HomeMy WebLinkAboutWI0100448_Geothermal Well Construction Record (GW1)_20160901DECEIVED r}
I]Msion of Water Resourrea
WELL CONJTRUCTM,fiLCORE
This form can be used for single or multiply wefTi
I. Well Contractor information NOV 9 6 2016 .. .—..__.
Robert Larry Wells x M:
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2603_A Watar Ovalltlr Regional Operations
kiheviile Rpglan-al Office
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�n^: i3IAMCTR TTiICI[1tEiSGka-.""_ .+ MATERIAL_
AWD Services inn
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V1��4J,� zJU�4"!Cl �lzD1b .-DFAMITER _FTHC-- MAT
I. Weil('onstruetiou Permi(# � 270. ��rr,
is, :rl+.rnnlirable wed! ranx!ruerin,, • . , :,:r: ... ..
0 300 • �in I fiLJ�C
3. Well Use Icheck Well loser --- -
Wafer 5ugply Well: ttte i)I471tT fEii sioTslaT? Trucxiress +MAT$RTAL
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AAgrtcuitural vilrri.. ivu :1h+h+
RGeothermal(Heatmg/C;ocimgsupp, ketirlenti:,�-
� �IndustrtailCflmmarc.ta: ItPti+�lP�+ia: rxrare! 7nnr,�•::yhn,. 8._vi€[ri - .. '
?ROM. M4TERTAL ENIFUCEAlBPrC MMOD & A1HOUlwI
' 1 �0t errna umpe
Ion- aterSnpplyWell' ��� V 9-�4: rr-a�j. .._ ._. M !T•1ped
IlV�0ilit9r111F, {:,,.• - !'
l Injection We11-e
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J.Aqu[fe: k2echarge
�.., ��. ran,+. ke�ric:7 i:ri �.,•.
7Aquiic:.911orage. and Rcc;ov-,
i
"ai • .: 'ini.
-3Aquifer 1-est
S[nnnwale• , 11Mag�
2Expenmental Technologg
,uhsidenc: )ntrn
R[reathermal (Closed Loop)
�Geothetmal (IlCatin Cool€np Retun
;. rthc ; explai, under Ream -
4. Date Well(s) Completed: 8/3 1
%,iP Flat:
5 Weil Location:
e.arl Perkins/Victona iackson T rUstee
Rani I itVi0wner Name
-n[::lih '1"1#• is•apn]G:ehEe --
74 Fled Bird Circle "Lake
T axaWV! NC. 2874
Physma,:kddress, Citri mid Ziu
Trans l_vania 85 eI '84_2 54-000
"ountti
Uk%0 idvntification ' ': ' PR•'
5b. Latitude and Longitude in degreesiminOteslseconds
or decimal degree:;
'if well field. one latnong is saffici am
35 7' 32"
82 57 12"
N
6" Is tarei the weli(s): Rpermsneni ,r Teraporlay%
'I- la this a repair to an existing well o „ XNr:
f rhi.v ,, ,r repair• fill out known well r:nnsr.-�,.•„r,•.:njnrrnorrn� -••:�• •.rnirlir [rr• :�rrr•�• •�•
spa+.• unae, ++ll remorkr.vs,fjo n nror
8. Number of wells cnnstrucfed: 5
',or multiple wfeelion nr amr-wnlev+upp17rfr• iJNI Y�r?1P ?ins .SO'me coresfrrrckare. yr»
vuhm,r one fora
4. Total well depth beiow,laud surface '@3 O 32 -
•r,. mrrlliplr .revs llsr air deptily� if diffe•�• • rrr,�rnrr 7f@..7100 r,j 10.l on,
-
i0, Static water level below top of i asing N/A
1f ware, fe,w Is above nasmg. rase
11 Horehoie diameter 8 •25 in.
12. Well constmetiou method
:.,: augei rotarv, cable, direct push :_n:
FOR WATER SUPPI.V WEI..LS ON(
13a Yield (gpm) vdethod nt teLs.
13b. Disinfection type' 'LMount
_ `l, yra!117' �[ti•)<L•s : �: :' if � {if.sindiCAl11e i.
non+
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g1477SRL11 EM1IPLACEi1f NT MMIDD l
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r(• .attach.ad''•ttouai;3lit'eYsittf- - ---— .. '
'Rr1A`
M DESCRTpTION frolor, hardaM, ..WY ck tYia N gMiu siu, e
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;• , 9/01/16
was (Mwre) .: omimcred (n amordow.,
' i 0 Well C,'onvi mcilao Slmrdurds cold ncG: -
.
rxs
4ddit[onal well details.
uage [[ rrnvide additional well site. details or vet_
.rtra- - .[ddit[onal pages ifnecessar-•
.5 gj,�g•,:
�., ut..10NQ
1`Ith[n 30 days A completion 0' Frei
'eel a Plaiity information Processing Unit.
�uxii •,rr•s•ir.'enter Raleigh, NC 27699-161"
deli:: l;i: •,: ;ending the forks io the address :r
ithtn 30 dav,)" compietion w 'wo!
• x••
•-ue" matift I underground Injection Control Prograin.
�ail4rrtiicr•e enter Raleigh, ➢5iC2769M636
�.4-U
Ott. unlc'_A1njjLtioa Vilells: u, addition to sending the form tr
i q uhrni, .,r,r r,,opv of this forrn within 30 day,;
n minty health deoartment Of the : nurt •.
wtn,c,31 : H.i%v,rori••
.'1"I;[lRevisad lay 1013