GW1--05586_Well Construction - GW1_20230825

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1L�r�(�I�T� tDtC�'I[®�J Il �®L�� 13� ForIntemaIUse Only; ':...,�'r+ae germ:'
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1.Well Contractorlinfjrmatioti:
•OaryThomp ol1 11
IAethATLrRZtDPIFS ':• .'•: ; a•
lVallContractarName - • FROM TO. . DFscanimON I
4 '1�A •' • rib f tcTl & F:'pc.- e'r-. 3 �,19�.
NC Wall CanttccwrCmtiEumannialar ,-zu, R. .2'3 t ffC t LI0 '2-C..r,a^
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/��l��i Drill, Inc. I5:OUTER. ASIRTG(fatutolti4ensedivells)ORLEVER(daa"Mohler-•.-.'•.: _,..•
r°l 'Faaonr TO DIAL Tmc[ ss'- MAMMAL
ComQmyNeme• _ •
'a _ b I 1 G�'a I (flt/.� + S`tr1P.%-% VuC
t, 1G INNER CASING OR-TUBING(lberrnai elaseii:Satno)°..:_•: •• ; - ,
2.Well Construction Permit# MOM TO I D1An1tt'!ER , mama MATERIALUrt all applicableuelIconmactionpemrirs(i a UIC Conn%Soo.Menem am) ft. ft. ta.
3.Well Use(cheekwell use): ft. fe. 1 • IL .
Water SupplyWel: 17.SCRE1nV:._•,.. •.•;•
Agiicultuai FIlOa1 TO 9IATiIEIPR BY.�li SIZE TfC fs rlaliZITAL®
teipaUFublie to
Geothermal(Heating/Cooling Supply) /w,'esidentlal Water Supply(single) ft. to I to.
lndustriaUCamtnercial oWes(dential Water Supply(shored)
briRation ls.GROiJT.. • t •. - •.
Nan-Water MOM TO tttsiaeaL& &nteucaanxrmnsucDaAnto art7"
Monitoringa ft. Za 1 cps, �t:�r ) l4Y ,
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1<gleetion tWel:. ��y ft. ft.' eti:Fs 0
Agitiferliechsrge • DGroundwaterRomediation - • ft..
' Aquifer Storage and Recovery DSelinityBarrier '•lasatuniGRAeELPmartraenneable) • .
Aquifer Test QStormwaterDrainage aaoal 'To atATmtw, ; En sC©iirbarra nn .- •-Experimental Technology DSubsidenceControl fa ft.
Geothermal(Closed Loop) DTracer •20.DRILLING LOG(adrtch addldoaatsheet ifoeresssay)
Geothermal(Heatinglcool' Return) (explain under#21 Remarks) Moat TO • '
utS Other D f6 lb �- DEsrltII�rroxtrBlot:rmtaae,,=oll/mrktva�p�nia,�.�i
c, la�3 Ctby •
d.Date WeU(s)Completed: X Well IDS co ft tab f`
SaWellLoeadon: ft ft ©raj JhY+�bl �b"
Br
``� Ib15 lug GCA:,:�E
Br t?in1 koii�ti.c.rk N) toy ft 345. sc fs-aN:bt:.
FneililylOcruerNaraa 'Facility MN tifappli able) a fit:
t44 w,&&Cw :1IAtg-y t_61•c_ bf.Va6I1 Wt. ft ft
•2t.RSMAit cJ : °°�`t�PNKIealAddtar.Gq.mdZP "_1 a'ztd ft S s _! V hP,V e.
hLef
p County Pam!Men t:atlasNo.(PIN) i AUG. 2 5 LU'n
' Oh.Ladtude and longitude in-degrees/minutes/seconds or decimal degrees: o q t:1.3
(iftvell&elyd,onelaUlongisaafiiaeat) �/}� > rat / / cv 22.Cerdtimdaa: IMOt7rdaa,air = _"�
3" 56t obi. $ s"N if JCa IJ, 640 1. w I �a�Y3�
6.I•a(are)the wells) erotaoeat or DT•empa'ary Stpna ofC ell Contract Data
7.l s tills IIt0 an Eysigning this fora,!hereby eervfy that the irall(s)use(aura)ennsaaardla aceordanee
repair mrfsfingwell: Dyes or :. o with 15A NCACO2C.0100or15ANCACOZC.0200 WelI CotatraWon Stmilaidsturd tiara Ij this isarepatr:JlUett flown ireIIconrtrucRoninfo:wef and esplabr'rheanaaeofdfe Copy ofthi record has been providedto:Astra.alma.
repair:orderN21 reaararreetlan cram the barlcofddsfomr•
2:1 Site diagram or additional well details:
S.For Geoprobel DDFI'Or Closed-LoopGeothermal Wells having the same You may use the hack of this page to provide additional well site details or well
• construction,only 1.GW-1 is neared.Indicate TOTAL NUMBER ofwelis• coastrum en details.You may also attach additional pages ifaecems..
drilled: f SUBMITTAL INSTRUCTIONS j
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9.Total well depth below land surface: • —(o fL
Far nrnktple wells lisfall depths ifdfferatt(esanWte-3@a200•and 3i 100) ( ) co24n.for AN theWe fols:llowing
wiSunmit this farm within 30 days of completion of well
construction'to the fallowing; i
10.Static water level below top of easing: D (fr.) Division of Water Resources,information Processing Unit,!jeerer level Is above casing,use•4- . 1617 Mail Service Center,Raleigh,NC 27699-1617
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il.Borehole diameter: (in) 26b.For Injection Walls: In addition to4sending the form to the address in 24a
iZ�A/eU construction medloti: ra fit r.) A: above;also submit one copy of this farm within 30 days of completion of well
(ix.saga; y.edge,daeotpussh.eta) construtdiantofhefoliotvina I i
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC27699-1636
-13a.Yield(gpm) 5 • Method oiliest C-to-s�4 k'e' Me.For Water Snooty&Infection Welted In addition to sending the form to
136.Dtsinfeclioa type: l`E[���D Z. Aroount: (, the address(es)above,also submit one copy of this farm within 30 days of
/� completion of well construction to the county health department of the county
-where constructed.
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FormOW-I North CasolinaDeynument°Machu:natal Quality-Division°Mater Resources . Rasued2TL-2oi6
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