GW1--04114_Well Construction - GW1_20230623

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WELL CllS3l`��c�t[H�1�RECORD(�mg) For]'fatealalUse only: ;
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1.Well COldrec Dr Information:
Cameron Eazin 14.WATER ZONES i
Well CmutractorName is " Mal TO DESCRIPTION
4515-A jUSaG :-
NC Well Contractor OntiEmaienNmaller 15.OUTERCASING(fuarmilfl-cos walls)ORBITER ffeepppp11�-�aIIbre)
Aqua®fill,Inc. FROM TO DIAMETER THICKNESS j MATERIAL
Company Name
°(( 16.INNER CASING 011 TUBING(ReotiarrElal doseddoop)
• 2.W� t On Pam#: i-003, " FROM TO oaraasssl�a THICKNESS MATERIAL
Lig►all applicable tt>Rttanstrustionp (Lc.UIG�mat�•Raft Tartan=ela) ft. R in.
-
3.Steil 111Se(ell well use): St. ft In.
Water Supply Well: 17-SCREEN _
FROM To )DIAMETER SIDTS'IZE TRIMNESS MATERIALIlt
Asriculhnal Oldimiciptaabiic it. at. in'
A Geotilerau)1(Reatitig1Cooting Supply) Residential Water Supply(single) ft R
it InclustriallCozom iai °Residential Water Supply Oared) 18.GRofl'F
7 !Irrigation EROD4 TO MATERIAL prACF14)EWT METHOD&Amoutrr
Note-Weser Supply Well: 0 $ISI
22- ik , G 4 if
*Monitoring ORecovery ft. ft
Injection Weil:
I2 ft.
' 9uiferReharge DGmandwaterRemediation
*A eta P19.ROMND/GRAVELPACK(ifoPlicable)
Flue Storage and Recovery EISalilllty Barrier PROM • TO _ MATERIAL EmpLACEMENT METHOD
' ,-f rTest c3StomtwaterDrainage is fs:
i'.Al'411..-3. Technology DSuhcidl`nt.Control R ft
VI'Geothermal(Closed limp) EtTracer 20.DRILLING LOG(south cdattanal sheets If NeasseTA
-"tGeothemal(43eating(CoolingRedlm) 0Other(elplain under#21 Remarks) FROM TO .DYSCRli?i[O1r(mter a rdae�sewnekA}pe sasir4ae)
4.Ieatewell(s)Completed: 51Z�1 Z) WeliThrt 7,0 !s 5 ft
n fr. s 1a�
9a.Well Location: f /�/ . s..7" E p r-m 4 i rrd�'i"."''.
• fit diG! dd WQ6Ot ` fL it: - am. /E 4—L.
FaeelrtylOweerNamn - f " Facility WO(if eapliwble) ft. d` JL'N ' 2023
any !/ f, n
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1r�7��i1 ! !� (� � YI,�j'f [L ft. I tli u,rra�::i 1;�;'..�
5P-1,;sgBill Physical Address.9`ity.and _ rzy A _
W i ice S 21 ItEIVIARICS �f �'V
• Cry Parcel Identification No.(PIN)
Sb.Latitude/and longitude in ehT,reeshninutmlseconds or decimal degrees:
Orwell��eid,cum�7�I gissuHfe,eat)N g0•$8027 w 22 CerOR{a/rti0n: S//
%7�j SigeaNccofCertified WellCantmdor n M " 2 /?
6.Is(are)the weffi(a). Pera�rneent or �7 eotporary
By stgieng thlc form.I hereby cent,that the aall(s)UM(Orre)rnnvmoed to araoslanee
7.1s this a repair a u ezioting well 1IY� or No with
os i o d liC es01brm� N�to C 02C�BnerFdt Conslnrata,Standards and that a
if11'i2 ig a►lim r.filf as""flit ae11 ca taknal r w and npfaia the oararcojthe !�'f provided
ir si•i der021remarfaser maroathobaeJefthlsjorm. 23.Site diagram or additional welldebalrs:
l¢e/DPT or CfoLoop Geothermal wells having the same You may use the back of this page to provide additional well site details or well
8.Far G j 1 GW-1 is seeded.Iadiente TOTAL NOIViBER of wells conshuctiaa decals.You may elm attach additional rfneress
construction, Y �� �-
driiled (85 SUBA�i1R•CAI.,INS7'RUCTIONS
9 Total well depth below lsmd serin 00) (ft) 24a.For All Wells: Submit this form within 30 days of completion of well
For mafNplewat4'BstaI1&Plk irde ( ,k 3@)f0°nd 1� construction intlrefollowing.
ij 1®.Biotic water Level below Sop of ca>lag: "I (ft.) lilyislan of Water Resources,Information Processing Unit,
Ifrratra let�;s a ure r r�/' 1617 Mall Service Canter,Ralelgb,NC 27699-1617
„ �i- (in•) 24b.For Infection Wens: In addition to candling the form to the address in 24e
I'1 I1.>S®tY°leeliatn. above,also submit one copy of this farm within 30 days of completion of well
ry n��ml; �� consmrctionto the faltowing:
i t 12,.coca eeast pub. Division oftd+oter
1., (i.e oast.ro' '• Resources,Underground Injection Control Pro
upPLx� °PLY; 1636 Mall Service Center,Raleigh,NC 2 7119 9-1 63 6
FORAR S [ -/ 2Ac For Water Snnnly&1'n f eeHon Wells: In addition to sending
l 1elhod o?t f: //11 R �e address(es)above,also submit onethe foam to
flBa.5ld41d�m) rb ///� completion of well coasbraction to the copy form within theh� county
tof
y
Aatouat county department of county
€..t wfiete n..nctmn.�
C flab.UiSinfeetion typ
Noah oimaa Department of0cchoam:ntal Quality-Division of Water ilesmaces
f�:m 11.4:4.d2-22-2016
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