GW1-2021-03597_Well Construction - GW1_20210823

828-622-7241 P'1
Fall 1619 Q5;43p Ci9argaterW911 Drilling ••
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3.Nydl list:(chock well list): 17 anal to
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t,'cotltetmal(I3cating/CootingSupply) E)Resldatdial Water Supply(singlc) fit• +(�
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tadustrid/C,ommereW DResidenthlWaterSpPPlytsharod) 18 Q11T - me y attar i
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Aquifer ltecljwj tr ofratmdwater Ra rncdiatitm VPL
Aquifer Storligo and ltecovery awittityBattier
AquifcrTett nswrinwatcr Drainage
"Xiwimetnal Tcctnlgltlgy [)SultSidWee Control
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Gonthetmal(Owed Loop) E376aetx . RI LQC
10enthermot Nettti ooii Rcwm) 00111cr Win under 621 Remarks) ft. , ,
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Sb.LRUlude and lonjotade in degreaslminnte:tseconds or dccitnnl drgreas:
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re em y,t el CwaCacrar �aae
hn AP 90MA,rbar rhrt+PW4 Km(»1 euturntffad m otantrelehrer
Is this x repair to an exirtiag weltXt s orlYo a•ab i$.t
1 •mY_'ar•'n2!.0100 nrl9A tYC+1C.42C..n?OO IYeNCmtrinrrtian SJWutardt mrd rhm tr
;rrldt is n mpair.fill awknow,n wdl.wastmaino bormalinnmal esplaur!lie aao,ti nftha copy'011,rt-,Fnnl haFbteo ploMdeAfilM Wdl A1V1ter.
ry7air rm4a?A 21 matnitct=rlwt arms Ile:barl•aflbtfifamt• :L&Site jwgsam or additional well dMlat:
8-For Geoprabeffip-or Ciaaed-1 ttnp Geothermal Wells hawing Inc same 1'01t may use+the track of this page to provldo addih'omtl land eft demiis tar well
cangnicrian,only I C.W-1 is needed thdicM TMAL NUMBER orwmils c1N►otruciion ctr+ails. You m8Y also nub additional pager If nMMMY.
drilled' Mrm•+_.--U'Swr.Ej,y``�'RLiCi�ONs
s.7lotat wc)1 depth 11etaW land sttt7Rcct_- ��� _( •} ll We1Lo: SUM*lids form within 30 dabs of cmmpltdion of well
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ParranlNprr frsanwk-3(F111IT-Tli(ylol conglit '0111n111cro11pWAS:
l0.Rtntic tvnhr lcl+S1 Wow tap of caAtag: j V, Division o f Water Re suurees;lafbrmaNan Prct awing l)tttl,
1b171Naf1 Sorvicc Centeir,Raldgk WC376"4619
//x»parf�ir:lJ.sinl,nvccmYng,tqr'•" i
! 2,tlt n... ■�ti•rHon Wd1a: Lt addition to Sending the!boat to dw addrm+s in 2An
!i.ltoreholedleetrtcr: ! ---_(in,)
,.y�L/)• � ttbnve,oleo submit one copy Of this Elmo within 311 days of completion of Well
12.W01 cnnetrnetion matkfld! ! l/ i!/`ter mmstractian to the folitmim
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Division t►t1 36 M mail S" CcndclrgruuPd ater RatclgM NC 27094016 otirem•
FM WATERSLPM_V VVEMS ON1,V:
t3a.Yield(gpm) Method of teal: . 24c. il --- gD etc&ioieetlon Go4ft� In uddilica to sanding the form to
the addrrw(cs) abovq also Submit ono copy of this fort within 34 days rrf
ekmotrat ix)MIA tion of well construction to the rnnmiy health departmcm of the county
tAh.1)GsinfcctioR tyQc: vrizat+e ootmtnemd.
Itann CVt-I NaghQenlitm f?apnnmront oitinvlydnmome�l Qttatl4y•>X�statt of s4atcr Panontces Rrvitaed2-:N 2al6