GW1-2022-01000_Well Construction - GW1_20220107

828-822-�7241 PA
FM)151905;43p 0,IAalwatAl-WellDrillinla
WX �'UTSTRUGTION CO {�+ Fn�InteRrnt Ugc niyc
' i•�C3nntrprtnr I nlbrrataltnn, _•.-•-•^------ _ _ ��.^.--T--_-V__
Of
Will Colitrmot mint to,
MC Willi
Conttna�otCetttifinanlim wiffinhn• r �, C 11Y• for VwiWtLImism a �
i'rnrpnnr Ttamr. m)6.tIVN6 _ .__._
� �j
1.Well Comfirlitlinn Permii f1:^�I!`��� ' -- .r, fil, ft,
i.ldl rdl n/yr(fmnfc welfemtnntrtJea/u+rnrttt(1.tr,L!t(:,Cmtnty,Su+tc,Ym'+nacre,rrr.,J ,, -_ •-- ^-
;.lVdI I ftc(Chech wro Ilse): �..--
1•Vttei�Snpo�rWt'fi�
AAritadtarnl ��'7+t'�`�'tmiaipal/Puhlic '(! (t_ t4, in. � _-_
Cte(Khr7ntal(Fieatittfi/Ccrclllag9lgipty) �Remildenfiat WalcrSapphr(single} ft, fi, —in.
induxtrint/Commercial esideriftl Water Supply(shared) OUT
7
Non 11'attr SnppN�11'rll: „�...._
A4nniMtin ORocnvaty ti. fr-
ff. -
Arluif'a'RechAtgr• Cl(iroundwatetRemediation .19. AN11 u�k -
!AquiferSforAAemldRec:nvery O'sminityt;nlrirr tntoM TR �� x �sI W
AquI'' Tts( �SwrimptcrDraipagt ---
Experimental Trel,uningy i�1,Subsidenra contrat - in.
Crcnthrtmal Cloced i.nn ��_^. �OC^
CietNttrnnnl(Hestia Wolin Rctanll Otlwr(tx lop in undat O..1 R mal:s)_
(t.
I.IIAICl4rt11(RlCatntltrtEd _— Well lilt/
_
Well).nraHnn^ --- -•- �� --—
FO
I�.trilitls'(%m t Hmno Fan1ity[DR(Sappllcabir.) J!_ ------ --
JAN
Phhyysiictil A�dArrc.,riry,xna(�,nf - ------ -
.-ir-1L S._l V\ ► ,xi.aIAAIG4 ,_. a ,: y Ur��`_.�-'_
C."Imoy J+nteol idrmtifirntinn Nil.(PFKI ------— i�1�(�
NI).I,nfflrtde And Innplfnde in dplirms/Minnfift-M ennds tit•dreitnal dap-p-cs: -
6 „nll field,mt b0onli is autfltlnnt) 0 0 1;1.(1tAlne on;
ti,1�(rtre.)tfi!wl11(A) Rcrinnnent or Orrrmpornry
,q utr.ofCctalfierlWellCttMmatot DM�"'-�...
1 .rlJrnfnl'OAA•h,rna J IrerehpRIntlfj'thm doe n¢di(e)Vim n,•m7:J rtntcrrtrrryt n,iwMr.4mmp
%.1e IN.,it repair to Att existing wril: Ives 0 No >:+rIt 1.S,1.tie."p(.'e2f.IlJfld ar t.IA,Y(;AC O?C.',1!?pt)A'rff(r petn+rlimr 8fnmfnrA,t mod that a
!1'rhA;,v»rrpvir..fi11 rnukarn,n mafl.mnxrrn,:riMt ilffi,r9ea1111,mar .,pini,r rb,•nr tear of+hu �npr�nil&tt Ar+nnlNnehh'o pMINaiNl7nrlNrwrtfl ntvrMr.
rr;Mir larder t 21—arks n-01M1 nt'em mr mrk$10101,form.
Rlie dinRram or RfldttlWml tvntl ilfeAolfa:
R.1%vtr C:mprnbefllt"T or('tttaed t.ono GtMhernlq!Weitz hnvinct file snnlr You tnmr u`'e lhr.hack of this pages to provide additionnt Well site detail.¢or well
,x!nsm,rtinn,ent�I C,W.I is needed, liulianta TOTM.NUMBER ur'H ols r.onetnidiott dclmils, You spay also Mteeh edtlitinrlai'paPS If 110MQVety,
driFlul�",_,�
't.1lolnl well/IeptA WOW fond suriiice: Submit Ihls fbrm svitbin 30 days of compirdan of well
Yh emxlr(pr:„yOlt lkr ntitlpfhrifdi((enrnr(rxrmpk-411410'And i0100') - t�1111RlAlCtlntUtltQC fdl0lei111;
t({,Stntir water,level Iminn top of raping: _,_ .„_ ..—., ._(ft.) Division of waiter Rtt watt i,lnfnrtnotlon Pnwimft unit,
ffn'nw rterrlls',rhnoxcperng,trot•''• MaR Servk'e Center,R41d9h,NC276"-1617
tt.Florctole.diametcr. /� �O fn.}
_L _ _( ;1•tB.1 n�r 1wMrtio� w MWIft. 41 addition to sanding the tarot to gilt Mdram in Ron
!?.11'rli ronttrncllnn Inethnd: r T, alsnvt,oleo submit oat-copy of this form within 30 days of complMon of wellrn lsstttactintt m the follnlv)ng:
0 e.nodal•romq•,r,*10,direct p,tah,41e,1
Mt7 WnTIRR Sr;PPr,Y WFt t S tNtI.N: _— plVJsfon of Wahl'f1tllrgrretV,1}ndkrgrQMt1A 11((f>`tion CAn[roi i'samram,
_ i 636 Dfail.Service Center,RAMIP,NC 27bn9 116M
1.1a.Yield(Roan) S iylemat)of test: _ ble,!f ,f SginnlS_ iniaetlon Welts: in additiotl 10 5pnding the RM to
-^ till: addrrss(cs) abovo. also submit otic Copy of'thig tout wl"lln 30 days dif
t i>Isinft:cgrm lypC: Amour,_,,,,_,_,,.,,,__ rnn,pletlon of'veil cnosuucdon to the;county haMin depanwilt or Ipe enunly
j°"m+'�tw I North rinmlinnDcpanmem ofinevirdemr•Wtnl r.,raallty-Di„isu+n of VAICT Resnucces Reuhp12 24-Za1R