GW1-2023-02808_Well Construction - GW1_20230417

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• Z.Well Construettnn Per>sitti: � FROM -to orlen.reas 'aim sr,►T$mtar.
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3.Well Use(cheek well use): n. tr. Id.
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ic Q R in.
Geothermal(limting/Cooling Supply) Residential water Supply(single) rt. rt. to - .
Ltd ustrial/Commaciel _ DResidential Water Supply(shirred) __
_Irrigation FROM I TO MATEitQi;.r- >3MPUCFMmNf Mrn100&AMOUNT
Non•Waier Supply Wei s'h � `t il!(' n«fenttering pne�r 0• a , ,: i l,ll.
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action Well: _ h
• AquiferRechtvge - []GrouudwaterRemedjetioa
AquifcrStorageandReeovery DSalinityBonier 'iGRS'ItBtiP.tCKtoM TO aFi at&e,)_ _.-�. twC& =•'=-
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Geothermal(Closed Loa: riTracer - taa.-3)R1 (i7Lt5GrifiEbaadldemiahibr"Ttneciaiii ' b't:••.. we-"-' •
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arice teitA o r(expto1nundere2nRemarks) PROM TO . DESCRmrIONostenhi �ica
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d.Date Weil(s)Completed: /-la,,[?Well Mil Q fr. .7 fr. �Q�te.tyre-
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Sa.Well Location:
- .//s? c/ .e /Al 9/) 30>z 7 '- c.-6.y...'J c
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/23 41,4br ile rrPia/lrs 2f 5p a '. rn :._.'r
Physical Anna,City,and u >.. .. `
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Sb.Latitude and longtinde In degrees/mlmuteshecoads or decimal degrees: t rr c;r t 'r; :_ ,� !�t;;;
?(irRall6eld/on�e►adllongis,uMniant) �f� ' �/) / 22 Ceerf m:Soo: �.G S.D. "; •, _
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6.ts(are)Mewelgs) Permanent or [�Tempnrary Sigm = eriSed Well ConOuntactor ; - Date
7.Is this a re g By signing dig faros 1 ierehy eergg.that the TWIN leer iktre)mtuaueted Or accordance
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pair to an existing well: [Yes or Ono with iSAJICtCOIC.0100ar ISANCAC 02C.0200 MI CanoruufanSandal*and that a
ffteisItarepair,fillwuho ,wdteanurnctiahlffa a atimaud again the iraumtglib IVY'Phil fend Bat bunprorfeldro tits veil ownen
pitch der121 remarks mien cum the haatyl►trtsform.
23.Site diagram Or additional well details:
&For Geoprobe/DPT or dosed-Loop Geothermal Weld having thet a= You may usa oho beck of this page to provide additional well site details or well
Construction,only 1 GW-lisaided.Indicate TOTAL NUMDBRof Ilucuondelads.You may also edsch sdthiional pageconstruction-dela:You may also Clod'additional pages fncees:my.-
drilled:
./ SURIVIT`t'AL NvsfRucitpNl . .
9.Total well depth beloty bud sadacer fj (R.) 2dn.For All Wean Submit this form within 30 daysof
For auWpletrettsfara►JdcPhAlf)lrenr(a /e.38266 4ad2®106`) completion of wolf
v
orl construe/inn to the following
• 10.Statte water level below top of casing: SO (tt) • Division ofWater Resources,Information Processing Unit;
ljxare►lereltr above ctuiagure+ 1617 Mail Service alder,Raleigh,NC2769?-1617
11.Borehole diaer f�
met [ (IA.) yfb..For infection Wells: hi addition to sending the Comma the oddcros in 2Aa
'12.Well construction method: , Paw(l ( above,also submit one copy of this fbmt within 30 days of completion of well
(+x.age rob*.cable,direct push eta) vv'' cOn9nuctien to the follDwin�r
. - BQR WATER SUPPLY WELLS ONLY: Division°Mskr Resources,Underwood Infection Control Program,
1636 Mail Service Center,Raleigh,NC 276991636
13e.Yield �l�1 i Q
tgpb) t/t/ /� Method of test: tarp(--Rtir- For Wafer Sunuty&infection Wens: In addition to sending the Loon to
13b.Diakticctloatype: !t the address(es)above,arm submit one copy of this form within 30 days of
Amount. k GOpf completion of well construction to rho cotinty health department of the county
where constructed.
FmmGW-] Nona Omani Department erEay mneacelQoafiw_DivlsiaaofWaterReromres
ROvlsed2-22 2e16-
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