' ci;Ak
w.ELL CON. ... . .
This forme -be medfrsingleormoldple walls MAR. 1 4
1. Welt Contazc@rluformation:
NC Wall Contactor Cedifi n en Needs,
Yadkin Well. Company, Inc.
Company N.,ca
2. Well Cens6vcnonPermitg: (1/xdl 0o/Y
taranwM¢nblt wdtammra,=rmnpernnrtrya. ca,my, Smre, r manna, ne)
3. Well Use (rhed{well use):
Wxter SuPplY We1L
OAgricaltural pManimpahPubliu
OGeothermal(Hesting/Cooling Supply) DResichadlel Water Supply (single)
oludushial/Cmmnemisl CReaidermad Water Supply(ohased)
GAquif Recharge
oGroundwatar Recauniatirn
0Aq➢1@r Storage and Recovery
oseVnityDealer
❑Aquifer Test
uslonmvater Draivye
oll,arimadd TacMology
Wobsideece ContmL
VGeothermel(Clased Loop)
OToscer
4.DRtc)V,dl(6)Completed: 6-74(0 We11IDq
sa.WalLraa,athm p Phone number
PacJity/OrmerNmw FawlityIDM(dappGaable)
V190 otil }VC. (k /l(of um.,4-,c, 2fl13S
Physical Admear, Co, and Me
19fu-ke 2721-�(_cw8)-ao7
Carev react rdasuff-a va.(PM)
56. La duude and Longitude in degrcca/miuutes/seconds or decimal degrees:
(ifwdl geld, one lallongissuf6cienq
3S- uo. S'y/lS N b/° 37. S"70 w
6. Is (at the\vell(s): �Permavent or CTempotMy//
7. Is this a repair to an existing well: Oyes or RNo
{Jrbbpmxpainfi((mrtk,mwavell cmnmrcdct Irf... sea, ondealahle/re clue flhe
repatroardc,0.21nnnnbemffee m' .,,[,a back enhrLrfa,m.//
S. Numn, cfwclis constructed: �o] .dSP�gl `
Fonculagae0,yecnon mvmnmefnvirppinvelh GNBywhh the's aomnbnnb, yopmn
mAmn Cnelrm
9. Totahveli depthhelowlendsurfscr. S0V (ftJ
F,..... /Ipinodlt On altdeph.Udf7ru,r(ecanPle- 3@200'm02@100)
10, Staticwstet levul belommpaf,.ei,: (ft)
Ifwaterlevel rt ob— —a, son "."
11. Borehole diameter: b/ (fit.)
12. Wellconsh'udion meth ad: Rotary
(i.e angs,mtsay, cable, dimete %em)
FOR WATER SUPPLY WELLS ONLY
Fo:Ll�mrml Daao
2 lU
r:
9 RA
]4. WATER^uP
S
PAOhI
.TO
➢PSCRIPS}Ox
3 a'f''ltio0.
eye
-----n
ft.
13.OUTEftG
PROM
N f'mulH-east wells OALINBR
i0 ➢LUrt6TCR
ifs
TIRC[MPSg
lice Iel
L4IMIAL
tt:
fM1 (a.
16.RWERCAM
OR.T 1NC eol4ermel dafeJ-too
PROM
TO ➢}MIEinA 'rRrCIPR66
MATC¢W.
R
1R. 10.
17, SCREEN
PROM
To
➢tememR 6Lm'a2S
m,,m,Ms
MATeMe,
ft.
18. GROUT
pnOM1I
TO
h1ASIIN.4L
IPLACRhIRNSh1RTA0➢& ollxl
R.
fE
et.
It. 9ANll/GRAVEL
.PROM
ACIC
To
!a Hum "
hLyTPRIA4 PaBLACGNLNihICtAOD
ft
n.
R
n.
2..DUIIJe!GLOG
nmeb.ddid
... I s5eets lfto- as,
MOM
To
nce CuTc.ox ee.e eama.,e ,ennea,
[ O"•
Cam' .n.
/NP fJ�.r.1 �FGi4.
EjCt n'
,SOO R•
%LlCOfcs /t.
R.
0
fe
R.
n
mop v
tt.
ie.
21. AEbfAR&S
of loos es, Bore Ilia. of 10o s —
22.0 I 'Seattle.
s' fcmi welt Coweaar Dam
Wres,g 26 jump I handy M"ll tlmnha nsl(s) nwt (one) scntln,ah olh. emoMarme
ofth ISAMAC 02C.6I00 m'JSANCAC 02C.0I00 NIICemoolHon Smadonls mrdrbnrn
eapy of fhit remi N but bee, p,nvld d fa ebe well owmr.
23. Site dingram Or' addltlemd Nell details:
You may use the bade of this page to provide additional well site details or wall
conshuction details. You may also ehacir edditianel pages ifnecessary.
S(BMITTALINSTUCTIONS
24v. Far All Wells: SWmit this form wiNin 30 days o£ completion of well
c onstruction to lha following:
Divle/on of Water Quality, Inrarmatioss Precessieg Unif,
1611 Mail Service Curter, Rxlaigh,NC276993617
24b. Par Iu submit Wells: In addition to sending Ne farm to om address f all
abovy also submit l copy of Nu fo}m within 30 days of completion of well
ansNrctionta the following:
Divisloa of Wafer Quslily, Vm e,,mmd Ioj,cH.. Central p ogtsm,
1636 Mail Set O's Curter, Raleigh, NC 27699-1636
13a. Yield(gpm) �� Method attest: 24eP W t '9mmd, L>I' t' W ll nddhiontvsendingthefomto
The address(,¢) above, also submit one copy of this form within 30 days of
completion of well conconicity
traction to the sty health department of the coon
13b. DisinfectiaD type: HTH Amount: Cups where conslmcted. ty
I%
Fee-QW-1 NONa CoolicaDVartaxed ofFmicamoent and Neutral Resonance—Divitiad cantons, Quality Reviaadlm.2Ol3
/6. Data site Visit-edc 1e_21-fs- BY: osa'

(, `E --THERMAL WELL
N
1. Ws canfra,maawarmaee.: 1 MAR 1 4
NC wepe°ntrecmr CeN6catloe NumLer
Yadkin Well Company Inc
C°mpuryNvu
2. Well canat:v<6on P<rmlfk: Otl;=O/ A�/jam
Lrared noraaaa wdi<aun,r<rmr,purmn p.e. ennry, ran. mwa<,em.)
3. Wdl Use (eheNnvell uac);
OA,let ltvral
OMunic)pal/Publlc
OGeothennaj(Heatinp/Cooling Supply)
ORwiden5al Water Supply(single)
Oholwhisl/Commercial
OResidential Water Supply (shared)
OAquiferRecharge
OGround,veter Remediatian
OAgai£er Stmage and Recovery
ogabnityHanior
OAquEo Test
06tmmwatuIDminege
�0aperimevhl Technology
OSnbaidmve Control.
96e0thermal (Closed Loop)
ohacer
4. Date Well(s) Completed: We1lIDq /'-1' -- QQ
sa.WalaIo,Iannn: Phone number
FScil,tylOwnerNanre yaaitiryl➢%(ifapptiesble)
PLydcil AaG<ss, Otg and Lp
Q fnY�'LC� .27y) - 11_ t7 afRi- 662J
Co., Peael WendOeadevNv. (PM)
Sb. LSdfude and Lvngfivdein degrees/minutes/seconds or dedmal degrees:
LEvell6ela one laN°ngisau(ficienQ
3S' uo .z'S<G N_b/° 37. ]3 w
6. Is (are)tlie well(s): Egpennnnent or UTemPma,
7. Is this a repair to an esisliog... if: Oyes ar R
tJrhls is nr>�ir Jil(au(br°nsr we(f<ommrcrrmi]rl rnro'knmrde.pla;g0en...aoflhe
r Pm} corder#21 rnnarb e...;ae e, au,,a bn/c�koJthp/sfmnr,
B. Numbnofwelis conshv,ted: 1r oT
Far nulnple Fr/ecrlen arawwimneiDPY we(G ONLYwIrFpaann mhrrerfe"',o
anarnrr anal rn. "`° `an
22. Ceryfl,eAen
...me, Lj a^S 3djb dl CegSa¢ elrrun4nd°r Dale
v4rF SANCAC ]C.0 00aay15A NCACO2C.030(0/FellCarunaXor sood rdao dibeta ropy °Jrhp noel d hm bmr pr evrded ea the welt anon.
23. Site diagramoradditianal well details:
You may use the book of dais page to provide aMid..4 well site details or ,veil
wstmctian details. You:vay also agadradditional pages ifnaessvy.
-r
SUHMITTALMSTUCTIONS
9. Total well depth balmy land surface: 4y -S'L)L (ft) 24o, par All Me,; ; Subunit this form within 30 days of completion of Iva]]
Fo. ....hpfnrefls fo,°uoavh ldU/rnn(eaeonstmetiento the fo)lowin,:
➢ oisien ofwater Qmlity, an£ormminu Proeessieg Unit,
1611 Malt Sesvicc Center, Raldgh, NC 27699.1617
24b. Far Iutert'e Well,: In addition to sending the S tm to the addrus )n 24a
abovy also submit a copy of this four within 30 days of completion of well
eenat:uetion to the following:
FOR WATER SUPPLY WELLS ONLY: - Division of Wafer Quality, Underground Injection Cnn"'IP .gram,
1636 Me"Service Center, Raleigh, NC 27699-1636
13z. Yield (gpm) _Methadnftest: 24e. Par Wa[m5 I &II f C•-• 'sadditionlos,ndingthefmmto
the add.,(.) above, 'is' submit 'no copy of this farm within 30 days of
13b. Disinfection type: HTH AmauuC CUPS eompletlen of well coastrnetion to theco,mty health depadment of the eeunty where constn¢ted.
10. Stake water level below top of a°sing: (ft)
JJrvarcrfevefnubare maNg, eve"+"//
11. Herchala dlamefen b (in.)
12. Well conattvetion method: O
(i.e. auger, re lay, eable, dveetpuslye )
From Dw.l Nonaand N.1—IRcsaurees_Divlsion vfwater Quality
16 Data Site Uisii-ed: Jg_21_JJ. 13xe.naalm.zal3
Y� ore

CE
CJl�tn9ee� dQJ'i�n
-la Only 2 &h°3
e
3 A G3ov
R 13'
l N 3s" Ufa. sy,f
LA/ 37, S70
2N 3S'y0.Sky+
10 8/' 3714573
3 A) 5,-gk
W Sl ` 37. S 7S-
Y/pa1
'Vdnagon 13jetfk;
2 iq 1 OI� of
Iqvl'ga?joh A/C.