GW1-2022-00931_Well Construction - GW1_20220107

Fob 1519 05,43P Clealwat©r Wall Drilling 828 622-7241 PA
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1.Well Coaetrnetion Permit 9; \ - D�•JG _ _7A Du •rn MAi Yam[.
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Industrial/Commercial Residential Water Supply(shared) IS.
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iloring Reeavery ra tr
on Well:ila Rechor$c [irmtndwntcr Rcmcdiatinn - L 1'AfcrStoragcnndftctnvcr} �$tGnityC;ntrirr "»Rota' rqhcr TcetStnnntyal5r I)toinagc -- n
Experimental TechnnInp f3Subsideurx C:ontrat n. n.
Crcnthermal(Closed I,,p) QTrm:ct RILL, .LOC 16
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t,Dare Welt()Completed:_•„•Well IDN tr, rj`('p tt. M l AV,
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51).I,Rntudc and t(InRltude in dcgroeslmhutteslseenrtds or decimal drL+rcas: - ----------------'•---•--;ram-.� r�, b
(i;")?add.one lnMnng is:intiiNent) d + ;!' rtlRrntian: (�li '�l l( J PROCESSING UNF,
6.11(Rrt;)the well(s)0Pcrmnnent or orremporary rgaatnrc nrce-R fitvl 1 ontrnator ONE
1[v•uMinl,•rAh•;ornr,1 herehpcvHlfj!IhOl the 11.41(,)„qr AVOW)rrWtrMYr,1 ru r+cth.4oncr
repair to an existing well: Ves or No xdrh l.f t.'WAC.,02C.01AU ar M,4,VCACA?C.rt?t10(Yell(:'r ngrnc7irnrSlawlanft mill rhrrt r:
lfrhl�i.,•:,rriaair fi11 rmrknnnn volt"tensrmrlin+,irtfn,mn!lmrmrrlcrpini�r r!„•nnrrn't nfnc� rt'plr r+f1lr!t hr»n!hoc hrtY7 prDfid�Aln rh:wail nwlMr,
r.;x+rr rnrdrr CZi remark urmut nr 4nllm Site diagram or lidditional well dtllalis:
R.i7-nr CmpruhefillrT or Cinaed-1,»np Geothermnt Welin having the same 1'+tt+ntay u`.me hack of this pant:(o provide additional well site delaik or well
ux)nstnrrrinn,enia I GW,1 is needed, Iltdicate TOTAL NUMBER ofurlls cnnstruetino dctails. You may WSO Rttach additional pnges if nocewry.
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7.lfatal wcltdeptlt bctttw[Find surface: 1lia, fnrAp Wells: Sllhmit dais farm within 30 dn)s of cornplalian of well
1•�rnrglllpet+rNlslivn!!d.!prlteiffiillcnenr(rrnmph`-d(nlTgtl'mrdSLnl,100') cnnalrlictinnto The following:
A 0.Scoor water level 1►e(nir top of eoslog;,,._.,'0 __ (ft.) Division o(Water Relewrei%Information Prot,essiug Unit,
ll'Mydrr'Ir:+•e11,•nb.rvd ertcing,oat• 1(,171M1ali Service Center,Raleigh.NC274".11617
t i.ltarchole dlarpCtcr: (- ` - In,)
( zAt/.Tor injection Wella: In additao�tt to sending the fotttr to rite tlddlt*t„)24n
t?.1Vrlt rnnstnretlen Method. nbnve,nLso submit one copy of this form within 30 days of completion of welt
(+c,mrac•mtap•.r d.k,dircet - -- coizi etinn m the following:
1=11,ate.)
Division of Water Rracurces.underground Ordectton Contra)Program,
q WATL R Si'PpT y W)r^1,L5 — 1136 Moil Rervia Center,Ratclg4,NC 27F994ts'3fi
13a.Yield(topaz) Method of test: 2.1r., r r ' t'r S{lp�r ak Fg(gSj)on We ts: In addition to Bonding the(torn to
r_ the address(es) above; also submit. one copy of this form willlin 30 days At:
►►isinfectitm type, Amount completion of wdl construction to the county hcalto depnnracrn of the trtunty
` -- �ahnre exrntlnncted.
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Norsk QnmtenniDcrnnmmlt nret-kdnmrnml C,+aall+y-nivi.vnn of Water nnsnnr¢s Rcoisdl2 h4.2a16
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