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dun-Wester Supply Well: 0 ft. 120 I` !Bentonite !Pour
C\1(vn!en,Y =Rc.rncn I fr. I rt. I 1 ____1Injection Nell: rt. I tr. i
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CExpenmentallvchnology :SubsidenceConrrul rt. I ft.
0Genthermal(Clae(1 Loup) :Tn:er In.DRILLING LOG(attach adlMFioards3rebrif«arel w'�
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4.Date V.ltls)Completed- `//ff2.S-J'►'el)ID= ft. Ii?.5-
' ft. fii.(i (i/`S'khiLirr ($o,L '
6a.Well Location:, s)J It. i 2� (t. jfj�1 y, 0 .���� 1.L .S{�_k
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'7LI(3 I/64, Vita,/ )Y. L5Ar„•.11a 46, ft. ; ft. ,
fr. i ft.Phvs,ral+cdrett.('try ar'd 7...r(11-t'ou;w.•. 11-04 is-)6A ii,a 0.-'GV.T/ // /�j .1.REMARKS r)a (O.-f r,„„_t%,siLk (catwn No(P1 ,! I
5b.Latitude and longitude in deg rees,roinoteslseconds or decimal de',rees: -
or.cil tick.on,btiong.cc_ lc.CM• :2.('erllfiCaP n;
-- - -- — --- isAg _� L6.Itlarelthrnent.): .'..Permanent or Clempuran5:; w CenlicdNeUCottaar 'e
d.a:ea•ns.r✓.:cJmnr/herd.mad rho?site..ellgq.or(,sere/.nwrvr'rd:nat.c'rdn.wr..u:.
7.Is this a repair to an esistiog well: C Yes or !..."to 75.4 kr.sC 0 C 010n or 13.1 1iC,iC•TZC.n104 nit,Cowcrucaon Siondards and Out a cam
it ran.•a.r,•'an r.!rwr enc.r weh r naVrwr umr.nlnnnarrnrr and d,p n:1 the axle,,r,f rho of rhrr rn'rd has hemp,r Ad m the•ell o'•ner.
•rwru rrud«t.'I rl.nJJrtJ.Kean e•on Me M;i 0'11".'for.",
23.Site diagram or additional well details:
S.For Geoprobe/UPT or Closed-Loop Geothermal W elk has mg the same You may use the back of this pace to provide additional well constructwn.n o
consttuct:on.nnly I GW-1 Ii needed. Indicate TOTAL NUlslBLR of wells (add'Sec Over'to Remarks Bos).You may also attach additional N;;ea If neccs..n
dr,iled. 1 24.SUBMITTAL INSTRUCTIONS
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9.Total well depth below bad surface: .W Ilt.)
f..a.rrnr•.••,rrl,h,1,r(rhpri,r1.hr,..nr rnnrnfrl. ;z:nn aadJ(a•lOrr'I Submit Ibis GW-1 within 30 days of well completion per the following:
24a. For Wells: Ortyloal form to Division of Water Resources ID1'RI.
10.Static water lesel lot low top of casinM1:40 (ft.) In W formation Processing Unit.1617 MSC.Raleigh.NC 27699-1.611
••M•rr re!r..rtw•r•o.•ry u.. • •
t 1.Rorehoie diameter:6 1/8 _—_tin_) 24b.For Injection Wells:Copy to Mit UndergroundIniectton Canso:ilt'i r
Prooram•1636 MSC.Raleigh.NC 27699-1636
L'_.Will cunarthelion method:Air Rotary
— ------ .4c.For Water Supply and Open-Loup Geothermal Return Welly Cs'y to it.
r,c ,, r ro4-1.1 ,4Sir.d•r.cr nn•h.etc r County em:iomnent.tt health department of the county ufleTe Installed
IFOR ti'ITt R q'PI'I 1'WILLS IItiLI'. , 21d.Feu Mak•r%Vals ratuctn wrr IIH).0410 GPO:Coo a list R,it'rt'L 1
. e Air Lift ra,n1�N;�:,r:.rir I i tiIa .,t1epoll..L r;.+ 1,t l
1 ia.ylrid igp'w) 7 Nrlhod nl test:
Chloe. Tabs 1 1/2 Lbs
Ulr Utsnrl(•tlion type: Amount: _-_ ..
' . .n \o•^.h froLna..:1,1nn:.:r of tn.nun.^.rrur..`r..I..•. ..:,ton..:„V.I£...wets,• 0........1... ,