GW1--06273_Well Construction - GW1_20230926

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wELL,CONSTRUCTION RECORD(OW-0 For Internal Use Unit-
. I.Well Contractor informatlon:
Cameron Bazin 14.WATER ZONES
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NCW�Cotihagor R. R. ,
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Aqua Drill,Inc. IRON TO
DIAMETER TmCttrtcsa
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i 16.INNElt GoR Totaamss MATFnrAL �(
2.Wel Construction Permit& J°��l FROM TOLin
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3.Well Ilse(deckled'use):
17-
R. rt.
Wa cSuppyWea: FROM'TO DiAMElER SID•i•8I26 TRIMMERS MATERIAL
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0NLmicipallPublie R. R.
1 Geothermal(Heating/Coo Supply) Ethskienlial Watersupply(single) - R. R. In.
ustoe —nV^ - Residential Water uPP1Y(sbomd) 18 S ? 'X
emuCEMENT METHOD&AMOUNTNon-Water Supply Well:
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FROM m • MATERIAL
s
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Wen: (Recovery tL fR i
a?'i, tt R ,i •
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i,� 19.SANDIGRAVELPAQCfTAReablel '
t al Storageay 1]Stdinityl3aaier FROM 10 MATERIAL EmnAceeerxrnsencoa 1
Y= Ter Test .•0S' terDrsioa ft.
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' i'• Experimental Technology EISolsir�.,,a Control • R. ft. V 7 eV
1� Geothemtal(ClosaiLoop) �Tlacer 2o.DRILLING_L00 fattishoBdEdanalsheetsifnecessary) ' ,- •.
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4.Date Wetl(s)Completed: I(q(2(i Well Ma • ft fe t2��� , :i;
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i i PhYdeal Address.Cd 9
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� /iS.k G 21.REarARI(Sd sSEp f 2023 R,� ,.County ParcelIdentification No.(PIN) Iii � ��� ,j t Fr . It'
1 56.Latitude and longitude to tl�rcea/miDtttes/secoads or decimal degrees: D1 v Stet
,}+ (iffw�ell field,oa/ r�eletllmaso=Maiml) 2LCerti$eaHon: ,
6.Is(are)the wells) ern anent or°Temporary sigmmta ofcenifiea Weucnntraetnr
to this orm I hereby1
i� 7.1s this a repairto on By string f cenh'that the u0A(s)etas(mere)constructed In Band that
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repairmrder#2lrmrmfv section erne iheba ethisf w
23.Site diagram or additional well details:
t
i S.For GeaprobrlDPT or awed-Loop Geothermal wells having the same You may use'the back of this page to provide additional well site details or well
1 drll clion,only1GWIistteeded TatfitxteTOTALN[JMBERofwelis construed=details.You may also attach additional pagesifneceasary.
SUBMIT['AL INSTRUCTIONS
9.Tat di w lls Septh below land surface:
6 S (ft) 24a.For All Welts: Submit this form within 30 days of completion
For taafdpletteuauran depths jlrTr&.rnc(aampto-3(a37oa•and zpplaa) 24a.b„c(iontothns: Sing: p on of well
5'
IRStbtic water level below top ofradn� 0
lc water lewd is above eufreere+" (iw) Division of Water Resourcaa Inforination Processing nit
1617 Mail Service Center,Raleigh,NC 276991611 ,
II.Boreiaoledlameter. 6 (in.) 24b.For lnlectioa ui na, In addition to 12.Wen construction method: V ,(fir obovw also submit®copy this � i thin the form to the address in 24u
Car aura:nary,cable,d;tietpusb,etc.)
construction to the followingV 30 days of completion of well
FOR WATER SOppLlr WBLi S wax: Division of WaterResoervlce Cea Underground Injection Control Program,
1 aterR S
13a.Yield(gpm) ZO Method oftest: �� d' '�ei�e NC the
27699-1636 gam'
24t;For waterstraDly do TDl�rton Hrrl�l.; ,�ado:to sending the folio t the addresses) above also 13b.DldaftxHon Amount
completion of Well eoasktiction to ePY of
Wis form within 30 Iila to
where conshucted, tlia county health demise r of theof
giyonty
FormGW-1 NortCamliaaDepartmentofEnvriropnaetalQuality.DryhionofWaterReviResoulces
std2 22016