GW1-2022-01025_Well Construction - GW1_20220107

828-622-7241 P'1
F c-h 1519 05;43p Cltaarwatel,Well Drilling
W1C X.CQNS�'RUCTI❑N �ECAR>I}{GW�].) lFor Intemni Use Only,
' I,WrtCnntrartnrinMtmatfDn; W_.____.. •-_- �._,_;:
-T�ir ___---�----E ONES
trn
Well Coulraelut Nalne te. ft•
V(:well CnnernNnt Certification Number ' ls,Q�)'iFR C SIIVts terRtnt fllwelk OR t1 t
it. tt. to in.
CmtytnnyNnmr. �16,INNER C NC OR Tall N aothge+al�lMld-IpOp}
•tVr11 Cnantrnrtiun Permlt sl: L,J �.�/uOt l.Ks4.--- 70 0� 'fflt,• �~ __
tt. k in.
iGrr alJ n/yrif(aMc r�rlf rM,.unrrrMa piemtrtr(l.u.!!!(:,Cntmry,Srrtle,trarinnr•r•,err.)
Y n•. � �. in ..
3,lYril I Ne(Check Weil list:):
Watts'Supply Well: Ai• T p Astar am !EA A t .
Agriculhrint �tuftmioipal/P1th{ic (?
C)etxherntal(T.3emmg(CaolingSupply) MesidentintWatcrSupply(single) ft, —fw,
(ndusirialJCommercinl Residentint Water Supply(shared)
7 �1• P TN A 11 1
aril DlIOa ----- .. n. h•
Non R'nttr5upplyVl'rll: _._ _ ---
A4nnitotin Recovery
G. R-
Agai!'n Rechptgr Q!)roundwntctRrnudialian -19 kAVIRLPAC
J!AquifcrStoragcnnritcrnvcy ElCDlinity,l;ntrier PROM TA •LACCMBNTMCTItAn
,
AquifcrTnt nstnnnwaterl)rainage n_
Lxperimenial TeelmnloV 13Suhsideoca:Control
GeOthrnnal(Closed Loop) 01101:er xli. i,i,l �LOG ehUe]__
PROVE 7R
ticntGcnnal(HcatingJCooli(nst Rsatrn) Otto r�plain ondor(121 Rc.nvt s) "" —ir; i�©
'C pate Krel1(s)Completed;1 O l�-�Well iDtJ _ -
Su.Well iJ ara/ion:
Ir
icn
l'Ailit):(1v.,rerMalnn ra�til@yl[hl(Ifrppllcahlr) n' [ n
P211ir.0 Addrecv,C(iq.,and 7.iipNCB p /� �/' ft. tr• - 1-.� _
Ml _ l� 21. M1IARKS_ . c' r `I i Fr-
C ,
C:aurny Pntml tdcoiirentioo No.(PiN) -- ..•--. .-_..— -�-'�•�1-R•t•--••-�___ `_'._._�
5b.1,AlltndrontllonRitndeindegrm/minotp-OserondsordecimAldrgrrrs:
(ii welt Geld.nne IaMnnit is si.mc rnf G ;l;2,('! (flention:
6,tswe)the well Prrm s) nnent or OrfeMpnrnry . u lit.r nrCcAlfitd weueontraanr n��
1,.N inP,!N/•,(%,ro,,1 hrtrwji mnify these Ar Aril(k)tnrr(Werz)n-WiliurAvl h,run-- MIM-r
i.14 04—repair to nnexixting well: Yry nr Nn x:iN,LSA.'Gr.'y1r..'a)f.Iilf/4 ni•1.fA,Yf:AC;49C.'.B?AD lY,r/1(:iminrnin/r SlnadarA.r nnet rhnr r:
if'Ibr,ivn rr�7ir..611 teak»num weJl.:nns,mdro+e irt(n,mnrlmr rd?�rprni,r rh.•rxrnn•r rr(IJ�c rr fly nfllrJr r,:rnnl hoc breed plDt�id&:rJ in rlaL wet!nwdrr.
,:;xrrr under r,z/rcmnrin.rrxngn nr rM 1Im liar k r fWh:f!rnr. ;,Site tlialt ram or additional wdl40101ist
R-For Genpraht(tiPT or('.loved-I.Amp Geothermal Welttl bnvinct the saute You ntey uu thehack of this page to provide add11i0nnt well site details or luaA
uons1Tow1lnn,^nit-I GW4 is meded, fildicate TOTAI.NUMBER of.":rlls rrmShvGinn driniis. You may also MMeh adilitional pages tfnocwflfy,
MIN.!i:,,_T: _
.-•------•• - -• JKIIIMI7TAj,riJ)',�C:f10tVS
9.Tolal WON depth DelOW land surface: -.• --_(R,) 7,ga, for Aq Welly: Submit this 1brrtt tyiJbin 30 Hays of complMan of well
Per Mr,/I/p/r�rYllili4r n/i�prLR f(jij(cnmr(tampl�"-d(n174n'and<@ron•T cnnatrliclion to the follolring:
t4.4tntir water level lminw top of rAsing: T _ (ft.) Division of Water Retaiwe t,Information Prot-euiatg Unil,
1!x•nlrr ir:+•nl Jxr:iv!vxc•I►Ang,q,,r "l L 1617 Mail Service Center,Ralefgh,NC27699•Ifillt
li-ikttrtrotpd)amRtcr___ l>G V _(!n.)
218.Par t� al_,cetio l 5WIP: In addition to Sending the time to the add in 74n
17.Well construction method: above,also Suhmii onr-copy of this form within 30 days of eomplction of well
0 e.m,gr••,rnMrX•,r:•ak,direst muG,ate.)
— -----. ctJnshuctinn m ihr following_
Division ofWater Resources.Underground igjmflon Control Program,
mf7 WATt R&tPPI V WF.t.i S AN1.V: T tf116 Moit 4erviM..'renter•,reateige,NC"449.11636
I,la-Ylrld(>;ptn) method of test- �^ 2dr., r ' 'r Cuedv dlc igjgpn ti We Is: in addition to minding the ram to
the, address(es) above, also submit one copy of IhfS fonn within 30 deys lit°
1n)n�01sinfertion type; Amount: rompletion of well construction to the ennnty hcallh depanrnrnd of the county
whore con¢trncrrd,
!nun CW-I North Cnmlinn Depnnmrnt oftinwicciamrrta gw.viliv-Division of Wester Rnynnrc 19 I ReviveA?. l2RIb