GW1-2021-03563_Well Construction - GW1_20210823

Feb 1619 05;43P olearwater Well Drilling 828-622-7241 P.1
WELL iJCTIONRECOP&M U._ For lntemniUse nty:
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tVeli rdtlttaaa Name
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ME"Weil Cnnttactore"Ifiranion MfMlw ( / //� ft.R $IlK6 Mr Iff
Cnntpnny Name
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2-Well CanwrielionPermittl: a �U
f ltt du trygrllaaDlc wa11 m,uuumlonJw,amr fcu 1/1G Gortat} Crars Ym rrntca -) f1 & h'
3.lYe1l lice(eh(tk wcil ltst)_
water Sappty wen:
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Agricultural �ManicipaUPuhlle i<t n 11L
04"M11 al(19eating/Cadjoa Supply) kRrsidetnial Water Supply(single) tt. IAL
induslriaUComm=ial f"}, `R,esidtattial Water Supply(shared) i8
irli lion r PAMIR BM net
iYntt-V►nitr 3upptY W ells
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injee on
Aquifa•Itechnc [30 n. It
Aquif`rStgrgC and ltactway �.5alinity R1 x VRI.FA L t¢Nrt,6 non
Aquit'crTLt �Sw=watar a-
L•'7rperimemal T�(pgy Subsidence ClL
Gcothrsmal(Closed Lwp) �TO= 2n I.1 LOG
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clatutamnt Hotttin in Return) Olher iRcrnarks)
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�,119te13'dl(s)C:nrtepleted;� 5 a,��„Well aw
Sn.Well Lncntinn- Sg kmach ej^-�hlylk
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raality:'fltrnerld�„a . FaalBylDO(tfa0plfcablr.) n
P1 tl Addmsx,City,and 7,ip r ` d' (�
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County Farce!fdaatit \ nimtinn No.(!� ��,^t�
Sb-l.tttitttdc nrdl on 1 3 V V
t Rltutle in dcgceeslmitnmsrsecoads or dccitnni drgrcas:
t J� uiautfltetent) ID(iit� 2x•- erti tine:
A.1a(ttrc)the walt(s) PermaBan or Drempornry finoat,vao CkitlQwdlCantma[ar Dale
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i-la this a repair to Aa erbdag wrJl: Dyes or MNo ritb 1S.t aCAV 02t:.d100 or MA NO C'01C.02M Neff CmnAtrrtkn Sllttlal%"*ant rhm,r
r'rhlaasnrrpntrfillpfaInaanluaQ oftbc SO,*ftm,:
rrMr under A21 rvmarb scs mn drew tfn:IMCA.of 111fs.ram,,
M Site diAgrr.m or ntltditiatml axn tdaetua:
S.!'ar G-mraheA PT or Closed-Lanp Geofbwa nl Welb having fic snare 11ou may use lite luck of this pW to provide addMonnl well rile datalia er well
nslavinlctian,ontvI GW-1 is needed. 1ndimto TOTAL NUMBERnrivOls carwt►idiandetaik. Youmaya[MaifachsddigonlpageshFm=nory.
drilled:
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Irotat,vcp.tcprip Now land surfaces 50 (tl•) 26. �gll ells: 3uhMk fits fbml within 30 days of completion of well
t���uplMpte�rrttiJtze,rlid rprlu;/dJDerrnJ(uar{nhr-3(. wzrm d 2@1MMo) cnn i9n L' c fillt7lxtog;
tn,stntire water lftkl below top of casing' (ft:) Division awater Rewt rem I1Ribrmadon Preemie;Unit.
(rx»h;,•lu�id►,r,atnYecJnyng fete IbITMailSUvtce Center.Wldgh,NC;X7M-Ifil7
Boltehotedblmetm lI f _ ((iin..)�r y sn igA Wnnex to addition to rmnding the tom to the nftm in 24n
M Wet;wnstrnction metted: jo�'ov0.obo submit dnc copy of this ftm wlptio 30 days of Completion of well
(i a.-IF"mtnrp.cam,llit'"tno6,cic.l trtttstintdintt to the fol itmittt�
Fly WATER w$ �ONLY-Y, Division of Water Reenumes,Undcrglmuno Inj tetlon ColtnI Prrograta,
16M Man sarglee Center;Ralelgfl.XC 2701114636
I3a.Yield(gpml , Metl:tnr!of test: 2tc For Y-akr Sny]9Y&faioeNon Wello In add tidtt fit stmdfag the ram to
the Wduss(cs) abcwr, also submit oacicopy of this form wffitfn 30 days aF
t3A.1116aracddn type: ,Amotmt: comntction of Avdl cdaestn:edort to the county health desanment of the county
wbm•e oonauarse4
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