GW1--05971_Well Construction - GW1_20230912

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WELL CONUEUCTIoll Meet Iu( 41) For Internal UseOnly; .
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L Well Contractor Information: j •
•Gary.Thompson - :qa.w®T RzoNss :, :••; . ..
Well�CantiucttorNama - - naoas TO, • DFSt aII71DIUtI
4lli 1g 8-A • 74.2,6ft• 321 4t. crna:E'H .`Z t 6ptt..
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NC Wall CatmactarCe eationNimbcr 15:OUT -CCASIN6(thlmNai:cosedtvelb ORLINERGf.".tkable):'-•"..-.'-.. ::..:
Aqua Drill, Ina. . •FROM To DT MEIER TmCIO Ess•. MATERIAL ;
CompaztyNttmo• 0t if fG tor2_‘ io. s,p�a )9Lt
�n 16.INNERCAS NGOR•TUB1NG(geothermaldosed:Iase): :: :• -__• ::
2.Well Construction Permit#: -7(10011 PROM TODIAMETERTmcravass MATERIAL
Ltstallapptreatla well consuneuonpemntsra WC.Canny.State.Vatanc eta) ft. • R. in.
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3.Well Use(checicwell use): P. ft. • •
Water Supply Well:
• FROM TO DIMOLTER SLOTs>ZE Tilt' SS nsea ram.
Agricultural If ,uoicipalPublic fa, P. in,
Geothermal(Heating/Cooling Supply) N,Residential Water Supply(single) fe.. ft. to. .
industrial/Commercfal Dliesidentiai Water Supply(shared) ••aa.GROUT.. . , .. . ..
Irrigation FROM TO a!ATEaiAL iiitmaCEMEN1n rOD&A 1OUwr
Non-Water Supply Welk 0 ft 2D ft- v6.•-:l'e• pci,r 1 )44GP
Monitoring Elatecovay P. fe " ci„..p.% ,'
injcctioa.Well: ft. R
Aquifer oGmundtitraterttemgdiation .•19.•SANDIGRAVELPACKOFtwa aabro) • '• =-
quifer Storage and Recovery DSalimiy Barrier moss , To =M EM
RAL INIMACpIrnttaon •
Aquifer Test QStonnwaterDrainage ft. f. •
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Experimental Technology DSubsidenceControl ft ft. •
Geothermal(Closed Loop) DTiacer '2e.DRL.LiNGLOGIattddtuddlfincetsheetsifunawaey)' • • ..
'Geothermal(lieatingWCoolingRensm) f Other(explain under#21 Remarks) FROM TO D£SCmPfiON(colaR[smdam,svII/mcittgp6 ainscc•gc)
ee Lo !t
4.Date Well(s)Completed: If-f if la Well ID# f e• 1 t.m re* 0 r�l y I yea got') -
So.dSrellLocatiom Sal,.e,,. '1.;'t\5) Yuri f4 tttr Din',ln,'Q S.ti—ax , -,c-t L
4(Ly V,)w D6... t ion.e.:5 tto m t i v fre. re:,` e.
Faclity10jmerNemo Facility lDFGfappttcabio) 1.�. (l S ' t- G f t1+v!. I-c. A
•`eioJ UCLA `` lke.. U\� ,9;N:�I„ci. tUC-.fib-w ft F ? .i �r r®
Mutual Addresc.Ci ys.mulZp tti ft. i, .:. ry n
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/r_g 21:REMARKS .. I .
S ...P.:r •2023. .
Camay
^^`�YY Paled IdcntWastion No.PRO I :tl ryt < .,,..;��LRi
• Sb.Latitude and longitude in-degrees/minuteslsecondsor decimal degrees D c;•.
(dwelt field,on be ltangisan sufficient) 22, flcatlon:
'6a•z ' 04. i t ASS/I N a°2M;.0-. ..3014 31 W
� 1- -2.-1,3
6.Is(arc)the wel(s)!ermanent. or Temporary -Si ofC�VdU Co mar I Date
�� Sy signing thisfomt,Iltentby ogre that the iraU(s)ens time)consanctam accordance7.Isthisarepairtoanexistingwell: ®Yee or K9z$lo with 154NCACO2C.O100orl3ANCACO2C.01110 Weil ConsauctionSmsda►ds and theta • -
ljihtsfsattepalkSU ens Mown well construction leorntauan and e let:Ilherratuealdie capyaft&renatdhas hew ptovidedtaSSicire!Gnat
SQairratder021 rearadhssreuon Oran the badrofddsInn 23.Site diagram or additional well deficits •
8.Per Gcoprobt IDPT or Closed-Loop Geothermal Wells having the same You may use the beck of this page to,pravide additional well site details or well
construction,only L G•W-1 is needed.Indite TOTAL NUMBER ofweUs. construction details.You may also attach additional pages ifnecessary:.
drilled; _ _ • S[IBNIIITALINSIR:UCTIONS
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9.Total well depth below land surface: ' .'� d (ft.) 20a.For All Wells: Submit this firm:within 30 days of completion of well
For nudephe wells Snag depths fd iercnt(esaarple-3a+OO'and2@100) construction to the following ,- i
10.Static water level below top of casing: ifs' (ft.) Division of Water Resources,information Processing Unit,
lftrater feral!cabareealto&use"." - 1617 NIaU Service Canter,Ralelgh,NC 276994617 -
Y1.Borehole diameter: ((a) n 241,.For Inleetfon.Wells:"In addition to sending the form to the address in 24a
• rt epv Ei•r above also submit one copy of this farm within 30 days of completion of well
12.Well construction method: construction to the following
Cte.anger.raw.cable.dtoxtlush.eta) •
Division of Water Resources,Underground Injection Control Program, -
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
•-13n.Yield(gpm) ')mot' Method of test: ( i$4-`'Pt e- ' 24e.For Water Sunp•iy.&Infection Wells: In addition to sending the form to
. - • the address(ea)above,"also submit one copy of this form within 30 days of
.33b.Disinfection type: k '/G a Amount: 16& completion of well construction to the`county health department of the county
where constructed.
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FoosGVl--1 North CarolinaDepearecet ofEnvinunneatol Quilt-Division°Mater Resources Revisal:-22-2016
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