GW1--02907_Well Construction - GW1_20240510

COAISTRU ON RECORD GW.1
Forinternal Use s, .. . 4. i .
•
•
•
1.We1lCbcdrtctorinfol�nafion;,
�Prin t:Fbrrrl,
. . ,.. �ary:Thom son ` : -:.- •. . •
Well ConffectorNante _
2*.WATERSON&g :"
NC WdI QontrietosCertiBeetion Nom6er
- 195 ":. 1q
qua Dnll;Inc
Ooeppaa DnH ; ' _ TCASING gy 9: �;r•>�t.►7 rni,
S.OUTER at•ne1:
tRDM • c_eD
. .ft. racsalatIrs21
•
twev coaatn;�p ierridt
3--a_\s .
Iti.IltNERCSSINCORTl res . , -cm`aa: ' C
li.tdl4a metikencons. »t r�fie N,acor Fii°nt TO _. • • _ :.• -aR. -- ,
• � . . . . Si .sr, I�arlmue,.Ae� -
3.Well Utie
. (cr4kwell uu):. L. .- . ..
. • .. ; 9M Agncudfurwl: . ' . . " .. , •I.scs�eN ,. __
-- �6Rnnicpav�tb
lio.-
� rt euaanaR
SsuppI3, s`/ hel_WeterSuPP (fie) .:-. •• >I: .-n tn.
*ladustrieUComaieratal.' Residential WaterB--
n- .. n..
•
td fret_tlott. ;18.QROiJY ' •
. .. . ly(ahatetl
NotsWater Supply Wes; .: ; - .•. :. _ FROM .::, ' mnlRta on,r
0. •
36 teaRecharge - .- • .: f G o ndweterpetnediati�i - " • n •tt• . •
•a.�SeBeaadRerovery - QSa�ityBatiier". >9 BANDImtAVE.
. •: . 1d : .", � , .
DStonnwaterDiamage t�tt�ce• ..*. •Mean
*Bxpedmental Technology
. • ":• . . EISahsedenoe Control • "-: -' : ." " !:
lR Geothermal(Closed LooP7 • r," - m-
n .'
•
zs.DRnLniroioa•osm"artptionalatl ..,,
21 t3 : •` . Rabin „laimnnder#21 m:
�•t3tticr ... Ftmst
Rt�ailm f - elascRerrewvr�:m �.,,,t��,s.t.orr.�i
4.DateW s)Co a,S-I W4 R►enitl?(E _ ;t}
o n
04 11- ot+1 o�Rat,e�� (ie" Se,: n,
1Tet'e7►
• •.�el�
- i,.R 2024..
• '� ft -MAY 1 n
Pawe1Identigphof N0(P1N) '• , i_,iTr`t. T -Ei : ,� :r• v ' .� . __-
Sb.L'atitnde etad longitudeI dege' /miniitesk eonds ur dedtnyl(ifw hI11 1d,oaelaNhgis dew: ,b w
N
w
6.Ware)the weals)jpern.nent "or sip,of _ $-a.=ay :.
" - • •• Or" eUCoattactor
7.• this•a-. • .Oil sxtGing�veQt :�Yts• : •: - .BY3 eleg rkls f hee6y"errr&that the ite11(r)nec Date
:Uvisslaotepotpair to
i t ieg went
:. ..' Ivan ISANCACO2.0109 or 1JANCtCOma 0200 t3'ell nst ctIon tang In ac rlthat . ..
> rtridrtwei t iiknoi well c ri:avian l gnmrd all the emkiii(Oka �00:014 recp dlmabienp.midredto ihe+�Jl.in i en d r mid tbat o..
8:For CProheN)li'1'or
- . • . • • Z3.Slte- • • "
e.:For ctioa, Ci eji Ceothermd Well havteg the Edina . You may*0the bank of
only 1 GW 1 is heeded, lndioate.TOTAL NUIMBER of wells .consuitepion.detni s._You fl y Dial well site dettteTs drilled. " .• az,woll
• . ,. . oleo � had
additi
d.= ..' ,ag�efetece ry,
9 Tbtat wd! 14UB11�[T°tl�L INSTR 4'i'IONs P .
dtpth leloiv land tmrlice:- �S
i*TOW
ldlplr w�slfse t l ii6;'11•0 1 aril cii1.pie- (�2p0 mrd2 10 — '( �.'Z4a.doe Att Wtn.. -
14 84Hcwatar.lavei al" oz>s•truiaron t tins foam within 30 days of completion"of well .
Ilei Stailuie!!s ati les tbelow top of 4610: -Q - ..
rat+p «)
Reraurs�
Dfvldut nrwt
1617 Mill 11RaWg ,N Pepe 9..itl Unit,
11.Borehole diameter: (�) Gaiter;Rrdeigb.NC 27699.1617
n• 24ta a to addition tos
iZ Wall constraetlon method: — Qotd►t( I•" Ale- above,ciao euhmit one .•• the foil;wait address in 24a-•
(ta.�,m s.cable,tirectpmk etc..) ••
� constcacti this'•whhm
._sa to the"t$Ilo4vi�. •FOR WATERS. .11PPL.Wi3,L. ONLY: DivLdou of Water Rtu
days'of completion of well
• >�UitdetRneotd It�eeHon Control
13n.Ytetd •_....., ...,.
1636 M611 t9ervice Center p�+m,•" .
.� (Om)- - ,. Method attest:" � M i. .RddgbNCZ7�1(t�" •• .24e.Frir Water Sn its&ln1 toai Wetirt•".In addition to leading the form to" -
>3h.DTsPnfecHon ty• l3�'H'Ib�/n A ®�_I 0.• - ". the eddiess(es)above;also�„lt ate copy of-this tbrm.within 30
days. . Completion of well•on_sttaoti_aa to ttie_ county.health department of the of .
whale constructed. • c4untY
tow t
North cerolina Dopattmine of$avuoemonml
Qouty-DivieionofweiterBesoaeecs i a.:.}...1 t"...,.:.