GW1--02914_Well Construction - GW1_20240510

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'• ' WELL CONSTRUCTIO RECO (GW 1 �.
For Lttemal Use.Only;
1.Well C, etinLro atio '. I. 1
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1s.WATER o I.NSS 1,• •
MOM TO DaSQIITiON
-NC wen Oontro:tor Codification Manta
,(�' 15.'OMERCASINO(forrialti-oud wells ORLIMA(fine linblc)
�ij!/ r R �1%�� PROM ro .. DIAMXITR 78IQQ1=59 MAiiRGL ft R.I _'� In.
' .' 2.Well Conslraetion Permit*: `'t` 1.1! 2 ]i.INNER cupid ORTUB1Ntr(>eomerraal alsredane)
.PROM TO . •P DIAMETER TIRCttNLSS MATERIAL
Airs all applicable well eawhret/on permits(I a UlC.Cornty,State,PmfaneR WO R f"7"---
•3.Well Use(check well age):
Water Supply Well: r. • .17.SCREEN . •
OAgrieultund OMtinicipallPublk ntoM: To aIAM.TSR 1.,sLOTstrs TmC7WrSS MATERIAL
'. OGeothettnd(Heatin ff Coormg supply) ldentbd Water Supply(single) _
OlndustriaUCommercW m n i.: •
. ,OResideatid'Water'Sttpply(hued)
• is.GR0171' i ' •
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_ ' 'OLrigatiol ' _. DWells>100,000QpD . ' • sR • TO • MA . rMrIACTME tTMelBOD&AMOUNT
- . Non-Water Supply Well: • • (1 r
OMdnitoring ORecovery n Pk � l� �_.. _
- • Injection Well:• • rt• ;<.�r�atd
' DAquiferRscherge . OGroundwaterRent diaibm
OAquifer Storage and Recovery DSalnuiy Battier D.SAtm/GR1 VNLPA.CK(lf aeDUnhla) • , • • •
OAquiferTest OStolmwaterDninsge • PROM• • MATII!]AL sealacntl�trb>zrsoa •
0Bxperimentd Technology OSubside:ice Control ,ft.. •R - '
OGeotheand(Closed Loop) abeam' - • ,
'20.DRILLING LOG(■tt■ch additional sheet,ifnuessarr). '
' OGeothe mal(• eating/Cooling Return) OOther(wrplain under 11i21 Remirke) IntoM To DssauPn0N(star,iotaev,',Moak.ye;,ankh�,.ta)
d.Date Wells)Coinpletid:. -49�L�w '+ •
• cll D>riF • It Ili,
.. grim,4[7 t
• 5a:Well Location: it t)
•� _ii. / ts4 • ' : ' fb , _ . y_Z3, yam.
Fia7ity/Owner u{ i' r p t1.�..F�''�S:!I 7 7i.:.�.-.
N ° Facility IDS(if appliable) i! . R, . s `'• •�.:a w' a a.,L._� - -
'1 el/ •Che r , L1i• ,ila2�cl pa pp 'n • n' MAY 4.1_
Physical ••.tsty,�az 0' 2024.
County .'l'(:','.�9CI '
• • Parcel floo iSatien No.(PIN) ••
5b.Latitude and loagihde in degrees/minutes/seconds'o'dedmnl degrees: I } •
(ifwell Sold.om latiloog is nitReient) '
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f.Is(are)the neds y e — �' .•: (�( . • eZSC—
O:k rmanent, er. OTem ore a 8'G s m:6e a ti£ed
7 \ p n' �. well Ccatractor
7.Is this a repair to as existing well: OYes ,or g3°'rsn►nsih4jo►m.lbieb•e.en' tharrhswell() -Ormel eauaaacdnr
!/thl:1his a r pair t o am exist inl ' o• o fthu .lC 07C:0100 ott7.7/ f C 07C.01001Pell dMQ �'
r ognrereel/dn iY)fwrwNlee a rs afn the name ojlhs olthli Hoard hay been Cwvhttet/ae St srd titer o oyp�r•repot under/Il►eemrbscentn'anon tha bacR•'ojrMejorm A�{ded Fe Mewl]mtrea:
23.Site diagram or additional wed details:
'. 8.For.Geoprobe/DPT or©offal-Loop Geitiermal Wells having the same ' You may use the back Of this
page to• • Constructing,early 1 OW-1 Is needed. Indicate TOTAL(•1UMBSR of wells (add'SeeOvee is Rfai'ario Box)You �also•ido additional ona1 coaettrrction info'
drillal: _ . . � may attach additiood pages ffnetxsstay;
!.Total well depth below land surface:_ O 2 •1 24.3iJBI�IITTAI,B'1STRUCTI01!is
F'ormuU/ a welt UiI all (ft multiple depth hr_3At00'and2@lop) • ) Submit this GW 1 within 30 day
s of well completion per the following:..
10.`Statie water`level below fop o(easiag: '' .CO Q 26a. For Al! Weds; O' rfwat.rferstt,aboveerarhrg tree+..I (R) Original form to Raleigh,
of Minter Resources (DWR)
information Psooessiug Unit, MS%, .�(�. •
C,ILleigh,NC 27699-1617
11.Borehole diatinter: ' e/ 0 • 246.For InieeHon Wells:
, • Pro 1636 MS COS'to DWR,Underground Injection'Control(TUC)
12•Wa>ftNstr>.eYatatethod: . O ak , Program. Cr'Weigh,NC27699-1636
(is.eases rotary o4114n!1s°et
t+a+4 etc,) ,. 24c.For.Water.Sa and O enLoo Oleic 'sidebar'Well:Copy
. FOR WATER SUPPLY WELLS ONLY: •' - � ' epartmoat o cototy Qo the .
24d Bor'Water Walls roeloelti over 100 000 GPD:.Copyto D
13a.Yield(gpm) I • Method of lest: • Permit gram, 11 MS WR,CCPCUA
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C.+. C1Bh: 7 9- .
' '13k DbiskeW�fjps: l • t'
Amount: (i!/