GW1--03154_Well Construction - GW1_20230505

i
—WELL X)NSTRUGTION RECORD fGW-11 Forlhternal Use Only: "
1.Well Contractor Information: ( ,
.J 3 IL C9A'1'EEtZObIES
FROM TO I DESCRIPTION
Well Contractor Name 0 it, ci20 R' 1 I U`Z--) __
440 93_. `g_ Ire Ft.
NC Well CautractorCettifr.tint[chanter :S.olrrEit cnsm O Mrmultleascd was)ORLINER rlr le)
r aosL TO DIAMETER THICKNESS MATERIAL
A.L3 0 U;(..,k-11- /__I (l C - ft. ft.
Company Name 16.INNEIt CA&ING OR TJNG(Rccthermal dosed400p)
r.Well Construction Permit 8: OSS a t3 a 2 - as -1\ FROM ,TO I DrAmatlrtt TItICRNES.S I MA.r,RIaI.
LW nil applicable well contrruction armlis((.e.111C,Comfy.State,Variance.etc.)
PP P Y O It. �J ` [C. �, z M. S�e Z 1 fur-
3.well Use Wilma well use): ft tr. �-
I7.6CRIEr1•
Water Supply Well: rods_ TO imam art st.ors ZE 7 THIL'KNPSS ALITERIAL
*Agricultural. °Mu olpal/Public R: it. to.
a Geothermal(Heating/Cooling Supply) t:sidcntial Water Supply(stogbe) it. It. in_
NI IndustrialICommcrciat DResidential Water Supply(shared) I .GIt?iIT - - . •••
!. 1 Ati011 FROM ,TO MATERIAL Ei7FLACcUENTMErnt04&AMOUNT
Non-Water Supply Well: 0 ft' _ ,2d n• ReFaro PePUI.G
ill Monitoring IDRecovery IL I-t.
Injection Well: �'�
ft. tr.
Ni •sparer Recharge EiGroundwater Remcdiation l. SAI�DIIIRAVEt�PA tIrapplicabtr}
•golfer Stomp and Recovery i0SalialryBarrier PROM 70 MATERIAL EitPIaiCE1TlaSdiErAOD
Aquifer Test 05ttnTnwaterDIsinage ft. rt.
&Experimental Technology OSitt)sidcncc Control G: ft.
i.Geothermal(Closed Loop) EiTracer 20.DRIEi.ING LOG(attach adaititrrsirbonaifonezy) -
*Geothermal Heatlnt(Coolin Retain) fCtber(explain under#21Remarks) ' FROM R. 2 1 ft.-TO riota(�.ttatt cur t .�,ln: ��ra1
Clay Cy-r-6v_rG '1
il.Date Wells)Completed: 3)3.I
_wen nDl _21 ' /®oc rt• �'can t t-e_
3e.Well Location: R. tr. P"': m a''Cr'9;i r, '",:7nt..
Qia -I- Anal✓ D` 1.-ri eg rt. + 6 ti...`1,..' Abe r"
i
Faellity war Name FacilirylDr=(itapplicable) �qI
tr. ft. MI Y 0 .5 2Q 23
2odi `F3cc L k. Dr,I M,1ls ` vTR/I'oc ,�$1� nil ft.Physaca2Addrcss,CityraodZtp ; Its It. itnut�..1 ;'r•^7.'.. .,,.... o.
• Ct?!Or
lei_ct rs \ 9G 20 I SS91 Lp aI.IMAM
County Parcel Identification No.(PIN)
Sb.Latitude and longitude in degreeeltninuteslseconds or decimal degrees: J
Orwell field.one letllongis nffe'mnt) 22.Certification:
S°a1 'v. b`'In521t N '2° 3/ ' 4-1 . Del 2'11
( w f
I3 [23
i 6.Is(nre)the well(s)42Permanent or arempnrary panne ol`Unified Well Contractor Date
By signing this form,I.hereby certify that the weft)was(titereJ conmvered in arronleneP
7.Is this a repair to an existing well: Elites or No with ISA A'CAC 02C.0100 or ISANGtC 02C.0200 Weil Canon:at=tandt in&t and titre a
IRuleSra weft:filI CM!hooky:wall eanat-velanrf rnuttranand..p!"ra$mrmrwreofthe eoPYof this record has been provided ro the wall owner.
repair under#21 remarkssectian or ante hack of thisform. 23_Site diag
ram or additional well detain
IL Far Ceoprobe/DPT or Closed-Loop Geothermal Wells'twins the cacao You may use the bock of this page to provide,additional well site details or well
construction,only i OW-1 is ncedtd. at=IndioTOTALNUDIS K of-welts ennsuuctlon details.Yen may also attach additional pogo:ifne:asea y.
drilled.
1 SLIRR�TTALfllgrguCTnONS
9_Total well depth below Ian dsmfaces /00 �
S (l.)
Formulrtpiewelsi'iea r/ipths:l'diYerent(emmple-N.200'aid 2©1G0) 24a.FOT All the following:Submi1 this form within 30 days of completion of well
10.Static water level below imp of casing:
0 construction to the
Iftratcr level is above casing,ma"T° (ft.) Dl vision of Water lteso eras,Information Processing Unit,
1617 Malt Service Center,Raleigh,NC 27699.1617
LLBorehole diameter:10 , �� Cta.) 24b.For lnicetioit Wells: In addition to sending the form to the address in 24a
i.z.Weil construction method: 1 )z. L above,also submit nnc copy of this farm Min 30 days of completion of well
(Le.auger,tntary,cabie,direct pnsb,etc.) '--. construction to cult 10110V1'in
FOR WATER SIiPPLY WELLS ONLY: , Division of Water Runmirces,Untlegrom l Injection Control Program,
163i Mail Service Center,Raleigh,NC 276941636
13 .Yield rpm) lig method or test;la/I. k -24c.For Wgjer SjwnlY&Injection.Wells: In addition to sending the form to
(',h�onl � ll1C adrilrss(es) above, also submit one copy of this form within 30 days of
13h.Disinfection type: Amount: /
t — _-- completion of Well cnnsitnrtinn to*in nn.mttr I,, ,t.ti< .a--,_....