GW1-2021-03569_Well Construction - GW1_20210823

828-622-7241 p 1
Feb 1519 05:43p ClBarwater Well Drllling ••�••
WELL L CONSTUION � EC ORI O 1 r Fnr intemni Use nh'-
i. Corttraetrtr l(,nl�!'orLma/fi''on/•'� _ -
C tkys — '14.WA ZONES
• rttoN •rn nes tv
ft.
1Vc1!Conlraga lYamr
+!C Well CnntranorCatificntion Number "lS QIl1 ER CASING formsiBaated OR
tt ttAs osArutw
Ol\I( mtoM tr !t �A
Cnmpnny Name "t6.1NNiR C ING OR TU>>UINC ebs><wi e
at To CUMCr»t Tat HATrAtAL
2.Well Comtroetion Permit*- !L & In.
Ust all applicable well axtrtnrcdonlxWMftS 0.4 ING7 can no"Stair;Verb—,;eta.)
3.W141 tksc(check well use): 17,9CR8 N
Water supply wen: „ , ro tstAMgrhZ! sLorstae TalcKlRttBS •HRIAL
Agricultural OMtmicipallPubkic p I►• ft_ "�•
Geothermal(Iieating(Cooling Supply) Reaidential Water Supply(single) M t�
in.
[ndusiriat/Commttciat JResidenfmt Water Supply(shomd) 1& p •Ra o�AM
copal 70 MA'r1;R ILfAN
Non Water Supply Well: fa
Monitoring Recovery tr.
injection Well:
Aquifer Iteeb 00roundwnterRcmcdiatinn 39.SANO/GRANBLPAC k[a b1e
Aquifer Stmgc acid ftoovq) CjSalinity Bonier DM TO MA L IIN/Ld�C M nOD
txtrmwatcr Drainage FL
AquifcrTcst � R•
L><perimental Technology fjSubsidence Control (L
ReOtAcrinal
eothermal(Closed Loop) T[aeet . LpG" To
Hcatin tin Return) d►her( yin undw>g21 Rcmarl s) tL . fl-
it.
A-Rote'W01(s)Completed:� � Well IDtI
tr L..
Su.W 1 Lncatinn: i n n L
3 Fsolity[Oil0fanplicablc) g'
1�acilitS:'(Sk�mcrldame {VQ . F -.._..
I 9
P ,cn)Address,
/Cl ,and Vp �j L 8 s
21. AR
C ounty -- Par¢el ydcptiiication No.(PINS)
,b.latitude nod longitude in degtees/ndnutes/seconds or decimal degrees:
u ?2.Ce station:
(ii troll fieldyone tttgangia suflicicrd) c t `
!i.Is(arc)the well(1;) `Pmnattettt or �t1 emporarv,
S3gnoturc nfCertlrrcd WdlCantt terns Dale
��'(` l,;U.U}T/BJi OAT rced nYm.I Aerr-hylCo tril)htraw ,Thal the Iwcfl(X)xar 1SamzJ eoRrtrtM7w1 in°c°srdmrcr
7.ia this a repair inanexistingwkdh Oyes or JJNO adtl,ISA.W".4.702f.-U100rtr15ANCAC-0?C.0260WellC0wtrnaiauYtmnkvrlomt+lthme
/Jdd..icarcpa/r.fillwulsrnwnrwll.was,rrrulasi,p'arntaliana,al plainrhr..ace,are.(ihc +lPYnftlt/trClYirclhacbhJil1MVAwJnl!ie wort fMMkr.
rivair render V1 mmaltkS scerfmt otmr t/rt borknf/Lfsjnm,• 2,&Site diagram or addititutal well derails:
1+ou may usa the lack of this Page to provide additional well site details or well
R.For GeoproheMPT or Closed-1 onp Geothermal Welltt having the same cimsmirAinn details. You may also attach additional pages kf noceasary.
a instruction.only 1 GW-1 Cgtleeded. rndnmto TOTAL NUMBER or+slt
drilled:— nrta, _n cr� ('iTOPtS
p.Totnl well depth below land surface,-. (R•1 1+P.6 149Y A! Wel9. Submit Otis farm wi0lin 30 days of completion or well
FnrmnbtpteKrN.elisealid.:ptlu'JdiBer+mr(eromnh-3tFF±1100'andit`llisfil}9 conqMUim 10 the N101Vla$:
10.Sortie tvalmr level below top of casing: (ft.) Div;Clon of Water Re m=64lafnrmatiOD iRroressiag illtlt,
1)'s nh'r tear!14 edv,ve mwng nc�~."(� 1617 Mail Sorvic0 Center,Raleigh,NCx74"-1617
ii.F)ondtotediametcr: (in.) 2dtt.Fir la ction lVe[is: to addiooe to sanding the form to dig atldrM in ZAn
atsove,also submit one:copy of this form within 30 days of cumPled0 t of well
12.Well constrae6on method: oxtstmctionto the folltrMM
(i C.yoga:,--in.mbk,d1r9ct push,w.)
Division ofltlratet•Retlaurcec,Untft:tgmtnid 11(jtstion Corneal Prt►gram,
FM WATER SCM Y WELI—q ONLY- Pig 1636 Mail service Center,Ratelgh.NC 2709-lAfi
L3a.Yield((;pin) CD iWenwo of rant'�--J.--- 24c•&r Water Sund> &To al"�llft in addition to sanding the form to
` the sddtess(cs) nbovq also submit one copy of this form within 30 days of
Amount: comptction of well consunsaion W th connty'',health department of the:county
13h.Utsinfccttan type: where constmemd. i
I+nmtGWi NntthCXsmiinnDapmmmentafFin.•Ircinmcntnl Quality•AtvrsrnnofWtucrtiaganreess
Reviwd2 22 2at6

6
l NOMA wompare""o
WINDOW
T � � lzs