GW1--06191_Well Construction - GW1_20241021

•
' {
II i
' WET•T a CONSTRUCTION RECO (GW-j.1 1 For Internal U e Only. .
. , I.Well Contra a •
tonnidlo :•
. , . dthk
•if {l : • •14.WATER BON'S
Wentbdr■cleex f PROM In DDattrrroN"
Vc5 � 7/aft.
/00 RD, •
• FFi R .R
NC weS CoohactodleaGen f .Nmmbe i IS.oonot. CASINO(far meld-cased we% OR LINERpfay Stable)
13 ry fh•�v s II FROM _R r TO I DI61VS1IIl rHFQ01iS3 MAILWL
camp.eryx■m. I R r��
T G•
' . IC INNER CASING ORTUBING&edit:ma doled-lean)
2.Well t:oastnetloxYermleiF: 1 y'D 5•3 PROM To. muumuu mamas • M&TWA6
Uri oil applhmbla well earuha.son pandt't(se(!1l Conti;Slate.Varian"aft) ! R u R 7 b
3.Well Use(cheek well case): �'• ,. ;S l�. iC(1 YG
R P
. Water Sanity Well: . ' , li
V.8CREEN
. _ PROM TO I. I DUMl1ZR SLOT WEL •rDTaQMS3 MAUL
•
OAgrieulturel OMunicipal/PYt61ic , _ •
`OGeothermal(Heeting/Cooling Supply)i dentielWaterSupply(single) ft.
,ft. L "
. ORecovery {
. .OlndwtnaICommet Tel rdenid'Water s y(' la.GRour
-: Wcis>10000D GD '" - - FROM TO MA VMA QUNiuITROD&AMOlrriptiol ___a
. Non-Water W•e• '; ' , R23 : "Aka r.1' OMoaitoriag ft'
Injection Well: !t ft 1' - �G.,,Y
l ls..:,..r1 .
aAquiferRecherge OGrmmdwafaAemediati� R R /
OAquifer Storage and Reeovery OSelinityBerria. •
D.SAND1GRAMPACKOfaiUPScable) . - - •
• , •
� ft R l PROM TO MATAWL IRIQ•. , •.N: .. . OD OAquifer Test OStotmovntaDtninage ,
•
" °Experime tat Technology OSubsidenoe Control 'I' _ R I{. ' R
a DGeoesm thal(Claeed Loop) OTeucer f�. `
30.D1i11LLIIYG LOG(attach aidttlaaal sheet<<seems■q)
• DOeothamal(ElealinglCoollagReturn) • OOtha �� FROM TO'''.
. . DFSCRtrnQNfdsr.i�das,wVled"/"•erish■,�
C i (e> lihr adds r121 Ransrlo) n, } R
4.Date Well(s)Completed:. /•-Z.�- t Well DNl . li: • n 1 n • - ,
' . 5e.Well Location: . 1. till R
R 'rj-tuiti ' •FQST••P,✓ , t•
R R tom..
Fia7ity/OwnetNsne' t a
FadlitpIDF(i(appSab]a) ft..
P R,
1,t:ji. SA e re -Ft-Rcf . • k o b I. R OCT �. I Z_0Z4. .
P e 6w,and pp { R , ..R info car-•.V r'-n
• :LREIIIARifs `„= =t• ,,
come;,, U � +yi.�: i.
Ysrmt IdcaH6catim ratio M i''
56.Lraitedeuad longitude In degrees/minutesheeonds or decimal degrees: ' ' 4
, (ifwell Solki oa hvleng Y sulfdeet) •
N /Z• .�f W
- " , ' iii.• - , .
6.I1 are the /Q 9
( ) ireu(s): Yernraeent—or Oa'emp
7
7.Isthis■rciralrtoaeexlsUngrrelh ,. OYee or No. • '�1(04thLiArni,lhcnebreerrry ANthamll(s)mtr&ere)eaearetdhr
- l7.Istrarrpepaiill broMl well sthig , amox, •i ' 13.11VG(C SIC:0100or7JA iC4C, Chown . lCataitertf
'repairsmiler121roisrbsectforior � 1° �. rhonoMlr.ofthe of�ilsreeoid has beenpras/dedbdietrrAoenrdr. Sbsdartb�drhaft
• anYabaekajtMefoter i
d.For Geo ebe/p • 23.Slit diagram'Ur additions)!well details: •
p Y7r'or Closed-Loop Geothermal Wells having the scene You may use•the be,'ck of-this
• • cOnstrucdulled: tlon,;only 1.(3W l is needed. Indicate TOTAL NUMBER quells ( Se art. )Yo to provide'filch
well construction o l Ovct'm Rdt: Boar).You may also attach tMditiomsl PeBm ifneeq
.� i • 24.SUDIIHTI'AL
•. 9.'ffatal well depth below land surface: u INSTItIICTIONS ''
F`arnrirlffple weds 1W adaTiplhr(lrldoant t •• ;
•+ ( -9®700'4sd?p0(I) (�) Submit this 0W i Mt Jn 30 days of well campletioe r tie
10.stage waits level below top(ceasing:• Pe following:
10 St atfend la Ic w1.e'l evel my oe r+- /� � C�O �� (R) 11a._Forte ems: Original form to Division of W
• �!J .- InformetionProcesiimgU 1617MS ��
• _ 11:Borehole diameter. b s , C+ wt ,NC 27699-161 �
.(In.)' �] 246.For Iateetion Wepi:Copy to DWR;Und "
12.Well eaastroctlorr e -Ej �ta}w,1636 MSC,Raleigh,NC 27699-1636 �&oadrd InlectieeConteol
(r a .ate Method: • 1a T a-1'(.i — A Yiar' .
rOhtR a �1OEt�'!�'�) • I • 2!a Far Water 5i " I and O o-1.ao Geotbes•l Aeturrr Wells:Copy tc•
FOR\ltrl,TLA 8l)YPLY WELLS.
ONLY: `� 13'eavuenme�t cpartment county
•
24d pp 11 For WaferWes redid!,
r 100 000 GPD:Copy to W
R, Cll13a.Yield(Rpm) etiod oftat j )' pamttgams, ., SC, eaC27G9 9-11 is_ :136 jiedtii type: Amouu.@ D
L !I