GW1--03412_Well Construction - GW1_20230518

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Feb 16190fi:43p Cleatw►eterWdaflDri}ling --..•
WELL CON CTION RECO RI}{GW 11 For inane/Uae 13:
i 1 1.Weli tos information: _.
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2.Well caaatuhtctlon Penult# D1)1 e It. �•
list apldk ahle tell1eautmalon plurally WC CorrarY.Srom Varirmc4 etch
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3.WdL Vie(check well asae): 17.St:`RR
wAgrilor tiVet1: E3Mimieipal/Public (f tr. w- t a+
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tadtural
Geothermal([3ethtiaglCotdiog Supply) �identi!Water Supply(single) tw f' i°
Indusltialleotomeraiat Raelhxoisi Water Supply(shared) a
irrigation Saw -70 ,a �s. - 's to nylon�i sa Amour
upNat-Water SupplvKrli: Th. Its 1 ��•',I(� { ►t.�
CMonitoei IaRaavely O. fa
glletiAm Wait it. R
0Aqulfer Recharge °Ginundweter Repudiation t4 SAMftllGRAVRL PACRK1irhtat ihllel
3AquifcrStorage tm4 Recovery E3Sslinity Barrier TO MbAltflt I orirtwcdittYr Amen
bAquiferTcvt �trtw'etcrDrainage p•
jTixperimeatal Tcebmoloyy DSubaidenco Control ft. R.
OGcothermsl(Closed Loop) DTteeer TQ,t)RILLPi1GWG(Wash '�'0t"s"' u t,na rest� )
(ieolkemxil(Heating/Caolirit;Mom) feri twin Intact 021 Remarks) :tax n, 6 fa. ! • Y
4.Date Wdt a Weil I118„ qo (a 1 —
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Se.Well Loendnn: ' e(.J1 1 • .
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Daciliy'tlxner . fly Mit(ifgiplienble) A. h f �" 'a r o o f y,�'
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P i Mikan,City,and Zip N R a_ , L��
fit.AEm1ARKS i _ ,,,. k.r:
If: ,� arCoo y Pawl identitientien Na.(PIN) \ r�
fib.Latitude mad longitude in dcgreedoilmites/stewltds or decimal degrees: ' - -
(0 41 field,aye tettMng in suRictam) e 2ZCe :r• on:
aa' ea z 711 N ' t SR 10 w .. ' q 0 A3
6.Is(erc)tale wdl(s) Hxinnaeet or �!1"a�rarary Sr,"Me of Onti eil d~aataasar I
Ix this a repair to pq("Salawell: �Ycs or No 42C1tr_faret,/h1tdn S AN that the ned164*o firma)eteme as oeaor rce
ill II:ICA:i►21:.QtpB ar 1JA NCAC 87C..ONID IV I CensttxaitneSiviedaeisemt thaea
ffd h is r9 r..Nl mabxawnmdI atere trs ett:m w�imottniaxd pin the wore ethe a YafififS WordfirrsbfaCtt pnwidied In rho well ei situ.1
matt A2/rarpaters ytstMrr tree a the tkertoftbrsfa7ne. 23 Site diagram or additional well*Mika
8.For GeoproheijPTor Closed-LempGeothermal We)b having the same 'You may use the tack of Ihie page to provide nddidostal well site deal or well
meln:cinn.on1yIGW-I In needed. fndinato TOTAL NUMBER ofwells cotlttrudiolldetaits. You may also attach additional pages ifaeeessary.
drilled.
below land t
p,
57 5 1i�ushlrrfrar�J �uc� s
nth!well depthsurfacesfa) .For an Wes; Submit this foam'within 30 days of completion of welt
Far nu:110o was list atsdapthrrl erentreawpla-3021hrawl2@lo07 construction to the Mowing:-
10.static water level below tap of east
If"ruler fad lstrlvhra (IL) Division of Wirer Retrureee,lalbrtoatioa Preeessieg Unit.
. I ,� 1 i 0 1617 Mail&mice Center,J It�eighlYCSTd�-i6t7
Ii.Borehole diameter: (la) • 24b.FerJalaciioe}Vega In a tioo;to sending the fans to the address in 24a
12.•
Well construction method: Move.oho submit one copy of this fwm within 30 days of eompietko of well
(t c.auger Mary.able,direct push.NO l construction to the fmllotiiiti ,
FOR WATER SI'itP'1.Y WELLS ONLY: Division of Water Rraalrte&Undc'rgrOYd filiation Control Program,
SO
1636 Mail.Service Comer,Rrdaigtr;NC 276994636
13a.Yield(gpsa) JO Method attest: 12:4; CI 24e.Far Wirer Sanely 12 iufeetlao WeV1 In won to sanding the that to
the nddress(es) above, also submit coo copy dit&ia foam within 30 dayn of
tab.Dtnin(cction typc Amount: completion of well conshoaion In the whey health demount or the county
• Where constructed.
FennCrw-1 North OnolimtixpamnatunfEn.taiiimiaint Quality-phloem ofWaiatlta9aureea I Rav(ned222-2M6
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