GW1--06548_Well Construction - GW1_20231006

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NC Well ConhuetorCestif eon Number ft. — fi
Aqua Drill,Inc. 13.CATER CASING far cottl crt:,^tl vmlta 1)R
t-�. PROM TO 1.Ii>ffFt iPar,.lkYyle
Well
party l�laLle rI. �` DIAMETER� MOM MA7TOOM
Z.4i1 C�k &saCQa`3 Permit Ai �y� lJ L7 7 j'�C�
L.W e -.---�Lam S S/ ld.INNER CASUd7i OR TUBING schism I etese34WP)
4P btettblCOnstnxlJoap attts(taClGt'a , moat To DtAnttsaR rtns n7nTtssuAt
0'���Parlance,etc) ft R In 3.Well Use(ehWts' well ttse):
Water Supply Well: f t• Ig
*Agricultural 17.SCREEN
lit E.Mtuucipa]PUblic FROST TO I n1AL7E17.72 St.°TS= ITITCTOMS M.1tfM1,
Getltlft�Iaal(Re ng/Coaling S 1 ft. Its
nFP y) Residential Water Supply(single)
�t��aUCamtnetaial � ft. ft � Fey
�Resideatial Water Supply(shared)
" la dPEt1)UT
xols-Wote�Supply W MOM
()3a: TO PMA-MAL rMnr,ACELONTeu-rr;on&/moan T
•
Injection W 11. iii
Recovery ( f y e:l c.
111f Aquifer Recharge
OGroundwata fit ft.Remediation "
t quifer Storage and Recovery Salinity Barrier FROM
SAND/Gt2AW:3.PACK(if avelfeahle)
all., - Test FROMTo MATERIAL EDtP1 AC8r/mrrt9ErttoD
II Experimental TtxhnDio Qtt3 Drainage ft. ft
83' °Subsidence Control ft. tt
i ,
N Geothermal(Closed Loop) Eltrincer 20.DRIL INGLOG(ameh.ddtuanal!beets Ifaeassa y)
It Geothermal tali! ,,liar Return Other(explainunder#mil Remarks) Ru
at TO DISemnnow(ea*.i,,.inneu...svtocx dy r,"mtn csu.edn)
I/ ? j 2 EL 60 a SFi4.d-
4.DateWell(s)Cotnpkted: (0 7 l Well IDg (t R ��' ;,,. .
Sa.Well Meanest?. ft. le
inl law l v,//layi,5 r 0 6 2n
rociUtylOwaerNawe Facility IDtf(If.pplleoble) IL t,r;�;..,_, u l3
2.5 z i -Jo ev✓t c . �05y iL i-. it ,
Physical Adders;City,end2P It. ft. -.- �' ,;
J y, 21,REMARKS
Csdimty P reel Ideati(IwtionNo.(PIN)
Sb.Latitude end longitude In degreeslmlaulesfseconda or decimal degrees:
(if well fold,one tilling 9s s�cient) 22 CerHBgtloa:
6.Is(are)We wvdll(o) Perann�t or I Temporary Signature ofCoa tied Well Coahacmr beta
TT By:Wag!hie farm,I hereby oertifr that tha intl(r)nuts('a'v)tonged to accordance
?.Is this o repair to an earls'tlag hell: �% err No with ISA MAC 02C.0100 or ISA NCAC 02C.0100 Well Construction Srmtdardr and drat a
{fu(slaaru7r¢ir,Plataknownwillcwastructioaff anderplalateawareofthr copy ofthtrreaadhasbtrAprnvldrdtotkewallamKr
rr�atrundr#21rm=Issectionarea the[vac!'thtrfcrm.
23.Site diagram or additional wall details:
Gant ttDTc"Jd1PI'or Closed-Loop geothermal Wells having tha lama You may use'tho back of this page to provide additional well site details or wellL For
dim only 1 GW 1 Is needed. indicate TOTAL NUMBER of welly constauabton details You may also attach additional pages ifnt cessaay.
drilled: $YARN YTTAY,INSDWCCTION
9.Total well depth Below l:ad saafttce: ®w (�) 242.For All Wells: Submit this form within 30 der
For matrlpfe weIt,- tall deplcu tfdlQrrmtt(rsample 3QZ0r1-16)'and 2�IQQ� coastractjon to the{OI1oNiag ys Of completion of tool!
10 Static water hovel below top of casing: Mall
( ) Bivl:ion of Water Remoras,Information Processing Unit,
Ijmarer tenet is abaV cc inyy use+" 161Mall Service a Center,Raleigh,NC 27699-1617
11.Barrbole dints=ter: ( ) 2A6 JFor Ott Ia7t F7sIIs: fa addition w
shove,also submit one 18 the form to rho address oil
E2 Wefl ronstaustton�d-tt,ad: io' �>l conaructionto the follawcemng of the foam vrithin 30 days of completion of well
(Lc.sue.mmry,ab%a per ) Division of Water
FOR WATER SUI'PLIl WELLS ONLY:
1636 Moll Service Cent ergroraid la)ed27 9:-1636 grog
•web,NC z7ra �$
/5 ftkWod 24e.For Wa4ea 5uamly 8r* s + : In addition to
13a.Yield(ppaa) (Veit;
'% 1 the adthess(es)above*also submit one ropy of this rtndtng the foam to
131t.Yllildrfedtoa type: -. Adoring 1 f,n 7 stia�ad to the coin hen1th dtivifilin 30 days of
. the co>rnty,
wogi Depertazatofeari momenta1Quality-Division ofWeterR
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