GW1--00101_Well Construction - GW1_20231228

i WELL CONSTRUCTION RECORD(GW 1) ForIntemal Use Only: `�-'�-
i 1.WellContractor Information: I
• Pao L PO f/Jet •il 14.WATEILOD!IES i
Well Contactor/gameEROhf iTO I 1 DESCRIPTION •
i` 4 �4- 11& Dir e I �ey � ��,��
Ili NCWeilContractorCeniEcationNumberft y
�� t /_I t 15.ODTEROSSING(formal&-ah davelis)ORZ1NERC P licuME)
(, J l PROM <FO- DIAMETER��{t J{�I CQt j
j
THICKNESS MATERIAL
k{{ CompanyName� 1--.1 ft: l I/S"'i ilr lay in &iv1Z/44
16.101ER:CASING ORTOBRIG{geothecmalclosed-Ioop).
2.Well Construction Permit#: 3 75-606-- FROM tra - DIMMER. THICKNESS MATERIAL
List all applicable well construction penults.(i.e.We Court};Stag Variance,elm) , ft. I ft. In.
I 3.Well Use(cbesIrwell use): it. I ft. is
Rater Supply Well:
itSCREED/I-i - - - -
� FROM TO i DfAMETER SLOTSJZG THICKNESS MATER
D urric pal!publie It I ft. in.
k Geothermal(Heating/Cooling Supply) DIRcsidentiai Water Supply(single)
ft I ( ft in
I;'; • ti Industrial/Commercial DResidential Water Supply(shared}
i; _ litigation 18.GRODT I
P FROM TO MATERIAL EMPLACEMENT METHOD&AM
Don-Water Supply Well: C ft.
I. it 414-1/,
otr
iI • onitollilg oRemovery ft I ft; '
cl Injection Well:
it'1f Aquifer Recharge DGroundwaterrRemediatlon I
ty 19.SAND/GRAVELPACI`lifappNcable) - -
f
I, tlquifer Storage and Recovery �i allot Boater FROM TO, NLLTERL6X 1 EiVIPLACEMENTt1'fETROL
r' Aquifer Test ©IStormivaterDtainage ft. I ft
"t Experimental Technology - °Subsidence CoutroJ ft. I ! '
Geothermal(Closed Loop) QlTracur 211.DRLLLINGI:OG(attach edd"riio mil sheets ifnecesserv) -
Rum TM Geothermal(lleathrg/CoohingRetum) IOther(explain.uuder#21Remarks) oEsettlPrloHavtor,heraaess,soarcucictyne rrlc
4.IlateWeIl y —Q3(s}Completed: Well ID# .??1 ft* ,3p fr. &My erraw1iile
'I
. 5a.WeIlLocation: ft 1 ft,
{ h (5-Efetft. ,ft,
I, EacillyJOwnc Namc FacdityiD9(lfapgticabie) + f 1 'ft,
ches r (JCL('
% let / f ,- =z
Physical Address,City,and ft f , ta p ;
l; A5I 13136 i 191016 21.REMARKS - - JE C +ice ^I; 4
`,I _ Co Fat elIdentmcationNo.SIN) �JEt j !CC'/ ,q: U' ����
•
;' • Sh.Latitude andlongitudeindegrees/minutes/seconds or decimal degrees:•
I I ~G � ,'��' : l%
'' . (it well fieid,lJat/lang is sufficient) 2;Z,CertiScatlo ~
I, IFF
I ‘';S«a- N Yf 3ef 7f w
i; 6 Is(are)the well(s)Nip ermanent or t�ITemporaly Sit: ofCet ed�Velt cror Date
i !
By signing thus form I hereby cerif r that the wars)was(Were)•constructed in acc
7.Isihis a repair to an existingwell: 3'es or r No With ISA Nate 02C.0100 at ISAY NOW 02C.0200 Wen Construction Standards as
tOtis ire repair.fill ast known well construction information and explain the nature ofthe copy of this tecor l esbeenprovided tothewuffowner.
repairunderf2l remarks section or on the backofrhirforat.
23.Site diagrar or additional well details:
• r S.For Geo robe/DPT or Closed Loo Geothermal Wells having the same You may use the back of thispage to•i; P g g provide additional well site details
( - construction,only I GW-1 is needed.Indicate TOTAL NUMBER ofwells construction.detlails.'rollmop also attach additional gages ifnecessary,
I:+ drilled: ��8 SUBMJTTA INSTRUCTIONS
I.!
9.Total well depth below land surface: - (fe.) 24a.For All Wells:; Submit this loon within 30 days of completion
I;, FortnuhttptewellslistahhdepthsTelfiereni(example-3Q200'and2@100)
construction to refol[owing:
j 10.Staticwater level below top ofcasing: . 7Q .• 1 i
+ 'limier level&above casing,are ( ) Divi9lon of Water Resources,Information Processing Unit,
Y it'l Malt Service Center,Raleigh,NC 27699 1617
+' 11.BorehoIe diameter-. (p y (inn,) 246.For Iniecfioa Wells: In addition to sending the form-to the address
IZ.Well construction method: I( l �QtY`t-r above,also subhlii•one copy of this local.within 30 days of completion
r e:auger, sob p >>, } J constntction-to tie C ge,unary, le,direct us eta 1
}`. .FOR WATER SUPPLY WELLS ONLY: Division o afar Resources,Undergr ound it ecti7 Control Progs
Q /� ,{� 1&I36 Mail Service Center,Raleigh,NC 27699 536
13a.Yield(gpm) O PM Method of test: 1 O 1 d# 24e.For Water!Smmly&Infection Wells: In addition to sending
the
I 13b.l3isinfeetian e. the addresses) Bove, also submit one copy of this form within 30 t
1; ��� � ��rL completion of vieII construction to the county health department of the
where constructed.f