GW1--03278_Well Construction - GW1_20230511

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Feb 1519 06:43p Ctea!waterWell Drilling • 828.622 7241 P.1
WELL CWIMUCTION RECORi1{GW Xl For Intorno)Use Only
II, ellContrajh I formation: ►-._ 1 - ,
., e ( lead�S , ,� To nt ,ati weilConnecta/Mint f` a.
... 113-4 - • 0. - n.
NC Well Cannata Conflatiionn Number�(� ` ' 15.ou'gg CASING(for - •• - ttn�l)QR OI 011=RI
c\Q4�11 U�l4.lrll .1 f V �1 br `I I i mom mi,-it r, �/l�
tt. n � n aa.• P
Company Nora thoswl
(VPBR )NC OR • teta 2.Wei Contraction Pewit#: wLL.Vz p -CL- `� , m � ca wAtRpltf
fist all grel Mfe twill entuuvalonpmms(La IC Con2Y.Sfalc.Mrlmx%rlj in•
it - ft— ID. I
3.Well foie(check wdl use): .. -- .
Water Sep*Well: IrIBNTa, _ofea ar 1ac0toe 1447721u1_ :
Agricuknrol QMunicipaUPublic 0 ft. tr- ia.
Geetbtcratel(F9eatiug/Cooling Supply) nsidentlnl Water Supply(singtc) it fr. 41a
Industrial/Commercial Residential Water Supply(shared) 28.oskoU7 -
fMgmion 71► >ata � ttiutN,tt 'Er ooAmoutn'
Non-Water Supp1yWi is _ I r. 20 n- Ce 11 a 1 t)u °
Monitoring OM:cuvely t.. *
njretlen'Well: U. -
'fer Aec(tatse OGranndwercr Remediatiun R
tpdfeStersge turd Recovery OSdini1y Bartia PROM
SAM VBL to aM" .,(4.. oaf,ftwcurrarrrlimos
AguitbrTcat ciStannviatcTDMIM - n_ a.
Experimental Technology neology .OSukaidenec Contort R. R.
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Geothermal(Closed Loop) DTcacct 20.DRILLING LAC t6a�tatla ipa�wrr)
Geothermal(tteatinp^CoolinR RCM .00 er(cxPlain"del#21 Rcmtuks]
moll 10 /isaleactyn_a�trr ataQ.aat
4.Date Welt(ai enotpieted:3"21 Z3 Weft W r - p tr.to 4.1 ft. Ot1Ufl L le
Sa.Wett Loenuoa: ��br 'qq4 la L4a R PJUI Is. _..__
rer1lei ='oresA- Scharr l.. e.. �� t�t`Y�" r etitle- Fr,, i--4y-
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P tly:'Otvrtet F,{tt�ilt�ly�IIu�f(iFappttcabtn). tl, t� Yt`j„'A,A*.'LP o t, 5 n
T©C a 1 L I e— Y 1 lei ti� ` ::ft.. �� r, . n y —ti ,�
P� V f 1 okagmARlt7r n;. o��Siir�li I'wt .,
If1iG„�rr"�:: rt'
Cauaty Parcel[denilleation Ma(PIN)
Sb.Latitude a W laagpade its dcgteeslmim czlitconds or decimal degrease
Orwell(kid,au Whom farpdineisrtt) 1 I 4om
' a t qao ,N 7S 3-3 w 3
Z.blare)Me wdt(s Pa nement or QITempmrar$' Signature of caHfird Ie1W Contractor "` ' �'�
By.ljmIng rhls,(or m 1 hen...O mtyy shin that gel tars,mars)eott aceed 4r aaaatdrarre
7.IstMtsa repair-to an existing well: Dyes or f9No w,i 1S4vt'rc:02C.OW0or•1.1A.YCACA]C.4900 Wet!G•andrtrdianSiodard and ihara
OW*isnrc/aki'',mrrbmvartadocximea niAlitarfonce =Air,111e natureeihe 40pP orals Mord halm Ara&1torligmil~cr
rigor cinder All own*=Oat presage Zed trlthfs,(arm. 2.1.Site dIngrai r or additional waft elelaila:
&FerGeoproheMPT or Closed-Loop Gt./Aeriattl Weds bowing the same You may use the back of thin page to provide adrdtional well situ details or wait
mn*tntt7(an,only i GW-1 is needed. ranee TOTAL NUMBER oti its construction details. You May aka attach additional pages ifnxeasaty.
drilled:
9 Total wcft depth baltrty hind surface
O0S ' lataTAf.mrtrRtiram R
•ha,•.Waltptcw.Dclit+aRar�,rh.+l ks t►la_9�F 2D4r�d.2@1007 cori Pt) 'or All Wilk: Submit this form wit in 3D days of completion of well
construction to the following:-
tfl.Rtatk water Ind below top ottseittg: -• (ft.) Weldon of Water Resources,I.formation Processing Unit,
rimier - l g 161T Malt Service Center,Wletgb.NCXT6s9-16e7
!1.Botffiolydiaeeler: � 'LP On.) l 24b.For iaterlloq Wpm In addition to sending tie brat to the address in 24n
12.Weit construction tolled: `V tO.v`�( above.abo submit one copy of diis form wffidn 311 dens of completion of wcli
(i c.awl rotary.cable,direct construction to the faliowing;
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POR WATER SCPPL Y WE1 1.41 ONLY:I
DlvLsloo of Water Reeoumes,Undclgrtfrtnd Nation Contra)Program.1636 man service Ccana-,Awe*.NC 27699-1636
13n.Yield(gm) Method of to ft( tic.Der Water Sanely&iairtellen W In addition to sending the form ter
lbu nddtcss(cs) above, lobo submit one copy of Ibis toms within 36 days of
!36 UIelnfcetiett type: Amount: completton of well cnccttuction to the smmty health department of the county
where onesttuctod.
PenCGWt North°MinnnopartntontoftinvirditihentalQuality•Divisionoftt/tuttilOHemeaa I 1 t'Ierieed2,22.7oi6
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