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W1:1,1.CONSTRUCTION RECORI) (C1V-1) Fur Internal Use Only:
I.%Veil Cuntrstar Information:
Lcoro
I FLCL 11_WA7'rR_/.ONESr Nana ItR(IAI '1a' nl:g('RIV'1'10�
(f !/�� n f EDh. /alpm
1 a c t+ 7 ft. n. Jl
Veit Cornrtrtor lbndi,.r!n,n N ur,f l 1
/f�f15.OtrTER CASING(for muhl-caned wells)OR LINER(if■ Roble
•1 Cf iC1on-Iry j,�, C I Ct n 'l ,—Fl r i.i11j it it- r j_MITI k tn. i 1111("I(NLAS MaTiRl.tl
t'ou.p.oe Nan,e
r �y u1� 16.INNER C G OR TURIN (geothermal closed-loop)
2.Well Construction Permit p: Li- C5- -/-rs 1--- III nIASIFTrR I IIn(nsiss NIA IMUM,
Lot.,Il npp6rufl., ll,omanrlion innnnr.(i r l I('.I...will.\r,rl, t'•rr.,,,,., r1. I ft. Cl. in.i �l
3.Well Use(check*sell use): ft. 11. in.
Water Supply 1\e1l: 17.SCREEN
HRINI , III mt%IF rFR stet-r ai l: rlu('krl_cS. sI%Inti .
\c,,,,d,oi.t slu' 'd-l'uhllc
Ejlicnllcerntalfl kitting Cooling NupplvI i•si,lenl 11 Wake Supply I suit Iat ..---. -- - t
Ih.. II. in.
Industrial l'onutlerciul 0I(cstdcnilaI Water Supply Islturcill ta.(ion' )
,Irn eat ion 4'NUN 14 tn:Rru ettYl..u'rsu:Nl+Ir:nlooA.(tlurhr
Nun•1\"tiler Nupply Well: ft. .._ft.y (�7--`E S
C]moaitorillg ORceovety n. ft.
Injection Well: ---
6.1 ft. -
El:\illtller Recharge 1:3(irnumlwniel Remedi;nion
I9•SANUIGR.4VEL PACK(lf appllcabl() r-
�:\quilcr Storage and It5Cm'crc f Balms,•it:min' :FROM __.- _ �_-
�FN1M1 "111 btT1:R1�I, f?lY1.A('EM1:Vf?IC'f1111U
0Aqulier icsi DStorniwaier I ha m lgc ft. ft.
IDI:xperinicntal Txlnolugy OStibsidenre Control ft. ft.
(31.isothernwl(Closed Loop' Tracer 20.DRILLING LOG(attach additional sheets if necessary)
r'Ruti— r III I of:w'RIPIR"tooter.It rdn.,.-,niYruaroe,Braind,e—rn.,`O(icolhe!ma1(IlealingsCooling[(clam) nudger(explain under 021 Remarks'
...��/) !_ C. t n. re a
i •
4.Date 11'CIl(s)C uiuplctcil?) 6/ I Wv11 11# l• ft. n. _._-..._.
,ic t1U n •
Sa.11 ell Localiml: 1,1• �a nil.
/� 1 val�L�/
:Y litill vi4(.,5--1)ict — n— rt. -
f:ul lea is u.r N."!
ut .,nhts llID lit:r+nhrahAl It. ft.
i
i do
Yh I r,d, e...(It).and L,1. -In. I It.
'b.la tj '37 9 L 1 teisa�1?,2 3 21.REMARKS - — I
Coon) I'.,,el I,lsnldlcanon:.o II'iSr __—'-
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
ft.Islar,.l the sitII/tI 1'ernn.,ei, or n I lIipnran. ?Ipnauac of Ccnilial will i ono:,n^I ()ate
I'i, .errr"
, -t/,,,!„',r, 11„•.i.. '.I c 'ilea,,II,,'„ 1,(lerel•/,1nl,,ent Wel in,n tear dnn('e
7.Is this a repair to an existing well: �l r•s ur No ,•.16 /'It( It o•, i,;,.i ,,, ; I.VS.I(',L'( ,I.'!,.,n,r1(ml,gii,,rlun.Hu,'/lyds and All n
/l lln.Is n,,/",., lin nnl Annul;u,•ll t-rnl,r,•n,'I,.,, nI., ,,,..•,.i.,n.1,',Minn Il,e n.11lrr'enl l,,, • ',,4.:. „ ,.,,1.... ,.i,.l..- , i, "„;f,,,, ,,.
.cool' wdr,'r,:l Iemar(a set thlii el;on the l,u,4 ell Ihn Ian n;
23.Nile diagram Jr additional•re11 details:
S.Fur C:coprnhelUl'T or('lased-Loop Geothermal Wells h;n'ing the sonic Vuu nnq use Ills'bock of hi ;,.Ige to provide additional well site derails nl'well
eonstroetiou,only I Gtk'-I is needed. Indicate fl)TAI.h1'NIIII'R of w•cII> CInsttllction details. Von roan Also attach additional pages it'nccessar).
dulled. _ S('Rl11T'I•AL INS7'RUCI ION''S
O.Total well depth below land surlier: r flll,.:.. „(I'L) 2411. Fur All 11 ells: Suhtltit this Brent within }ll dass of completion „(well
1.,,rnuo,/ u'rll,b,I;di,oust.:I,i,/lr,.w„•,,„rrl,,S , ,'nil .„IIP••!
CanWfuchtrn!u ihr lidlow'ing:
Id.Static water level belays tap of casing: (ft.) Division of%rater Resources.Information Processing Unit,
1/mwe,.letrl It:hour.1,,inx rr„• • .r , 1617 NIIIII Service Center.Raleigh,NC 2 7699-1 61 7
I I.Itureholediameter: 1.c/O (in.l 24b.For Inject' Wells: In addition to sendmt:11w form to the alms ill 2Ja
L,Y (1/� I / above•also suhmtt one snpr ul'this lino,within lt1 days or completion of well
12.Hell construction method: f E( r t I'V cn a :utle n h liu ,the tidlowiug:
11 c aurei.naan.cable.,l,'.i pia:"ci, 1 11
I)isision let Water Resources.Underground Injuc- Control Program.
FOR WATER SUPPLV WELLS(E7st.1': �j 1616 Mail Service('enter.Raleigh.NC 27699-1636
I1a.Yield Igpo.) 1( Nlelhod of test: L (. f1 I 24c.for Water Sutttih i. Injection NVel11: In.dth'lon to sending the tarn to
the address(es) .,base. oho .ubnm one copy of Ihis lien, .s ilhitl 30 days of
I.th.Ilisinfection',pc: L( ( , Ammt int: 1. , J! b completion al well construction to the counlV health dep:uttnem of the sonny
whete eari.Ilticted.
1 ono I iw.1 N.M.(.aminta I Iepannnw of Ifns ironmCnral Omit.,-Division of Water Rcs,.urccc. Rcs wed 2-22-2(t;11