GW1-2022-01091_Well Construction - GW1_20220107

828-822=7241 P•1
1:0) 1519 05;43P Cleat•watAl-Well Drilling "
WELLCONSTE2T�C IN ItECOk�9 t�*W^a? Fnr In
WELL Use Only.,
Vt �nntrartnrltnibrmatlo W �-.-..T-�---r-----_-.-
•------'^ PAOK •cn
0.
rf. - �•
�Vrll f:a++rcxa+x22Ni+ne T„_•Y,�_.---...._.__..__
WMI CnnrtnN1nt^Ce1tt/lfieMinn Number S C 4RVr+ r�m° L
r�mlpnm 1Jnmr. M)6. 6 �TO atA M I. _-•--
�.Wrtl CnaAtrnetlan Permit#: -- ^' tt.
IY1,err 111 r1 rv„re Iwitrm)m"Ielm)I P+rt,rtar tr.+r•+ac:,r 1Wyy,Turk Ym+nnr.e,are.j -
I
3.We"INC(check well lire):
Water MpKp Wt1T:
Agriradhtrnl �MtonioipAli'I"nh{ic �!) �- tr. tn. �r ----
Cre(xhr%minl(l9cnt infifCfrnlIn suppiy) Rrvidetninl WAtcrSnppk'(stnAtc) �''Ti. A.
....."
{ndusuinUCnmmrrcinl JoResidernial WAter SIIPPh'(shared) 011T 1 r
(`ion-11'ntcr Snpplp N rile fr-
�4onhorin Rcamnety tt^ -..,_• -.-----�---••---••--••�--
Aguil'crR"AlI p.. E)(iroundwnictttemcdiatirin 19, AigT1 VRLPA -
!Aquife.r Storage find Rerrlvcrl• 13sminity Ontrier 'P M M =__ e nc ztltesu_•— -
AquitcrTrr•( S[nnnWatCr1*1PAd+
lexperimenial Tcclumletny �Subsidt nc+ Content - ---
Geothermal(Closed i.trnp) �7rncct .PRe+H tlR.ltaMr._r_sl__--;
Cictrthrxmat(itcAtin oolin Rcyrnc)�" l)te>C�r ax lop in und Re.muks)
A.PA Well(R)Cottlpleted:1 4 I N Well}i)tl.._.----•------^---. - ._rr. �t ft. --- •• ..
—
Sa.Well l.nratlnn: ,1�S�• �/1 c'� • tp
Qh-
Ility
t,�h�ogpllcnhlr.) — ---
rr,
fhy.i/rd Adelrcec Oty,iud 7.(p _ ----- _
r in+ny�'� SGL.J pntsol idrntilirmion Nn.(PtN! I�t^...-T^_,A._4_...._...._--.r...._...--.....-..r--� .......- - ....__..__..
Nil.bnt(tude and ionAltode,in degreepllninutesr.9econds or decimal rlrgrrns: -- - --- ----•
6;1te1101111.onelAdlongkinf(lmrm) R r S1.,+T:1•tlficABon:
6.1411M)the wtil(•4) ermantat or orfrtnPorary li n am nrCerli(icd watt otlttnatar pAee
):v.et}mrnl,'+N+c_prrnr,/hemhp.rrt ifj,rhos Me IIVA(A)µerr rwerr)Pr^Va w.f.0 pr nc�hfAnarr
7.In 9116A rr airto nmexisidog well* jVns or MNa 'kith ISAk"W,02£..rdltle ft;.m4,VCAr BTC.',B?AO(YAtI(angnuxmit8rnnrlarA.a mnl Ass I;
(lrhrvi,c»rclrnin�Nmreknmin,Dell.nnsrrr,rrimrigflrynnrin,rrnrdrapJnirrin•rrnn,rrgf+ha enpl'nf((,fen:ran(Mnchh'opn»rfd4firAawci(nwnar.
rr;Mrr finder r zr rcrnn.Tn anrenAr or mt rin+h?r•fi of rhf.�.fnnu.
�;?•.rite dinRrtllR or addiHtllntf W111Illel011ot
R.For Ccnnn111trIlPT or C►erued-t,nap C,ettthermal Wt►i><bav(n4 rite snn7c 1'+n+may usr:Ilu:O11Ck of this page(o provide additlarall tveiT lifts de1Ritt or rueil
amvmmtinn,nn(�I C,W,I is needed, ftxticn(n TOTAI.NUMBER(ifavritc ennitntctino dtrails. Yoll may also kWh 80100nai pages IfrllteMhfy,
driller(:_,_.-:. I IR�r'iTAi 1(tiiTR ( . (1N6
`►.1fnrat wolldtptlt hclmr sand surlxcc: ,(it.t Fnr n� u vu A: 'submit this thrrn tyRilin 30 days of compirtion of well
r�rmnrr+,�rr,�r�t,;,.fir:��rnr�rm,�crcor{ntamjr/C-.lief,Tq(1(•n�Ad SCn,ioo•j rmrqjTtcctinn to the folioleing:
t0.Rtotic wimmletrt:I Itntoty top of tArilitg:T �_ {ft.) Division of Water Remurees,lafnrmntion Procemieg 1Jnit,
iI"xvrhvhme11,•rrlvro+rrpring,It r'• 16117 AIR Service Center,Weigh.NC274".I fill 7
t t.Rorrhole diameter: 1 Y ( V ln.
tom..^( ? ;t•th.Tor iwketiaw Wetla; to addition to sanding the fotttl to the Mtdlr>Y!1 in z4n
!?.Nrrlt cnnstnlellnn method: V#� -, T nl+nvc,oleo iuhmh onr-copy of this form within 30 days of compimem or writ
cualstrtietinn to dhc fol)nwing
(1 c.nogg,rntnry.e,,ble,direct(null,910POO
WATER St:PPr V WF.J,T S[NU1.t(: Division of Water Reacurces.Underground lgjlstlon Comm)Progrnml
7 fi t6 most gervim.Centex,statcio,Nc 270109.11836
l.tA.Yield(Qp>n)m --�;Kethtul of tesr�^` 2•ir, 71G 11rR(1( StlaRIL'r♦Zt ttRiOLrIAa 11�1114: In addition to minding Iht sired to
the oddicss(es) nhnw; also Srlhtnia one copy of'this fl>nn wittlin 30 stays of
Plonthcgon tppu Amnrtnt• mimpletion of,vell conslruedon to the courtly honhll depanmm"of the county.
—•-"..
°`""' cw.I MorrhCnmlfnnrepnnmem.nrliuvirrinmrrtr+lrl;r;Airy-rxvisurtl ofWAterltnenllRaS llnutaeA?.22-2aiR