GW1--03619_Well Construction - GW1_20230526

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Camp7nyNAnla IA't'il :tt�'}hitxxDtili Jlf'clt"""`� .-L"�,,;1tTA
ill 2,welt Onnotruetion Permit Os 0� a „w Ft .„,.MOW
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., un WI appflo►bto mil eansnrrsttou perru it!4. ono into-,,t nett s c►ad .
„ 36 WQ11 UR(cheek wall ato)t n, in,
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,stop.. t a o'yst 01111 4i17 t W Htl.LZ11 $. „ �'•1 1IIti'I�.1h l[,'1.`; :M,
IOC A uultuml MtsnfaP;taUilttbiia 44: p 0 rP, a R,, a ►S C C.<,t:
:011 Goothermal(ileating/Conlinp flttpply) ittantlal Water Attpply(elnato) " tt, p,
Indianola/Commercial 14.`ttildonllnl Wallop Supply(ahasvd) . . ..t,. 4..
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du* Mr In I ry d.a v►41. �.
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AgniPbrticQhatdo graalndvratar6tomadltltau 1: ►t�1{'!,1► ')f M�(,1`�k�If ,)
Anolrer Stamp and lteisavary (felinity lintxlgr tl'I, i�ritNrf llt2, AM;•.la t*, �;�t i�lr>�:k'1iEts?s
a►tqu111irTaet , I'tiitoninvnterDmiaago 6 0• a {?,, y / �/t, s„POMP Prr,+�
ttnbatdattatt Conlon at. , It.
Btrparltnvnlal Tsoltnola�}y {(� ... _. _
Geothermal(Closed lizoF) 'Ct�ar 10 4 i�t>Mtt,#rl rn'1.1.0.k ,7•t,:i 1 ; ')>47. 7,1 ,5,
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i Physical AddroAa.CO,andSGlltI . (1' 11. i
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County Pawl ltalllcattanikal{1tIN) 1 ,C s"",..0:—,1"4. •
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f1b.1.4111ud0 antelontlitinlo in t'lelit'eeltulnuteelaoceatla or tit/alma!demo; ••••••••••••••••—•�~„"^— v ,
tir well kW,ono InAnni)Is Albioni) Li r/ 33.tnotitltinlinna '2) `�y
t 0.11(are)Ilia vieti� 1f'OIn n®tlt or islifT'Pnporory
Dina area t® tntoe nr "�""""°"� etc
i / f 'a nfr thus ru Mare{r srrl •liter ilia i,wll(()ma Arm?caamn±ctrd In acenrennss
7,la tide n reply to on 41110tlt if Oh f{e Utl Fad n11h 1,14 NOW OK'.QI t)ti or Mt NG'4 O.W.Oa0011'o-lf KlmatracHon 8snnda,vrs and that a
•� �Iii's Is a rrnatr,,dtl our d►ta�nn l ennafnrctfatt ti+t'rnarlan 410 oplarn Irs.nonrre copy 4P►lils ow/sibs hee+r p oWdmi to tits nnN anvnr.
ropntr toter(IV resod,Jordan or on dm Ixtdt WW►fe,thnn,
83,0tta ttitnt or aodltlaptd nail do¢nitt►t
8.:tor CooprobeiDPT er Clated•teop,p Geolhst,mol Walla holm tho esamn Y011 fluty use tho befit of thia pip to Inovido additional ►ail alto dahlia or wall
nanatntutlon,only I(1W1.la iwcde indluol a TOTAL 1i1JMt) R of walla cantnrtwtlon damtla,;1Vun ntsy,also nttatnit addhlanal pagoa if monism,
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drlllalls..................... «.•.,,...0....., .. .1 I tl ) N
A,Total watt tte�1 tt1 Edda local onrtlteut„„ Uw ., 11't.) 2.4at, i, , , ,...:t Submit! thin ftasin within 30 days of aomplosian *rival!
1i Por mull+to WO Ito 01 rtapttra If tt( mat(pvttnya ,Q'01 dalr+tgi 11' aa0801lat pn to I'm,. %Aviv
104 Mile mites loyal Win tag!leasing: ..�,�„� (Dd Divirtolof Water Itt ett)'ou,lnfartnation Promising Unit,
Owner Mel is atom matnfh INV 11 • 1019 61011 garotte Cantor,DAMP,NC 17ti994017/
11,Dorohola di€1amotor!,,,�,�„ (In•) Mb, , .,ol,,f k },at ht addition to e+tndln tits filth to the address In 2tin
���� «have a so ru Y I I'ono copy of tides lbmt within 30 days of annotation of wall
11,'Well eoitotsel lion aivalitadt M �,,,, , aanetrltoAan Id Ate tbllawinfyc to
{ila,nuiial,ralgiyLo?9..to1 dhout iivah,eta.)
' .. ODleistlanoir4hrptorRosmnt ephintimettndltkitio. nOsatrProgram,
• n.,,..1 164 AgRQl.�RQd
ImC#lt OWl1'F1i19 ltlJlopl;4f'6fi 1,4,0 ONL.fit 106 Mail Simko Coneys.t�n,t,+�m I.w 2.raa:•/.,at1
13u,veto(wan., � Mothnd of toot: - • 24e, ,i t j t 1n addition to ae sling the Nna to
tin as ro no(ea) a,(:voo o to mho''ld^ono copy of this fbnn within 30 dnya of
13b,Disinfection typo: Aananrru v 6 P 0 1 crlmptetlon of wo%I construction to tiro county health deportment of the 0ount<y
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t Ponn OW.) Noah:atulino 13Apnttmm�l of Onvtranmantcl 1auatlty•Whitten or�vat it ttasoutaan Ituvtcatt 9.33.t0)O