GW1-2022-00285_Well Construction - GW1_20221222

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WELL CONSTRUCTION RECORD(GW I1 ForFitte a[Use Only;
1.Welt Contrnetur hformation:
J M �T11 51 ti
�• �..�"a"¢�"• FROM TO DESCRIl"IIOiti
NcJt Conttactariv`atnc _ 6 fk b ft 11 c11 J
3 _ _ C ,� '
ram,..��[~.�5 '� �� i , fr. `
NCtVellCnatroctorCertifieationNuniber _
Inc, ,
DEC 2 2 2022 �Qott TO r1Gdx,rm
ft. ft in.
Company Name InfiDirn ip-n l�rt>G r pit:✓ lJf.f
�+tra` siOE 26. CASII1iG[f1� TUMNG( elmedloo )
7.Well.Comirne$on Permit ff.- L Z Z— 'D o 4 t3 FROM r To I nVAT'SETER 1 'FSImrR �fATI
Litl all applicable well ransimiliattpemilfOe.UIC.Coak Stale.Variaore,etc.) O v � (Q•ZS SD�Z) p�
3.Well Use(check well use):
Wafer SnPP)yr Well: IT.Sty
gsa�t To ntnatart:x s�OTSIM z tC1. M
Agricultural �M cipol/Pnblic tt. ii,
Gctrtht rmat(HcaEing/Cooling Supply) csidetttiai Water Supply(s➢ngtc) ft: ft:
Indus Commercial E2Residctttlal Water Sapplg(shared) M�D�
i �tion ERM Ta ZMATERIA r:►trLnc �T�,st
NOIL Water Supply Well: � �. � ft. &.64J-e
+ NOWtnring Recovery ft: iL
Imectian Well:
3Aqutt fL
ifer Recharge E3GmundwaterRcmcd1ati0n
19 5LlNFlI -
--LTO ACK Iicabie
AQuiferstorn �
ge and Recovery Salirtiry Bonier Fao�i To
AgtliferTcstStottawaterl2rainaga ft
i+xperimcntalTeehnology OSubsidence Control A: fL
Geothermal(Closed Loop) OTraccr ?k DRiLi.INGLGGfatmeTiaddiHomishoaaft
Gcothennd(RoatinQiCoolin Retum) Other(ex fainunderd2l Rema&s) aS4 t)PseRIEYfioNtm►ar trardneati�ttrratk
o tt 170
4.Date Wells)Completed: - 18 W&W9 CIlj & 5bg( ft. Gi
ro- b1 t'-ej
So.Well Location; fti � fp
7U�t M�n'.°lt t'ire, � I fL
Pncility/Owner Name Facility Wffi ifapplimble) ff fL
5t)t Wo►�a rS �c(ct o br I�e.Cm lUe� e?S 1!¢l, fL r'
Physical Addrers,City,andZiip iL fl.
C,q MC Do L e 11 11 a�3 a T51?
County Parcel Identification No.(PING
Sb.I,aStttdeultdImtgitudeiad �s(miantes(secondsorderlmatd
� egress:Q`• (iPwell field,one 1at11ang is sufficient)) �.Cerfifkntion:
3S' �E3' q95.�>✓3�rr~r�Ia C-7-1 13,933 2re- t
�Q W —
`cll tgnamreofGett iedtveUCaattactar
6.Is(are)the well(s)ftet�nanent or Temporary Date
&y signing ihisjnmt,t he 7 certify thm the xellf.)tray(lure)cmturat
5 7.Is this a sepals to as e�sting melt: MFes� or No ,trot I51 NCAC a2c ataa or ZSeiaVCe1C O .0200 lVell Construction Sr,
psp I f to o d ' p jO�irtsnrepoirfillautltrolvttirellronrlructinninforttrntlanaad louttlrertoturea the PY f ��>'e�rdhasbeen rmidedtotlteivelIouver_
rrpairttnder�ltremarkseetiorroranthebnaFojrhisform. �
�.Site=d?,ug�am or addf�ion�!melt details
8Xor GeoprobeMPT or Clased-Loop Geothermal Wellsbaving the same You mag use the back Of this page to provide additional well sin
cons[ruction.ontrlOiY!-1h13=dGI.7ndiCOWTOTAF,MIMBOLofwelts ���efi6ndc2at7s_lroumaynlsanmtei�ndditionatpageci£aec�
drilled: SUKIUII'i"E'AIE_�]tLci'R CTIt]l�
4.TOW welldepth.below hod suiface: Sam (�) i i
Formaltlpteseeltslirtaitdeptluifd�art�t(emmplr3(a�?00'm,dZ@tdo'} 24a,For All Wells; Submit this form Within 30 days of con
construction'to the following
1o.Static water level belowtopo£casing: (6C7 (ft.) DI sloaofWaterResourees InformatioaProcesseng
Ifimter le►el Is above caring,urge"+" a
17iYfa1 gerviceCenter,Raleigb,NC27699161
ll.Boreftole diameter: �o• Z (m.) 24b.P+ar_inieeffan Welts: In addition to sending the form to th,
12.wen canstructiOn metFtort: aC 0 above,also submit one copy of this form whbin 3o days of con