GW1-2021-01677_Well Construction - GW1_20210429

Feb 1519 05:43p ClaaiWater Well Drilling 828-622-?2A'i p 1
WEB,,L•+COATST MM10i.1T RECORD it"W 11 � � For Tntettt►ai Use nay: f
i. ICa►ntraetirrinlbrmatiop: ��., � i
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Well Connor i fne �� pro
prose SM
NC Well Cantraamcatofi tiaoNlmter 4 ` fj �4 ati0 $8
CliahAjakr- W t1 �l R 1 + R , IMS
n: iL lef:
CAMponyName h(� ((
(Q C)A C) GO � t+.tNiV6R CA$lNG OR l UBIPiC Ueoarat►I
2.1Veil Comnrpgion Permit#: K ` ° MA
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irrr�w,•.imbrrire7rrnnrtrrrartonpanrreSArt,11�r ..�aa5'rBlt.Y4rtRTK7 CtL�
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3.lYrSt tine(chtelt Well ttse):
tN ter Sappy.We: �17.
TO THICKNinff I NATMLI&R,
itural �Man6cfpai/Pubiic () tt tit ih.
GVWhet►ausl(14CMIUVrA ling BuPpiy) 13Raaiderlilal water Supply Omsk)
indusaial/Commera)al DResidentw Watersupply(sharad)
18L G111011T
I nns seism saa t »s
Nam w Ater Supply-we* ' c fe, t
Mlottitanmg13itecovery U. &
RAJ Man Yval.,
Aquifer Recline DorrnmdwaterRcmzdiation IL R
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quifcrStwgV M4 RecoverySalinity snrrier 19 VBL PA C t►scnsoo
Rquit'trTcR rnttvatcrDraittaga n IL
faaperimental TedlookV oSubsidence Control n
Geothermal(Closed Lwp) DTraccr 20,DRii 1,1now Von Ifteaft,
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Genthepnai HclWa Reams) ma' inuttder#21 Rcmatirs}
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!,thteWdl(a)Colopleted: r. t y 1,. ¢ii IDO pt. tt
Sa.Well Lars► fl' ft LY
IL
iacilit)s7hsmxttamc . Famlit1+Do(sfappticahlc) n• R
MCI
icnl Addmx,City,and Z10 ft u
al. ARMS
Cututy •—• Panel rdemifimflmu Mo.(PlN)
5b-1,RNtade and fontp,Rade in degrgedolnutedsecandsor dcdwal degrees L.
(ir+wll Era one taNMt�g�tis(s�uiRcf�rnt) of a � tins: /
6.13(nm)the weil(sa"stets. or Dl anvorgry sipo me of t:e"IIlad i elI Coanwor pate
13v N}min�dtlr_form.I hrtrl+v axar)fjr Ant flan xrrl(aj►ms1 r�tlrrrrrAty!4d adeMrr
T.is this a rcpairto An odstlag well: Oves or 12Na saris 1Sa!M7'AC o2C_Qtrt9 nrTSA�Yl itC lilC'.NH+U Well Crmrtrnctianstaar&rd*+mrt thm.r
,rI"is.rrpolr-All mtrinalfn weve.0wrmaaw aNure grrho eppy afthis record kw hip pmw&d M the WP.7 owner,
—., IrrmderA21Irmdrkssmenoroa*&Wkaflusform.
2.UffiFa dia)tsam or nddUiorwl taYelt dmsstts:
8-For GeoprobeMPT or Clawd-lamp Getffierml Wclis having the same )'on may use the back of this peat to provide additional well site down or well
rx►natruction,only I GW 1 is needed. fadiaw TOTAL NUMBER ofivOls c"Wationdrimis. Yau may alst Mach addiflohalpttgesifnecconty.
drilG.ci:�_,,,. - t�61li1'ITAI•tl� t'CP1R_�C7Tty1V6
F.3ota1 IT-41¢pllt Wow tend aprksc;„ �� M) 24 ,AN Wes: Submit this fmm within 30 days of tmmplt don of well
nrahlplewe))xl:sral;dap►JarJEt@crenr{rmmpk-30.510ir ,Ad fool cousnotiontothefo)lw t:
Ill.Stadia amber level below top of easing. (R; Division of Wator ltaource%Indbrmation Processft Unit,
lf1werrert;Trnfvtreewty,Inc'• �'- I617 i11af Service Center,Wtdgb.r4C270!i -16t7
iI.Rombotedlemeter., LO O ,(in.) ytb For Inlyclign We V in addition to rending the low to the uddress in 348
above,Otto Submit one copy of this form u ifs 31i"m of cornplctim of well
it Well rnrstraefine MOON! rp cotlstruclimt to the fat)wAlls
li a.-a-,mmrp,,fie,;rwm ptubf tto.) Division a _
dram.
MR WATER 8tI.'gPi V wELLS ONLY: i m Mika Samoa Center,RAte*b.tC Injection
13a.Yieid l
li,l�uT�� MCihod of t� lac.,,�(ir Woter Sontlly&�p�jaaiWeilc fttaddition to scndiag the linrm tf>
file wilimsc(cs) above.. also submit one copy of this form within 30 days of
13b.1D1.dateetton type. ,Amount: eomptetion of well aonswuctnrn to tlia connty health delinti ant of the amM
whore tor7slrecteQ.
Irm►r►CitAr-1 tJoAh Carolina tJ¢pennant of iiaviruamxrtat�rafity-Dauosmn ot'Rrsoer Rtywaew tikaoiaad2 24 2at 6
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