WI0100456_Geothermal Well Construction Record (GW1)_20161004

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I. Well Contractor lafOr
Josh Plemmons
Well Contractat Namo
ivED 441180
ar Resources lrnr lmamal uee ONLY;
JAN 23 2017
4.137 A j Water Ouality Regfonai Operations
NC WallrtisnanotnrrenlflcaSienT unbar Ashaviile Regional Office __
Clearwater Well Ddifing, Eno, Hot Springs, NC 287'�43
Cnrnpanp Namo ry ` Fyn r I [�]
I. Wall CnnstYnctian•Fnrmlk#.._ Y V j, L] r i.+C! '
1.lxr rdl appllmhle umllpsrrulru {Le, Gn+rrny Slate, Varirrmlca, 4r-(Uix, err j
3, Well tlse (chock Well uta):
❑ ri.euhurn) 0municipalmuhliq
t3eafitcrmpl {fiealpnglCealingSupply) rMastdcatief Water Supply (singto)
❑lnduarisllcnamteMpl. 0110sidattiel Valor Supply (shored)
C1Monilari
MAquiter Redi"
EIAAui far SW&p and Recovery
MAquit'er'FeFt
FiMperimanial 7 eelmology
l3GoothermnI (Closed Loop)
riGroundwater Remediatiun
f�Salinity �iarrfer
C1Starmwa�r �]raillaer:
t7Stlhsidence C'ontml
Mhcer
4.11a1e wcu(s) Carnpietcdr'? 36 --1(avjj W
Ba, Well Lanntion:
d _.
nncifiryl4wnarName FaciliwIN012
M")_aq
l�
yl+i viol Adrhras City. And ZAp
Caumy Paruei [dgWfirOnn No. (FIN)
ifs Lalitvde pad I,engitudo in degreoslminittestmenads or deeimni degreea:
Orwell finid• Ono latllnn is sufhvoa 0
�- 1q W
5. Is (are) the walt{s): �Rormauetrt or 13'i amporary
7. is trrfa a repair to an estating•wcf3: DVOR or 46
PhO trn repnr , j11IOrdh mm wall crosftnmlklh irr(armalMn nadCeph n the rWlrrre of tha
ropafrrarrlar 921 nanrgr$x arllrm or❑Ir Ihn hack of Ihl vulva
B. Nnmbpr of wclla eanatrnetad:
tiny Mole hUccrinvr nr rra,t mrrrarRelfy,lptr dla Pwp)1 lha �ppte eapdyyrpcyrgx, yy,rr rrur
vr�Mv+o Ir rvrr, jrunr, �r/yU
9. Tatar well depth below land surfacer
pnr rnuplpin arils Altair day &ljdWareal (exdn+pla- 3 200' arrsi��1A0') .
. ra
��4lE�IRM�ws
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r
�753_
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T. t I Yi
22, Certlllearinn:
Ip
- /t. ___
elpn+oiCereiRM well CMa&curr p
IV 1144rr►9 Ift firer, f lrrr ba ' oarlO rhdl the nv,tl(j 1tar (wow) rniraslnemed k acr•nnfwre
v0th I" NCA(. OW- .17100 nr I M NCAr 02!` JMM WON C'orrsntrellna Xrrrnddrds and Mae a
rv,py n{lhlx rar Okm haenpmWded ra rha w..11 nlsalar:
23. ft dlllgrnm or diddiftal well dehila:
Yv[[ may use the bm*. of !iris page la pmvidc additimal VM1 site detwlla or Well
coisinlofion details. Ymrtnlmy also attach addittanal pages if nenearary.
SIUM""'AI. I NSTUC RONS
24o. Far AR VYbits: Submit this fort vAlhin 30 days of completion of well
e=ltmrtion to thr: fallawon&
ID. Slane water level below top of easing: � -- �. {pp,) blvlsinn of Water Resource% Infarmatinn Plneesaingvolt,
jjrsmrrrr 1c nellrnhnra<yathr(� rrnr. "+ ' 1617 Mail Servfen Center, iRafefgh,14C 27699-.1617
t f,llfrrehole diameter: (In.)
ix. Wcil Construction metltmh
f I.e. ;urger, mrsry, "ble. dlwtrush, eto.)
F[YR WATER 9T.TPpLv wt IL I B ONLY:
13M. V104 fapm) Method or 6car; Y ..�.
lab, DINIn&ctinn
x0, For inibetion Wel!? [?TlI,B: In addition ra Reading -the form to the Addtees is
Mo above, nlsn m raft: a copy of this tbrm within 30 days of compf edon of [tell
c:oa*ucti[m to the 'tellowinx
JUVI?fan of Water Resource?, llnttarground 1111ecdon Control Prngrom,
I6M Mail9ervfre Center, ltaflAb, NC 27094636
tAe.lzes& TWagkPWells:
Also srlimlift one copy of this farm Within 30 days of oarapiation of
well eonalruction to the eDllnly health depnrtment of the erxintywhere
constructed.
r= nn r3rv�r MmviCamltne Dt
Aa►tmen t of ilrryimmnnnt and l9anuni Resrnlrooa .-1Yiviaiorr nt' Wirer Raamrrtxr
ItoVhscdlingaet2pt3