HomeMy WebLinkAboutWI0100446_Geothermal Well Construction Record (GW1)_201608112X Certification:
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7. Is this a repair to as etrbtiagwetl: Dyes or �i¢O whh IS.! Ni',4CUIC.d100 or 15A 1�4Cp3C.02Qlf �'af Courr�ncrlwa Sran�dr
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IL Plumber ofnuella wommetedt You may use the back of this page [a ptuvido additional orall site details or well
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9. Tots! well depth below land surface:
Fnrmuhr�feeWIs#51,91Aepfha(fdr�eremr{COWd' @2ppd 1R9U Iit) 248. �AWft Submit this AM within 30 days of aanlpletion of well
' eanstructinn to the TurlawioF
1 Slade water level below top of eaaiM.
IJnnrerfewelfaohoveoasbrg, ura ^+" {�)
11. Berehole diameter. (in.)
1. Well Colatraetor ful
Rex Meadows
Well Co»>paomr Name
2113—A
VE ^a 1��!atonal'U.ONLY.
�r Resourras
438873
NC Well canizacrorCer:0iioetiaa Vmb 'r C)il'rfity Pt'C1ipnRi Operations
Rs't=t•.i6f a #"s•^[3 n Arai C]ff
Clearwater Well Driflirzg; laic. H Springs; UC 28743
Company NM=
2. Well Construction Permit#: �bi 61
rrsrarfupp,rrxreflpemfra�Q.Cow,ry. �..—._.___
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3. Weli Use (check well usM),
w IGGiiilral 13MunieipailPublic
Geotltersnal (Hesting/Cooling Supply) ❑Residential Water Supply {single}
131ndumiaMmnuzcw I71tesidential Water3apply (sue)
0AquiferRecltargs !;][iavuudl Ia Remediation
MAquf iijr Storage and Recovery C]ggWty Barrier
ElAquifer Test 11Sta,nwalarDminape
❑Btomirortrttsl Technology CiSubWence Control
❑Geothm mal (Closed Loop) 07mcer
4. pate Well(s) Completed. Well i
58. Well Location:
FaciGrylllwner Ise �`
iraaillty 1DN Crf�plicable)
Ptrysiael Adttr+ess, City.
p 1
>y C�
Pkeel Idemi6wdan No. (PIN)
5b. Latitude and LouglkAe in degreesfmiaatca►aeeonds or decimool degrees;
(if vMlt field, one?&&no ie =M'jM)
° 3,
Ca Is (are) the rrell(s). el Tent er 01'emporary
DMOM of Water Resources, Iufor Mrs,, Proacasing !Fait,
1617 Mail Suvlce Canter, Rahigh, NC 2769N617
24k ONLY: la addition to sanding file ibrtn to the address in
11 Well construction metimd. 24a above, also submit a C" of this fors, within 3i1 g um ewnplatieat of wail
(i m. aegar. MUry, cable, dirrctpwh, at.) coroructton to the following:
FOR WATER 91IPPLY WELLS ONLY:=...construded,
Y) W110.n of Water ReeoQreM URd"mund injection Central' Program,
t636 Mail8"ce Center, �teigh, NC2M9-i436
f3a. Yield [gprrr) Methndat'taest24c.�ar_Water9uaalvd�
L��..n AkL wlil$:
k3b aTectina types Also Su6tnil One onpy of this fbrtn within 30 days of corltpletioa Of
Amotrat:well cAmstmetion to the county health
depardttent of the county WhM
Form GW.t
NonbCarolinaogM&nMtpf15aY1fep111 M1tadNstttrri
Reromeas— i]iviaien at'Water R4ra4rGCA
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