GW1-2021-04569_Well Construction - GW1_20210429

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Feb 1519 05;43p clearwlater Wall Drilling
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t ICnntraetorinformuEon:
ZONIES
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1_ "�a TIEON T N
+veil ronmor Name rL it.
NC well enmraeimC«tifimtionnnmAerrX
011TBRCASENG �Y xyR�
Camprmy Name - arom.t
�' '/�.,� a tNiY6R CASlrtc i3IR wstsnr�ta
2.Well Comitrution Patten d: `ty TO
Urr aft vMdk+ahlc well a wimarlon p—mfl (1.u.UIC Comy,Stain.V.rrtmwfA air.)
3.Well ILte(Cmd wd)use):
WitCYSapntyVlicll: 17• TO S tcrcNaaB ?BRIAL
Agricultural �VtanicipollPub)ic p Ai. D- o'
Gsmherutal(IdealinvIctiollog supply) %Residential Water Supply(single) rt�
industrieUcommercinl Residential Water Supply(shined) g
Errl alfnri caw
7 liA L sM « .
.Van-Wnrcr Supply Well:
Monko' 131tecovery lr• fe
Injettlon d: 7 -)9 gA1VEfI1I GRAY6LPR.
a bit
Aquifer m
Aquifer Stwgc mid RoC(tvcry E3,Sdittity Barrier a>teout 1777E
AguiferTcst 0SwrmwoWDrainage n �
rdic70mental TMinoIgW E S&tddenec Control (L D'
i Geothermal(Closed Loop) [3Ttacer 20. dd
134 7 .w
Creodtetrnni fieatin Rouen) Other in un&r R21 Remarks) tt, lr. a (/
A.thIcUldl(s)Cbnepletrd:u ell IDN . R' 1 ft l _
tt.Well1, ` L
Facility naNmno . IL
,ty ON(ifapplicahle) 0 ff.
Physicni Address,City,and zip
Glnrary Nita!rdemifleation Nm(PiN)
Fb.l,etltttde and Eongittude in degrwAlErAmites/seconds or decimal degrees prOCes
(iiwellfreld.one ht%tiginsuffrctent) d e rca"on: �vifOrrr3p>WRSed"On
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6.Ware)theweiill"4 erranent or If.f"emporarF Siamalureofce"Irwd Well contraatar DstC
I1v ar}mia�U+Nr farm,111"FwAjo awt/fy Orr dirt twdl(s}war rinses c*PAMMW M 4EWA xv
I.is IN-,A repair to an txistitig wrlh �Ycs or tVv pdill lSf.Y(."AG 62C-4I00 or ISA NCAC 112C.'.OlnD WeII ewV1iw*a'?Stff*Ja'*Md ihar Jr
"ddtI—Fermin01MaAmwnwall.wmimclawi*rMalronondexplanrrbsnnrungrfhc taPYnftlifrd.anrrlhnFbxAprot rlJnl/a!ur�f/ntttru.
rr,I0Jr raWet II f rcmturc.=Mn or an dn:ha<kaf NNalann, I.L Ritv d iopmm or addida ml well deft1b,
8.For GeoprobeiDPT or Qvwd4.mp Geotha wRl Wells having the same Tou may use 11c back of this page to provide ad(Glional wail site details or well
wrtainictian.onty I GW-1 is nec&d rndicirto TOTAL NUMBER of wells ctm9trtution ttrta►ls. Yau may also aKai b titiditumet pages if noer�ary.
drilled: —f �JQtir r'r AL)lam 1�T,�t('f30tY6
7.total welldepot belasr hind SurAtc� ` ©� � •) 3Mi. for Alt W&. Submit this fprm with in 30 days of aomPl9lion of well
m,r mnlivpre v elis uxr al;deprhr fafam.i fexa aplc-3(glllllr•mid Iwl congwiXiM 14 the follWffl g:
I0.Statie winter level below top orcasiag: (ft) Dividon of Water Relources,10lbrmatlon Proeess11119 Unit,
ll-e ater km:l is rilwree txalrig roe^• 1617 Mad 5a► ke Center,Wtdgb.NC27694-•1617
II.RotrhotedlitmeMr. �_ (� (in.) Zth.For Islactilin Welke 1n addition to Priding the form to due addmlet in ton
above,Abe,submit one copy of this from v4Q t 30 toys of tornpledlatt of well
121Vei1 rnnrtraeliao method;, i""" r catishuctinn to the folic ink
(i I.mrgc,mrvy.cable,pirat posit.etc.) Waterof
er givice Center,PAtei NC 2709-1636 dram.
rOR WATER SE.'PPr.Y WELLS ONLY:
13a.Yield(gpai) a Method of test: 14c. r Wake Sunniv&ipteeHan VYelh: In addition to sunding the form to
die addleas(es) above, also sit L one copy of ebb fort withbtf dayshe o
13b.Disinfection type: Aruormt. wmptetion of Avail conshuction too the comity health deparhaeiit
ty
ahrare Constructed. i
Reuifand2 22 2Q►6
I-'mm Gw-1 Wr7L Qrmlian Depnrimon[of tinvlydain—al 0"Wity-Divisran oP Water Rasaueac