HomeMy WebLinkAboutWI0100690_Geothermal Well Construction Record_20230926NNEL1CoS STRL CTI
RD (GW-
For Internat Use
Pdrlt Fora
1- Well Contractor Information:
Clint J Babbitt
\V61 Con ra,Wr\am,
NC-3556-A
\(' W,11 C.nlractor Certitrcatiun Number
AAA Sweetwater Well & Pump, Inc.
CtImPany \ante
2. Well Construction Permit #: � � C) 1 Do (� 0
List till applicable xrjl consrrtri rmn perrtu, jr c. (11C. Crsl,n�, Slate. 1, rrance, crc. J
3. Well Use (check well use):
\hater Supply \V ell:
�:igrr -u)tural E]\tunicipal/Public
nroiherma) (Hcatin-_'Conlin- Supply) DResidcntial Water Supply (single)
indu,inal'Commn rcial QResidential AVater Supply (shared)
Ir•.i•_ation
\on -Rater Supply Well:
InjectionWell:
:) Aquifer Rmharal Groundwater Rernediauon
DAquifer Storage and Recover\- [DSaliruty Barrier
� Aquifer Test []Stormoatcr Drainage
�� s.;im:ntal Technology DSubsidence Control
�ieulh_,-nTW (Clus,.d Loop) Tracer
nGiceiI-,--rrta-I fflzating Cooling Rewrin) QOther (explain under -_1 RRcrnarks)
4. Date R ell(s) Completed: of VV ell TDf Q 1 1
Sa. V1 ell Location:
cIrL" C Vat (
= sty OA:,-\vrr< ac';=.� M-- (if applicable)
95 12,k10 r li I h fi 1o_Ul Le 2A61k
:x; ldarc>s- Crtj. aact ZIP
�z r
Paltel ldcr.Uficauon 10, (Pit;)
fib. L.afau& and loagitade in degreesiminuteslseconds or decimal degrees:
r:; v<d: f iG. cx f WL sing 1, •utftcizrr_}
14. VI ATER
FRoil !
R. I fL
ft. ft. `
1 1
15.00tTER CASt1G (for multi -cased rs
FRONT To DLVMETER
ft. j ft.
i
16. iNNER CASING OR TCBI� eut
FROM ! To I Dl.t�rETFR
ft.
fL t
17. SCREEN
FRONT I To
ft.
ft.
it:
ft.
ft.
( DIAMETER
ft. in.
tt- I la
OR LMTR
AT %T
termat erosen-loop)
i \1:y1 f 1%1yt. ,
SDR—j I PVC
)ROM
- TO
\t4TERL41,
E\Il'LACEME?+T \1FTHOD K A\lO f
�
; ft- D
It-Bentonite
fL
ft.
i �t IrI'1 L . t
fL
ft.
19. SANDIGRAVEL PACK if applicable)
FRONT
TO
MATERIAL
EMPLACEMENTMETHOD
fL ;
fL
t
1
ft. ;
ft.
I
1
;
3�
'' •Poe -1,10
gnaturc of C tirlcd Well Con :actor Datc
G. Is(are) the wYu(s)QSP
ermanent or QI emporan
At. qgnin)* 7hA freer), / lu-rehr eerti/t• thou the rsr!/!s) uac (pcvr% e'tuactnceled ir: uecordu+lcr
7. Is this a repair to an rt sd t; Weli: ❑Yes or �o frith I5A NCAC 02C .n1rx) or 1 S•t .\'CAC a?C .0200 if :11 Construction Slonda,ds and that u
(AI rriu lrwr.a ur/! r onefrurty r- tnfirnnWu n and rspluin the rwrmr o/ the copl• of thu n'cord has been provided to the ur/l ou'ner.
rcp.v t,nQti 21 remarks setunn or or, tla' hack of this Joron 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8- For Geup Only I if or 1!i ned-I twp caic'tOI A V1'ells having the slls construction details. You may also attach additional pages if necessary.
trntstnuctitxs. arty 1 4Vi- i> needed. lrrdicate'fOJAL h1,M13Elt al'wells
SI111Vf1-f'1'Al. INSTRU('TIONS
9. Total well deptY bel" lard Mr'fsee:yi W (ft-) 24m. For All Wells: Submit this berm within 30 days of completion of well '.. rnul/.ylr rrtt. nu all dr t./ha i/drllrrrnt Ireun,plr- 3�u 1t+U urk/1 u-itr!/} consituclion tU the 111I1nR1119!
10, Static %Bier level below top of uvinR: (tt.► 11i\itatin of Water Reraturces, Information Prucesxing Unit,
I1 cater lr:ri n Mort rOs,a? air 1617 Mail Service Center, Raleigh, \C 27699-1617
11. Reprehole dianwier: 6 (in.) 241). For Ipiecdoo Wells: In additron to sending the t0nll to Ile address in 24a
12. Well urnstlrnctlon rutthod: Drilled
p c :utgu. r.rry. eabte, duet prtr, etc )
FOK V1'A7 F:K Sl: i'1'i_Y WF.I.I.ti (11/:Y:
13a. Yield (Rpm)
13b. Disinfection type: CCH
etc, I imed
above. also submit one copy of This term within 30 clays of completion of well
conslruciiun u) the following.
Uivlrion of Water Resources, Underground Injection Control Program,
106 Mall Service ('enter, lluicigit, NC 27699-1636
24r. For W tut SunDly l&. Inirctign Wellr: In addition to s,endinb the time to
the address(es) abosc, also submit one copy of this ftmn within 30 days of
complcliou of well couslntctinn to the county health department of the county
where constructed.
; ,;n:: 6W-1 North t •arulma lkparrnrcut of hnurutunent.11 Uurlily - Mvixlon 01Water Resource... Revised 2-22-2oi6