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HomeMy WebLinkAboutGW1-2022-09800_Well Construction - GW1_20221027 B28•622 7241 p.1 Fob 1519 05,43p ClearWaterWeli DA111M] . WELL coN EeoRD(GW 0 Fnr in(emai UQn n yc i. Ut'nnhae{AzlnfOrMliaA: 1 '""""1•e xss T. well("nntragtxNatne f►, ft' ?tCWenCnnnntinrl'ettificatianNumt S. l R 91Nr l6tRt& � M MUy -,vim � ,t,1 `1��«,�� • -=---n• 1'.nitnnnyN�me 1 , 1 f �. V�IJIJ�.�� xO1VCtHRTIt P..Well Conxtrucaork Permit It: fr ft. DU (n, i.er0 ali opplimhle wail ranrrnrcean ptrtmin'fr.,:.t!!r[:nerv),;mal»,{4irrm+q;err 1 n., fR. 3,lyell lilt(check Weil list): ,17 N tsas rA upp tveq: m tt r i dttlrnlMimiaipallPlthlic p �. �- ln' v it-Ode:ndat Waler Suppiy(single) y" ik if. ia• nnnl(iieatinJCmtin 3111tl) �tiatlC.amm [)Residential WaterSupptv(shared) O10 �in11ft.ter�ttl,plorin ell: OI. itrHerlrorAc �(lronndwatcriic»ieAi9Gnn 14 � VR PA It Aquifer.SloraAa end Recovery [3S01inity(3nlries >,t n t rat xM uo�_ � AquitcrTvct nSwrnlweter Dralnagc ff- — • lsxperlaental�'�ehnolt7ity ®ISut�idcnca eamrnl • Geothermal(Clawed Loop) ULQG hnG rt ra.nrala tkr,eua � x eicpthennal ilr aOlin Retum) tliherfe%plain ender fill [t atics? 1C1 tc to �� ------ - A,date U 1.0)(s)Cam ietedS Welt loaf ^- !iy.WtIli.oeatMne \ii, `Ltf 11 4/ fr. fL K.uilby,10% Crll facilityll)ftGFmpiicALfr.) -- n. PtiyMirnl Ardross,rlil�, "���1 Cmfn(v Pao:nlfdeatifientitm No.(PiN) Itlia:fr71irit31 fC�:,35;.^,a ': 511.f.ntitndc anti IDnRihtdr in treed(i�,c(minittc.Slsccondsardccimnl r)cgrcevt (i wall rcldnnne lnlrinng is s 4i cnf) tticalina: 6-NUM)the weit(s {*crmnnent or �rtaflnrar�y Si altos neCtxirf►►st weu ceDtrnraor ppte �ju a�Fmrng ditt farm,l k"Wlry MAry AM Ar m.•1l(cj was(tw-•)rxrrtomrrarl In accnMrarcr 7.tathbit repair soon Watingvrrll: FjYes or iNo xrrhl.illr'�t•nac.nlfwn:tea.VC+1CO2f_',p7CDR'crl<:ansrmeanxSYnndarrlcmul,harn lftllriran�nlr,,lillmrtknr+untacllrunstrrrerinnb(fnrnwrrrnrmrrTrspfrrinrbr.rrna:>i•rrfrl�c tnPunf+trlorrrnrdhnc7,ecmpmrlr�d,tnrhe:wcflAwpar. r' wrarrfer 91r tria>Srtiut or additional gre30 def8ita: $.1Fnr GrnprohvtAPTnr('.lased.lA np Geothermsit Wellitbming the sane rase"jay also the hack of this page to pnivido addilklull well Xitn details pr well rxxmintctinn,aniL I aw-i isneeded I•ndicoMTOTALNUKp1�81311ofurils c,)t1.9tnirAlao dclaib;. YOU oMalso ripch addifinlal pion"ifnecessnry. drilled- --- j— �IJ�JrsatiZt['17QNlfi 9s Tatgt well tiopth;mlow land sunned:: (4l 24a, ft nu V�ft Submit ttnla than Nvi0tio 30 d83's of complydon of-.sell r%rrnatldplatrtgaliuwrld�rrlrcr�A:/fcrenr(eras{n/a-:(r�1?rr•orrdFlhtlna� consdttclionto the tbllolsing; In.StaticsvnttrIeVelbdow top aPcasing: .�(!1.) Division of Water Rtxent et%IrArmatIlIn,Processing Urdf, lf vu:•. 1617 Mail&rr4cc Center,ftaletgh.N1(:27d99-t617 1 i,llarchDledinmeter: (in,j 2f8 Rar rftecrian watts: lh addition to sending the form 10 Air siddrem In No ubave.alrn Submit line copy of this form ivilbin 30 days Of cortlpiatlrin of Well 1Z 4Ve11 cnnstnlCtinn method; fir.,Align-,testy.calk,direct pttth.ct c.) cnttsttur lion to the following --.-.•-_ i)tvisioo nft4pter IitaMlr�.ti�iCintlelgraunti TNt+ctton Control Pengrnm, PORWATrRSt.ppi-v VF.f.ISpNLY: 106 Mail Service Arenvw,4ea1e10'NeIL7609-1636 13A.Vidd lgpm) Meittntlef te.41: etc, finr y►rwtl f Rtroniv inieclloa dig: in addition to simiting the fhnn to the addtacs(es) Amn:k.also sn8mit one copy of this foam within M days of 13b.Illslnfecdan tkpa Amotme: Mniptetion of welt constmodon to the county health department of the enunty nhcro constraftA I+tan CU�-1 TtoALCarolinnf?tTnamentoi'tinvirrintncrtut Qtrdlltg-nivisran ot'tvarcr Itnymurav tlevisal2-��-2016