GW1-2023-02632_Well Construction - GW1_20230410

NVELL CONSTRUCTION RECORD(GW I) For Internal Use Only:
_ i
I.Well Contractor Information: -
l O 9-1 14e t�C 14.)VATER ZONES
Wall ContractorName APR 2023
FROM 70 DESCRIPrtOy Y' ,
4n7 �o n
n i �Do� 6cc .bro�v��o�ci Lf.'ln-ac'i 5G
NC well Contractor Certification Number ;",';,'.•;
p I5.OL'TER CASING(for multi-rased%'reI1t)OR LLicER(if a livable)
�_t(K-!' - A//4.,(— fw n v 1 co vn 614 A-( FROM 70 DIA\tErER THICIONi \lATERML
Company Narne - in
t� // -7 16.INNER CASING OR TUB1tiG(geothermal closed-(oo )•
2.Well.Construction Permit r",•: w hi 0%p 0 t -3 r^7 FR03I TO PUMMErER T11Ie1:.37ESS I t1:1TER1:11,
List ail applicable nell construction permits(Ea UIC.Counrr.Starr•Fmimree,etc.) ft. ft. in.
3.:'6'ell Use(check ryell use): fL ft. in
Water Supply Well: 17.SCREEN
•❑A;niculttual Municipal/PublicPublic
FROM' TO DIAMETER SI.OTSIZE T71ICKitiESs .ItATERIAL
_ _
❑Geothermal(Heating Coolin_r Supply) oltesiden al Water Supply(single) 10019'f t 90
t sf 2 in. 1 Sth t•(l) P c.
ft. ft. in.
❑lndustrial/Commercial ❑Residential A'ate:Supply(shared) IS.GROUT
❑hrigation ❑R'dL>100.GOO GPD FRO.11 i TO ALI7ERL•%L k-M 1--, -W
6' ,\T 3Ernoc;K.v ou.
Non-NYater Supply%Yell: ?,sf' gq, d R• ,.,�{ vile irtP%^'
P,14onitoring ❑Rcco%e:v t
6ravt�
Injection Well: �y 10 fr- J 1 r O ft- Ne0ee-,enl -4 rl kmmic re, t�
fL❑Aquifer Reclsarge QGro;ndrtiatzr Rcatetliatian ft. _
QAquifer Storage and Recovery QSalinit•Barrier 19.SANDIGRAVEL PACK.fifa mucable)
` FROM I TO I❑AquifcrTcst CStormvatcrDrainagc
3ATER[1L E;41P4\C&\IEN"tt1EIOD
eS fL f. GPR 1 A trtmMle
=SEeperimental Technology OSubsidence Control ft. ft.
LOGGI:
wthemlal(Closed Loop) QTt2cer �0.DRILLING LOG(atta Isif necesseothermal(HeatinpiCooling Return) ❑Other(explain uncle-=2 i Remank i FROM To D�CRIP rr0\(gt» hwdns fu;llroct r,grain«lees
' 01 p ft' 30W IaN �'tne - Nf1c� Sat i
4.Date Wer1(s)Completed: -'�O-Z?i Well Il#YeLr4w t(q L V apt o ff ,(-1,-o rt- I'rt n to r,
tK F1ne'-(-o rsG� StittJ
Sa.Well Location: G r a ft: 20,0 fL G S H s�t1 �'(
7zf2 .�C. ✓)kcvj 1 Yt)e kei Ellett >o ft. (Dols fL rots 1,-o«, e CI sr/
Facility;'Owner Name Facility 1D (ifapplicable) ff. ft.
V
Ph}•ical Addr S.City.and Zip ft. ft.
t
i✓100�C'(`. 6 7 70 o Z 9 3o 3y 21-RERI.1R,iS
County P+ca!!d_n ilieation ha.(P1N1 -
51I.Latitude and longitude in degreesirtiinutesisecouds ordecfT degrees
(ifwell field,one lattlone is sufficient) mti 2".Certification:
3-2-9 Z3
6.Is(are)the well(s): W ermanent or GTemporary Sigadture of v lifted wet 'onunctor Date
constructed in accordance with
By signing Uric fans•l hr nw
r�:rn're nij•that dre ll(.$)tras(were)
7,Is'thiS a repair 20 2n existing well: 7Ye5 or t No i i.,AC4C 02C.0100 m-;%,VC.IC 02C.0200"''ell Corufructiaa Standardc and that a ropy
if ibis is a repair,fill out bwn7t a-11 costr_•c:i0,,iafaratatfon and rrplam rcr nature orthe gf1his record Gas butt prmided to the well Disler.
repair tnrrler+21 remarks section or or,:ce h::;;of tit$farm.
23.Site diagram or additional well details:
S.For GeoprobelDPT or Closed-Loop Geothermal Wells flat L_the same You may use the back of this page to provide additional well construction info
construction,only 1 Gait-1 is needed. Indicate TOTAL N MER ofwells (add`S_e Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:
'_..Sl:B\IFITAL 1\STRUCTIOSS
9.Total%veil depth below land surface: d o' (ft.)
For tr,nttiple veils fist all depth it (example-3g200'crd c;trq Submit this G211-1 within 30 d2ps of ivell completion per the following:
10.Static%rater Iced below top of casing:
?•'.a. For All Wells: Original Form-to Division.of Water Resources (Dll'R),
_ . 'e' t tj rfr.'1 -
4 i aterlevel is abore casing,use" Information Processinc.Unit.1617 MSC,Raleigh.RC 17699-1617
7
11.Borehole diameter: ry 24b Is:C fo�DINIR,Under�und injection Control(IUC)
Program,16_ Paa 6 IsISC. lciah.ony(in-) .For Injection Well \C 27699-1636
12.Etre r construction method-. S ©�1 C- 24c.Fm 1lraterSupnh and Open-Loop Geothermal Return 11`elts Copy to the
li.¢au�cr,ro:azy,cable,direct puslt,etc.)
count}c1I%,rorlm�nLJ n_ahh department of the cgunty where insta?led
FOR WATER SUPPLY WELLS ONLY: 24d.For Water 11'ells producinn over 100 000 GPI)-Copy to DWR.CCPCUA
13n.Yield g m Permit Prop—am.1611 IN C..?sleigh,N 27699-1611
IaP ) Method of test: -
13b.Disinfection type:' L
Amount-