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HomeMy WebLinkAboutGW1-2021-03198_Well Construction - GW1_20210625 i WELL;`eONSTRUCTI 1 (GW-1) Formal Use only_ L Wen 6w trseior Iakraestio I " i/ 1ev,a' .14.WATSR270d�..., Wen Ca Name fFROM TO.200 WCwdZco c Nit is 0U7X8t?A3ZrfG mii'aL0.e�n`eai Be odtI�t�' ;,.=. YY 1" FROM T8 DIAMEM a Is•�fAL~ NEW 2.Wen haetioapmdt#: C.. 11 ({ FROM ILc oR�IL �- �� Laroff oppBesETe reII WE C.W.,%ft Yart m an) ft 23 & $ Y ma lCh. rL- 3.Well U6(epee@ weR ase), & ti i WsterSap*well: rod k c l-: FROM ro Y arAM� st er� KA2xui QCseo�k a� 1(Hes CaoLti ' aReadmiisl Wags SUP*(srogte) R fL OhtduTtti�iUCa�ae�l { DResidt i l w ter Stipp13'(shffied) fl I DWaM>100,000 CAD FROM TO I=K&MO uLR IDDSACIDOW MCIEW&Aa90M Noa-Water Sap*Wd: I ti Mew- "jecaft We& - + ' DAgaifadd�Fe � DCtsamdvaterRem�am �' & �' ' DAgmfa6w�aodRecamy lawsdt�ID sva>iPe Ms7Etst. f OAgm>ffaTest D•StoamwmalhainW tt OT�pa�ankl Ta�nniogy I 5 Oftbidence Cm*d R DGeothe�al(Qosed Loop) I DTracer =30rD�IId+I1VG IAi'.a3tiiiiad eodslieEei} _ :: -,:.::. D D0dw(oplamundw#21Rmadms) FSOM To4 DffiCREMOTt saifiat as S & 4.Date Wa(s)Co.—.. : to ILKII wa IDti $ R h- Sa.weRLoca8ioa: F J tiU R ruF h_�-, i x®e i FadTv C¢ ) & $ 1 (.Y :r1e $ $ Aa In 6jrw^.at',on l�rocn u Champ ( P=d Nit(PBO 3h.Latitude tail loagitade is " ulaWseconds or deebwd degeees of"a Shcl ooe hvbaisa�eieotI I 22.Certificatioa: 3L '22' 11 � ' w ' 6.Ts(ue)!the.►eIl(sk or DTemporwT ! D►d sip ofeanfmd W�coat Date 7.7stbisi boss �' ftftm r6y'oo rhirrlr—WS)xmtwm)eam--dmacs vu repair Cis •My'. or ago ISA)C-4CO2C010barLUICACO2C.02003PdfCvnvmd=Swdadrmiidmaxp .yd*isa fiQ—bowipeQ erforma%=wdapfaber46a="V%by ��,eooraTi�bmiprvviaedmaheMllavno xp�rmaderlll rmr�se+ertonar aftlashrm 23.Me dbV moradditiond weD ddamLs &.For GaopeabdDYT or Cseotheratai WcHs having the same You may use The bark of this pap to paovide additional well aaastemcdm fi& aonsZracapo,aoly 1 GW-I is. TOTAL NUMBER of VM]k (add'See Over in Ratans Box).You may also zMach s i itiaml pws ffmcca" daged- t 24.SUiBMTITAL DOMUMONS 9 Totdvw depth bekw hmd I ZO r (�) Snbngt this GW-1 w;thin 30 days of wen completion per the fonowfag: per radtlpLerills6staII�r,Y .�200'omi2®100') IO.Staaelwaterlevelbelowtap ($) 24a. For All Wells: Qzigmall£om:to'Dm:doa of Water Resotaoes (DWR, � � f�matian Processing Unit,1617 MSC,Raleigh,NC 276WI617 IL Bmvbok diameter. G , s j n,) tab For Isiectioa wells Copy to DWR,U-dagvimd Injecd-C�outad MX Prwgr�,1636 Mat;Raleigh,NC 27699- 636 24e.For Water2n aid q2 4M Gad Beum weBc Copy to th (m a a>� eahk dsxtpar>w,i )i cry health earmiq what ode FOR WATER SIIPPLY Y: 24d.For Witter wea Lr PD:Copy to.DWR.CCRCU. 13LYaW i E Method of� Pe�iirtoga�,1611 R NC27 16I1 13b.D�eetlon typ, Amount: I r Form OW-1 r North Cw*n Depatmes ofBviraomrm d Quality-Divmoa of Watcr Rmomus Revised 6-(r201 i