GW1-2022-06465_Well Construction - GW1_20220518

828.622-7241
f t�t1 1519 QtaAp GIe2llwatorW�lf Drll4biia
CID G'W^ It�'�tr)nlcitrtnl Uso nly:
1,Well C.nnirartnrInWeatto „ ng6
1Vr.11(:mllsarAtx NPlnr --..... �
/+1CWetICnnlraAorL'tx115aattn Airiintrer (� -.•� T � 1
t.
f:nmprmyNmm� n �h � J PU► •,_
x.Well(:)nxirnetlon Btetar'llt
bi.rt all opirlimblrr rreil rnrxetrnnrbniwrArllx(l.tA iilr:,t MtrNY Slala,Y,trlAncc,clr.) Cn.
tt•. „^
3-Will 1hc(ChRik Wrll 1190:
WA1el•S"0*Wtq: -
Agriculturni �M1rnIeiQDUPuhito i;l
CActxncrrttat(1'lcating/Gonitttg suppiy} BU101ilenlim Water Supply -
� tltesidential Water Supply(ahtlrlxl)
UtnuarcintlCommemlal •r r ��
:Von WAtrtr 3uptly W oil:
Injection vvdl.,
Ag4ifet'Rnellrw;e E3flranndwstaxltemcdis[inn ..P ltii>fGi VRL rAC -----V LAa jt tt i
f3atrler 1tn01[ '"""-
AgtAifcrStgray;pill lmovm C)•4alinity
Smttnwater 1)rainagt
AcptllcrTrst C
Experimental ToellttDloiE+ 05obsidena:Cmiml
„ittk pit. I L tSre CIA -
(�cothartnal(Claud Loop)
T(mrA _
<feothcnnnl Haatin soli Retool Oltler�lop in under i121 2ernarks)
u. --
1.b>At�11Vdi(rt)t"mttpletRd=cJ Well li<}il,",...,..---,- -.-- Ore_
Sa.Wtll Lur:e[Mn; R. j. _ ---------'
r t;aeilttY[Df+iif rtpPlingbir.)
l::+rilih:thS Noma . ..._---�, - !t. w-�,�•--¢a^;r-^C, r.-,.F4�,
1"r Sinai AAdram,tilt ,and UP
f:uurty �r�' knreal rdentitimlion No.(PIN)
fib.p,atitudnnntllmtgfihtdeindagrneslrnimueglsecondsorileeimnldrgrus:
l;2, ,crtiftr. lion: �, i,'yrzn it r+r' : ✓ •�• ;,:+ I ���
Wwall fichl,anc lAmang in 9u13icicnU —_I
U / I
::i�nmur C7ertlfivtWellCantraamr plNc
me(are)or welt(at ii't�rnrtncnt or I t tm}lnrnrV
rl�ls_iinnr,I hPrrl;v emtlll"hnr r7rn rWJl�,.}tmr firnrr)tr�xvtNA'7�,!(n-0echrAa!ttr.
XCs or No oolrh lSrt.ti[:ar.-02C-/lltlll nr .5A 11'CAC 47f.',0200WeliiimtlmrfinnSlnndard"mrrirhnr.r
i.ll,this to repair to an eximflog well: e„l,lr"pris rec-11m)hap hAm MOW lfi llin m.
war!om ,
rt"fbb.is:r ry"Ir. l i tmthimn watt.nx,.,tnu:flnn it�n,mattnn mttlrYpin+lr lb�.:,M+urr.n/'ihn
rr:f>plrunder Alt mm da.urlian orfmflu:Pncknfll"S,(amt, �*tingnm or rddttthkpaumat to lH11a: tvell site dotalb ar well
YOII n1aY t19�the buck of thi6pAQta I�ltrovid4 t►dditionRl
8.nor Getgtrahe/AlPT or C4r»ea-Loup Gesiberml W41%Wing the SOMc Will tray aloe tattat:h additional paFR if 11rroemuY
mnstmctinn,only I OW isnersied. 1'rt&#4TO'rAl_NUMBER pf+vrlls
ddlled:�__�,.,_,.„-,•, _,,,_,r._.��.-_..... -TA rt»r� ii1t1'FFA'RLCTIONB
�►.7rnt�t woil dR(11A ircitrW Iattd SNt Mst%,._.� =x - t Imo• or
- �' � d pia:fallrn tivltltin 30 daYa of cnmple[3on of�Vel(
FM mnit/prc wcnv my r nAiptlo tj'dff4rnnr r!•-WIV/a-3(ri?T/lfr•and%(fit lOR7 ,snn9lntetinn In the ARIDW1R:
It.-Static tvntertewrpl below top of VA RR:_ -W- - - — -{ft.� nivintna o(Viiamr Rcsnurcm11,R41 glh NM11 70"(11a;Pill
!1 RINI•lim"I Is r 41m,rming r c"'
>I617 i@1ft 'Servetc�Ceatet^WidBlh
+ Lt addition to rending thts thmt to the addfm Nl 24n
[i.11nrchnitdittmettr; {tn.) h" t'this fca7n within 30 dltys Of a4on1.111MCM of Well
ahovG,Alao Submit we copy a
IZ Well colluntelian 1nn[itnd; cnamuctiunro the fa(lnwinz
ii n,unbar,mtaq•.N*10,pirtNt grnh,stal trg[n
_ _ maialnn ot'ylfater Rrltnttrct:s.uatdr and Injection Coatral Program,
i�(f1fR WATk R tS[RPi V WELLS ONLY'
r Irm Mall Sat•vloe Ccatrm,RA16lgh,NC 27�O'1f63b
1 i 2tc, u R ntY&init*etla yVe tt: in addition to sundiog the m to
tJa,XirtQ(R11AlJ r 1 r � MGthntl nr Iest• ----- _ r n�.l"
ab4 nddress(es) n6nvu also 5ubntit Ann copy of thFa foan within 30 drryo of
tad,Im"fecttnn t Atnmret: CRmptation of well consttaatiun ha the antmty health dapatfreent of the County
3'1�:-....—....-.�—•--^^^ ------• •where connllNnttSd.
r+m,n fitA�-I NartL(1,mlinn taapnnmonr.cr'[ievlrtinrnrr+Y�li Qnethg•f�ivisrnit nt!Norar Yknytntncaa Reuiitet12:27-241 h