GW1--02165_Well Construction - GW1_20240408

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WELL CONSTRUCTION RECORD(GW-11 ForJntecnal Uiseonly:
1.Well Ca dradorI Information: •
_� "YQOM TO DESCi1 molt[
weucoauaetarl
IQe Weil cwaaseuor( tba25ta1&s 1s+oUrEaCASINc dfeoriessriMOOxiriEROT . ' : :.
"Mall Veil b VIAMIP FROM TO DIAMETER r :Ulm= MATERIAL '
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2.Welt Oorudractionramitik [AU_ , _-_ F TO mann R mamas nut bi
iirt all anilIco kwlleanantafooprspis4tlww*tint:x Cirri sac) tG R
3.WdtIIse(dleckwellease) R. m a.
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liwfer'ilrittercuituraiSlipPiflYeUs rr:Sctt T ._ •. . :.•,.....
ntlalETEl SLOT m�raviss ...MATERIAL
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►solialu alQR�vaeo l aTate SUPSytt need) :”.i :-�r. ., :;:::. - ....-'gam
lhaerSupptyWik .. . . .. . -. . 8 •its ing pRetowp tt B.
. ohaWeH: . .tiferRecharge ��t dfaat�Rm�iatim Ace sANDA3ataY�ei:PACI.(ira c '_-. :: .::, -
StotagomrdReeare�ryy 0SilmityBaml FROM"_PTO ,�uaTE r : Fats a>frzon
. uiferTest r31alaA%krnr �eri alTechnoiogy riS aeCasdrol it �.oiier al(Closedloop) riTcaor .7pk 1RILIEsVoLOGit tkidd"diaitAtiltIt oico—c .-.: - -.thermal{A PJCttoTmeRr has �e eiat l Retuarks) ,.moat . • Tea "� Desto rntafour mli,e;: .esxv ,.„t*.,tt
4 Date Well(s)Completed; �7(1 ' � t'-R-t`��
wdll'D,t- r�
5a Well Location ?'u 5-6 Ro
c`fticd-)-I..._.'t.► � _ S j L 05f . ( 't fl(01i`it
Fac i-kio-astR'iow Faatii slur ..'=....) tt• D. i.
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$1.1.atitudeand lade SlA 6Iseco Idserdecimaldegmes: vi,n L,
(duciifutd,coo licllorRis6Affa6iCffi) 22—C liot� I4
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6.is(are)theisell(s) Fesmanctit orDTenTpora�rs s- wateoatractor Data
'.osaura tlxrfono I lecreby orre II c the WO)m s Wry)muaaelsd in accordance
7.I4Wisarepdrtoans ting.well: ©Yes or DI No with LSIN dCO2C.0i00or154MAC ow'.020RfrellantracrionStandards and that a
.fthfslsarepafr.finotelawns scell consastertaairsranaceio coete ►ertndrnonreepee coNoffds,'sea dhubemtwosfdedtothfreellon►mr.
rtpairamkr#21
74 Ste sT>agramor additional wtAdet,its:
• 3.For heap e/DPT or -Loop Geothermal Wellshavingthesame You pmy.4 abYko nsfm this Ls ana hddiet iaadrtattipoar tais wnne site details ec%wfi
aapsbisatiag0a1ylOW-1isaaeded.IndicateTOTALNUMBERofwdls
drilled: _ S,iB/417.41,INS tUCT1ON$
9.Totativd1 depth bdon laud swim: .%O 5 (ft.) 24a.!nf.,!Welt' Submit this farin within 30 days of completion of will
Far+ealdpkwUs lid at likes reined( -3e200'a►dag.fan conFhlsetianto Mowing: I.
1O.Stmtiewatetcicvelbeim,top or tasb>v . -ko .(tt) Division of WaterRaource4btfornsagon Ptomain Unit,
ljtwaterkeel Whore omino we^•r g.at 1617 Mail&rinses:ger,Raleigh,NC2 769 9-1 61 7
11.Borehole diameter: '( , !" .Cul-) 24h,For Tn Gm Wellt bi addlilOII'to sending the form to the address in 24a
/ above,also submit one copy of this fond:within 30 days of completion of well
12.Well cenestcaU.tiarinethod:„_�f?I tAr -_ . - -. commotiontothalbikn ing: l'
(is astm Wary. Te p •cal
___-- ----.----- --,_-- R.__._. wow=of Water R cns�U gfalsefnjeetto:ControlProgram,
FQRWA.TERSUFFLYIVELLSt30i1:.X 1 MOWSnvieeCteter,Aakigh,11C27699-1di6 ' •
13o:1 Veld(arm) 1-4 , Methodolt'test mil_j _L 1447�7 tic FsE.W?t.ftpic,bk/nift09,will* k&Won 10 sending,the farm to
9
the address(m)shovr7 also submit arts copy of this Am within 30 days of
13b�.Dssrosliort types Chief: n e, janmenk r j• OL . you of tint commence to the eatnty health departmoit dike county
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