GW1--03298_Well Construction - GW1_20230512

Cleann►aterW�ilDrilling 828.622 7241 \ p.1
Feb 15 19 05: 3p
•
WELL CONSTRUCTION RECORQ_MW 11 For Internal Use OAP: - '
1.M'll Con for i rnstlon: _ _
1 Qii) mots ZO
WellContragarNdtnt ft R- l !•
(:We1et:ent adwCaetiGedicnWtmier '}q.01717ARCASWBtf rintTw b il�lfa zttituw
i\\,(ii\C mom [la 1
hisuss t,,n„a,,
ComgnylVnma il Contraction remit 0: •t , ` —1 t° �16.lNNtiftCABINGOR W AS
1V11V, {/� 1 V ' To n 111.1�du31a
idW�e rit ra u niermn penalltP.O.FiG Comp:Sloe Var mxa.et f. • IL
; m tr. Ifn'
&Well Vie(cMR weft use):
m um• momennt stored8' 't'ntCIC9¢Q _mar:atM.
WaterSappWWcll: mumto
•Agrigdbva OMtndeipnUPubic () 0. st- to.
ill Goadtetmal(lfelitiittgiConliaSSupilly) 0(Reeldential Wator Supply(single) ft. ft. {m
TM lnduslriallCommeraial f Residwuial Water Supply(shared)
'y9- -iiT .
i room T o laA 9 csietaceasersir l tono.Ammar
NwnWater3tlplgKdl: - V IL 'Lb ft. VCY1rt c
�
III Monitoring CiRccovery . ft. 1 ,
nieetlan Wdl: ft. n.
■ • •iferRecharge Groandwatcs Remedied:in
© 19 SaAI>?K:RAVSL PACK(1[ 0 �.y,�C�y�yr�i'►wa
nluti Battier Pools[ To�1AquifcrStoraglstnidRecovery � ty n at.
1 AquifhrTest �'atetDroinaga
VI Experimental Teclmoltlpy °Subsidence Control ft.
0.
111 Geothermal(Closed Loop) CTfIlCdx 0D1111.L1VG 1.ocht1!th , , typraralm+ra..saa
*.. Odterf" inundof021 Remaxis)
IM GedMkertiral H- Retail) ff. R • '
IL
4.Daft Well(s)Completed: Well iD& t *,
�i JWt l rt nmtupt: � 5J1!(
rr t000d gaff L • 1
INaissiowtref Facility ER frrfappticable) n. a'
Physical Address,Cly.atd Mari O f\ G
Me.�0 xl ill tiARM
Canary Pam tdemiQeatiao Na.(PIN) MAY 1 2_ 2 023
5b.Latitude nod Iongftude in degreesimimlteafsecoeds or decimal degrees: :�L's�
(ewes Belt,ma mttlong issuinafat) I 2 : C dons l��ji rYi<t<>G 3a`iti TsL�x
Sign � re�tttr�lJwet,Cmtraomr �e
6.Jta(arc)tbewdt(1) Pa�uaflrttt orr°T�'
wry atHtdfRb,Ltx form1 haeelia mtyy rkau the svidiN,ras{trmv}cessuvarat its acaordmrre
7.In this s repairto an csirtlag wells nYcs or 12No with ISA Ante:RC.0100 or?JA NCAC 62C.01119WefiCnnslnrarmr San dal&rind deo ir
iid*isa:vain fill ta;Mum;wetidaasuaufnwrtransattwr and aVain did mauve iiihc topyejtlds ream?ltArbeeepret dNlhemitreflm
rx+vkunder All rorsa►laszrlat aro*era bank oftbfsform 13.Site diagram oraddlihmal welt dents:
8.ForGeoprokllDPT er(affffd-L,ttnpGe(Wernml Wefe booing Menem You may use the back of this page to provide addidonal well ante details or well
corntntetien.ontyI OW-I le needed fnticeoo TOTAL NUMBER ohalls construction details. You may alitM.tMb additional pages Ifilxesary.
dn'lied: VDMITTAIL INORlitalp '
9.Total ildl depth below bad whom 405 - —At 7Aa.for AN Ws Submit this form'within 30 days of completion of well
Par rsehiptceellst/srdleigel' fi@ffarme(csaapla-3(_D20tr'asal:@IOD7 cormillITACITitothefollowing:
IQ.Stalk water level below top ofoutlaw (I) Division of ater Resources.lhafaraudlon Processing Batt,
/flmierh l IBaJ'nre rosins,use".► 1617 Mail Service Center,Raleigh.P(C17699-1617
IL8oaebote diameter. Lo I gm) - 241s_For Intre tine Wells, is addition to sending the fetus to Ike address in gen
( • shave,also submit one copy of dais form within 313 days of completion of waft
12 Well construe method: ► l� construction to the following:
({e.mdgd. tacint cook,direct push.etc) • Division of Water Resources.llnttergrunnd.Inf a tloa Control Program.
FOR WATER SCFPLY YiELL S ONLY: 1635 mail Service Crater,RMCEgh.TIC=699-1636
It- Method of tom: Z3 lnr Wafer�Spnniy&ful jt{Qn Wedhl In addition to sanding the(lam to
13a.Yield(Sped) the addrest(cs)abova also submit ow copy of this ibmi widths 30 days of
Amount: completion of well construdslou to the coonly hvahh dcpattmeot of the county
fib,uriiR[CedQn type: where cens{tuctad. 1
' I
Itotm GW-i North CbmlinaDepwtaecntof iinvitoeinininf Qwdity•Division ofghtlerlta5t0nes 1 0eviio52-12d416
______—._ - -- i