GW1-2023-02444_Well Construction - GW1_20230404

Feb 1519 05,43p CiearwaterWell Drilling 82M22-7249 ;t p-1
WELL CONSTRUCTION RECORD{Got--1) For Inferno Use arty:
1,Well cfIntmtor1lrnrormatlo
IK WATER ZONES
IVeI on � . ZztaoN TO DUCRWMN
m
- - - — It• t4 ,
VC Well�Ccntearam�Cat�ifi`e��inn N�m�6er /////J��o (yy (�►'�\J OMR Cpg1NC for moth used wells OR Li.Mm a
M DIAML'! 'elt[CKHBBS M TEaW.
ft IR $ ta. i ,
Cgarpnoy Name t6 IIYPiIi(Jt CASING CU TUMCi t9wtaWd CtmEd-t v
L Well Coaskuctian Permit#: 1 ` z T��� t' � 'm o + nttaartss -MATEML
e.Lrr aH oppJioa9fe Dail concrnrralaApafnrifr 0.e.UIG Catmfy,SUU6 lrarlmrce,ettl f't. rt.. in-
3.IV&lice(eitrek well TlSe):
WmtcrSupp(y WMi: I7 SCtt6EN
PROM 1 i0 DIAMBTFSL SGOT917.6 vinexNew 7HJ1 ®tGL
Agricultural M_ tatieipaUPubiic (? R 0.
Geothermal(lieatinecomingsupply) esidattial Water supply(single) R fL in,
IndustriallComtnercial Residential Water Supply(shared) 18 CROU t -
llti rltlerl ROM 70 MATERUL EM LAC M OD&AMOUNr
lYna�interSupply14e11: rt Zt3
I�ranitorirtg1311ccovery ft. fc
injecHnn ell: ft. It.
Aquifer Real►ergm QCroundwater Remcdiatinn
AquifcrStora$G Md Recovery E3satinity 9anier )9 SANI1/GItAUBL P IL MAE1rRTAL� T2VRLACEM1iNT6itrftOR
AquiferTevt f 3 tnnTrwaterDrainago IL °
Experimental Tedniology 13Subsidence Control tL tt-
Geothtumal((3osed Loop) Due= 20.DRILLM LOG fattach0 si rtetasa
Geolttcrntal(Hcatin soli Rcarml Olber[ex (n ender 021 Rcrnarls) FI6N ° r< �irr.eeo
•t_Date Wdl(s)COtttpleted. L3VIR ID# re (t:
�SIL Well LoceNan:
1:uility:'(lxmer Name Facility My min
able) e n�
P i i Addrose City,and Pip '/ fL R-
V 21.MEMARtcS
1 .
Caunty Pnreal idantifiealion Nn.(P"
5b-Latitude and lonaitttde in dcgreeslmimttes/seconds or decimal degrees:
1000.,is ault9cirnt) 0<6-9 r --3'
6.Nam)the welt(s)#� ermarieru or DTempnrnrf SiAaaime o �ntfi«t Well CmU wear p� -
T AV sfpmtag tJrts(orm,I Herrhv eaurtlfj Thar fAr.a rlf(sj x�a fH•oreJ emrfnwAul by aeaord�rce
7-to 14is a repair to aO el"ng well. r3Yas oAim,
o, uarh 1 SA:tCAC 02 -Q100 or ISA NCAC-Ur.0200 Weil Cantrrucrian 5lomlards out?ohm 2
pranrrherxunrrrjrhe u'p)'off/us reeardkwbr4mprol'fWjathi:werlawnu.
r.�air under r;2f ttsrrnrl�sz+enmr rrraat/ic harJ�aJrhlx jom,.
23-Site diagram or additional well demos:
S.For Geoprohe/OPT or Ciostd-la►np Geothermal Wells having the same Vou may use(lie tack of 111ic page to provide additional Weil Site debuh or well
canglnrotien,only I GW-1 is needed. rrldicate TOTAL NUMBER orwclis coaghwion details. You may also attach additoml pages If leeesery-
drilled:
- n� DMI'MI IirMU—ClIM
0-Te1al"0111 depot below land surface- tt), 241:4- Emil Weill: Submit this form within 30 days of complellon or Weil
f%ar��liipfeweticlivafid�rt/�rifrG$en�nr(eiample-3'�1^00'mrd�a1108� con,9tructiontothefotloising:-
l0.3tRtic dater level below top of casing:_ (it:) Division of Water Remure m information process°g URit,
1(-top turd isrrhrtvecttrtng,Inc " 1617A7ai1ServiceCentenRolei9b.NC27499-1617
i i_Boneltote+liameMr n
. `�3 24b.For ti,leengn Wefts: To addition to sending the foam to Tice address in 24a
IZ Well construction method: \ U l�,Y�•Q above,also submit one copy of this forth within 30 days of complethm of well
(i c.wgc-,rotary,cable-vireo pusL,etc.) ------ snnsbuction to the following:
Division orW ater Rreourem Underground Injection Control Pr iY}R WATER Ri:P V'yY);[,l,,S ONLY: � � ogi'atp,
16M Mail Service Center,RatelO.NC 276994636
13a_Yield(t:pat3 Method of fast: 2tc tfnr hater SoAAic&igfcetlOR'We t(,i.• In addition to sanding the corm io
the adda s(es) abatr, also submit one copy of this form within 30 days of
tab.Disinfection types ,Amount: Completion of%veil constmction to the coUnly health deligrT tent of the county
where cortslmctod.
Pomt aw-1 North chr linancpmmwontuf Gnvlroinaivml Qaaiity-Aivis�an oL'Water Reyorncrs Revi M2 22.2e1 b