GW1-2022-07664_Well Construction - GW1_20220818

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Coon/tractor Information:
i//�yi+Jl{ �✓JLtrr[rf L •�.l,v jar>l(/ 14.WATER'/.ONES
-- — J rROM 'rU DESCRIPTION
WW"rllQ{<on7tre/c,,tor Name241 fl. ` 0 fL
rt. ff. �+r�_ c IILL /s Co
NC Wc0 ContractorCcnilieaturn Number 15.OUTER CASING for multi-cased weIts)'OR LINER if a icable
` / FROM T(1 IIIA\IFTER ' Il11CKN{:SS 1IATERLU.
CG�SLbL /MINA e ff. ft.
('ontpany Naito
Ib.INNER CASING OR TUBING eolhermal closed-loop)
2,Well Construction Permit 4: �! /; r r ,9 FROM ft. To ff. DIkMF:I UR THICKNESS NIkTERIAI.
Lµ7,(!1 aplrlSvtldr,req[aac'n7aviuo I!rrurrls If.,, (.`l('.(•canto•.Flutr, I hr inm.•r,rlrl
in.
3.Well Use(check well use): ft- ft. in.
17.SCREEN
Witter Supply Well: FROM l"O I)LkM ETF.R SLOTSI7.E I'll U.XNES". ?tATERI L
Agricultural 0M till icipal!Public ft. n• in.
(7k.x,lhcnnal(I lcaling'Cooling Supply) Rcsidemial Water Supply(single) ft. ft. of.
Iudustriab'Conunercial OR�, IM,I k4'lu Iv IR,GROUT'
bri ation ri�,a. ETI V FROM I'll, MATERIAL' EMPLACEMENT V{'nun A AAIOUN"I
Non-N'ater Supply Well: (�t(ff''! Q (�
Mortuoring DRe,,,Ar ! V 2022 ft. ff.
Injection Well: ft. ft.
Aquifer Recharge DC t"tih;"OR Uf1t I
QiBDG 19.SAND/GRAVEI.PACK pfapplicable)
Aquifer Storage and Recovery Salinity 13:1fr1(?'r FROM TO .MATERIAL- I:kI1'LAC{:MENI%IFTIIOD
Aquifer Test DStonnwater Drainage ft. ft.
Esperimental Technology QSubsidence Conrol fl. ff.
Geothermal(Closed Loop) DTmcer 20.'DRiLLING LOG attach additional sheets if necessary
[7119iff'm -pl DF.SCRIP'1'If IN color,hardnce mil/rockit a min air etc.)
Geothermal(}Ieating/Coolin'Rewml Other(explain nnt}lcyr!:21 Remarksl 0 n, ft. e C /c
4.Date Well(s)Compicted:7 I S-2 2- WW'ell ID#-S ' 3 Sft. ff• �`��t l c T s w�
S/a.N'cll Loca ft.ft. I
fL Cc£ 3c!` r i�-.:�r�rflv
Paedilv!Uwncr Name F9cilny lDl+(iRµfplreul)lcl r") ft
ft. i• •7r%��7 •
ft. ff.
ft. 1
1'hcsicul Addles,.Ctty,mid 711,
f� flrf j�.J(U � 21.REMARKS
('aunt Pnrcrl Idcntificatk n No II'IN1 >sv i ry^ �+Cl�-( i alA a�c76 l
t v
Sb.Latitude and longitude In de)tees/minutes/seconds or decimal degrees: 'p I ��
of well field.mic lal9img is,officicnll i' 22.Certification: ^' [ L'/('•f"�`�r- �S L' P r�l �� �%iy
35'_ 6 3 L'f Z 3 ZN - y- 232. 1 y6 0
6,Ware)the well(s)O1'ernlanent or IRTemporary Tignauuc ol'Cenificd Well('rnnractnl' hate
/It•SijmUtq this jbrur, 1.hovhv ,evlift•thaf Ihr n•r///c7 irrr,ru:•rrl r„rr,rrurrrJ.n ac cordiou,
7.Is this a repair to an existing well: QYes or [@No ❑•Oh 0A VC AC 02C"0100 art I3:1 A'(',I<"ilj('.It.'pn uNl('un.,n•urrirm.S7rardar,L,anti that
/f thr,w a rr/raa.fill nm knarra nr11 r.....I ,,rh-,,m/aroraliurr and r.rplain tu•noIm,rrl thr, rnln nj this rrrnrJ has brrn prari(!r(l br the re['/l corner.
rrl+nit under='/rt•nrrrrk,tilYltnn art oa the fort(nl flrr.r farm
23.Site diagram or additional well details:
X.For('coprobc/D1'l'or Closc(1-hoop Geothermal Wells basing tits same You nlay use the back of this page tip provide additional well site details or well
construction,only I CiWk'-I is needed. Indicaie TOTAL NUMBFIZ of,wells construction details. You may also attach additional pages i1'nccessan'.
drilled: __-- SUBMITTAL INSI-RUCT'IONS
4,Total well depth below land surface: L• (It•)
24m. For All Wells: Submit this form within ill dacs of completion of svcll
for midriple nvHs h,r all deltic,if JiOrr,va/rr,urydr•-?(a_'n0'and_ta 1(If)') construction nI the following:
10,Static welter level below top or casing: (ft.) Division of Water Resources.Information Processing IiniL
!I nar,•r lcvrl r.,ahrrrr ra,uel;,a.r "+ 1617 Bail Service Center,Raleigh..NC 27699-I617
11.Borehole diameter;�_(in.) 24h. For Iniection Wells: In addition to sending the fimn to the address in 24a
above, also suhmit one copy of this]firm within 30 days of completion of well
12.Well construction method: Sow✓/ construction to the following:
it.c. auger.rotary.cable,dirge!push.c•tc.t
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Hail Service Center.Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply C Injection Wells: In addition it,scn(ling the form to
the address(cs) above. also submitjone copy o form within this for within 30 ciays of
13b.Disinfection type'. Amount: completion of well construction to he counts health department o t f the coun '
where constructed.
Form(iW-I Norih Candma Depannicni of kii,ironntenial Vualil.•hi,ician ul'Wn!er Rcsoutves Rc,lscd 2-32.20I6