GW1-2023-02616_Well Construction - GW1_20230410

WELL CONSTRUCTION RE CORD(GW-1) For Internal Use Only y:
I.Well Contractor information:
J-0.yX g e We P_ i 14.WATrR ZONE
XVett Contractor Name FROM TO DES
yD� fL Is ft- 6f'e4.1V'h
1�- APR 1 0 2023 0
NC lVell Contractor Certification Number 70 ft- ft.
it e C
OUTTER CASING(for --+-p lie.b
15 ulfi��ased ells)OR L11 if.
To DIA51=11t
LF I TuJCK'NW
Company Name- ft. in.
I .DWN;�Nx E R G.SING OR TUBING(2emiler 2l�)2.WellConstruclion Permit,: W;Vl 060 t 237 FRO31 'o MA
MATERIAL
List aft applicable it-ell consirrection permits ff.e-FIE-Car,111r.State;Narianw,arc.) ft.
It. in.
3.Well Use(check well use): fL R.
Water Supply Well: 17.SCREEN
-OAexicullural � Eliviunicipal-T ublic FRUIT I TO 9LOTSME THICKINUSS NIATERIAL
ElGeothermal(HeatiwiCoolin2 Supply) ElResidential Wate.-Stipp'.Y Sc'',-SI.C� I 14t 0101Sc'',- 40 pt,-.1 C.
ft. I
ElIndustrial/Cominercial ORcsidential Water Supply(shared) IS.GROL7
01nigation 11XVells-,100.000 GPD FRO.11 i T
IOU.
Non-Water Supply Well: rx. Ile-'$ rI"t'v If ('
Lrld i7 9
e.._.-
I*Aonitoring 0 R cc o,.e ry --0-------P-1
Injection Well: ft- ft. lv&Lll-e-24� "411C JlpreelSu re-
0AquiferReccliarge DGroundx%zter Remediation fl,. ft.
'EL7P.A (ifaEpUcable)
AA'D/GRAA, L7P.A
El Aouifcr Storage and Recovery OSalinity Parrier '9.S
0Aquifer Test TFo-S I TO AIATEERIAL Ell 1PLACLAIENT MMOD
OStormwater Drainage is g IL
JExiterimental Technology OSubsidcrice Control
_Pq�thermal(Closed Loop) OTracer
'(C -0.DRILL G LOG Which addilinnal sheets if neccssary)
eatigJC..li.1-
tOd-t FRO31 TO DESCRIPTIO-N
Geothermal_(Hen 00ther(explain unde-=2 I R=arks) In size.e1c.)
tio-a/Cooling Reurrm.1,
0"oll- 30 fl. -FA o 42 ,,_e - ",e,(
4.Date Well(s)Completed: 30 113 We-111D9 NOL M W i(!J C F 6-Y "' 7,;
na.-I'Vell Location:
-IL
:70 It. lov
Facilityi0ivriurName V Facility ID,';(ifaliplicable) /OerS If. Is,0 It- ea
e/w,
(J5 Is- - ' rot - ft.
reepi g rev ckqe'-'r-
Plwsical Address.Ciiv-and Zip ft
16,9 ft. 1-L'A-/
t22 AIAB(15ooeL Icounty P- elIdtnif- tiinka_(PIN) f le la
56.Latitude and longitude in degrees1n:Fl1nutes/sec611d[§or,decirnaTileggroes- h
.5.5 -/0 1(./
(irwell field.one-lata,119 is suflicient) 2-7.Certification:
__W 1 3 'z
6.ls(are)the well(s): Wermanent or OTemporary signature r 'enificd IlCorwmctor Eii�
Ibc c
By signing!Iris four the it-ellft)was fivc�.)cnnsj��Ic din ac"r1lalee%,ll,
a
7.Is this a repair to an existing wefl: IlYes or ANo "A';'NC4C'_2C.0l ) le
101ris is a repair,fill out A7zoi%77 I t-L,11 i;1ji;r171a110n c 0 Standards and dia.,a t­qpj!
and e-rplair e nature qfthe 1101t'�Wcr
23.Site diagram or additional well deti ails;
S.For Geoprobeffiffor Closed-Loop Geothermal Wells ila-,s2,,h._,same You rnay use the back of this page to provide additional well construction in I fo
.
construction,only I GkV-1 is needed. indicate TOTALNIU.'(BER ofwells (add'See Ove'in Rema&m Box).You may also attach additional pages i
drilled: f neeess ar%
24.SUBNEITTAL 11NST.RUCTl0.-%,S
9.Total well depth below land surface: -J r� (It.,) -
For mull)ple ivelhr fixt ali dep1,Lr,;1 if; -00'ass I S feren!(trample-3@ Submit this GAI-I within 30 dav of well completion per the folloltin.:
10.Static ivater level below top of casing: 241:1. For All Wells: Original forni'to Div 'a -Resources (DIN'R),
9•t!se,­ information Processing Unit.1617 MSC,. Raleigh.NC-27699-1617
11.Borehole diameter: 7 24b.For Injection Wells:Copy to DIVR,Underground injection Control(IUC)
Program,16-356 DISC.Rj&-i2h.NC 27699-1636
12.Well construction method-. ✓55 I'll I 7-4c.For I'Vater S(i-c:m_gerl ratary,cabic.direct Push,e1c.) upply and Open-Loon Geothermal Return Copy to the
county enviropmeinal department of the county R herC in
;1aRLd
FOR WATER SUPPLY WELLS ONLY:
74d.For Water lVells producing over 100,000 D:Copy to DWR.CCPCUA
7 G 13n.Yield(g PermTt Pr"'9=1.1611'NISC.R=101,'t 2 99 F61E pin) Metlind aftest: 76 -
13b.Disinfection type:'_ Amount-