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HomeMy WebLinkAboutGW1-2022-01037_Well Construction - GW1_20220107 828-622-7241 p.1 Fof)151905:43p Drllling W iGIG C'ANQTRTT[��'ION C;0 4{GW a.1 Fit'r'1nt"cmRt Use Only; i,W. C)ntrpnnr bro mallnn; 115 — . f[. tVcnt:rntttar.UxNaine to _• _............... .k —., 0 ? oil CaanaNOt t'edifienlinn Nrnovra- C AN* farttia DialLft, err ia. V Jo- 2.Well Conidritallon Permit III fit. i.trt a!f n�ryrltmtrfc,rallemretninM»�unmr<rfl u,tlt(:•f:nrrMy,.Curlc,Vm'+nncv.rrr..l 3.1Vr11 i(ae(ONk well live): 1Veta Seppi•Y Wcli: _ , 7. t n ARricatltirrnl tinieipallPtfb{ic (T tt_ it. Cemitar9lal(Iicatinly/(:anlltrg 9ifppty) �aidentiat Watcr Supper,(singic) ft. ��l+, (nduslrinll(;nmmaraial identinl WAtet Supply(shared) r rrrit. _ NoR-1ShttrSuprly►►e11: -� OM- 114oni onn Rcaovery (a !r• _ — -- Aquila'Rechlogp.. ClQroundwnter Rpmedialiun 19 AM rtrgl PA — .. LAC THE IW- W aAtitiif,:rStotagenntlli;e Dvi!r, Elsmillityan(rim pox r Atluitcr Test DStnnuwnt4r T)rainagc _ n- L"rprriulemal Tcchnninity Subsidcilu Cnntmf �n tz ----- ttla,r Crcnthc.(mal(CiM1Sed l,rinp) �7'rncct ?IYl�itJl -�sd____, Geolliennal(Heatin_r�Coolin Retarnl Otlwr c�cpi ktin nndar Vl?.l Rc:mat4:s) tr, tr, feted, l_ Wll IDIV SO.Well 11.0ratino'. _ a. eLo M,�w...�... �. - I.rein'•:r(tru,or Mama ity ilht(if. Ilcahtr. _N' n" I _..-- tN Fen1f mp ) Physical Addrr..c.,fall,,and Zip K)L ----- - _^ r:ov n J ('ne+:al(dcnlifirntic,n Nn.(Ptif) Sb.IMIltide nod Innpitnde in denre�esfmhauteskeeands or decimal(lrgrecs: 61%wIl Geld,ant int9anti in anf%onnt) 1 ,I: ,(, riijilrotion: -MAOLLa NOq0 C ta(arr.)the wtll(9) IPCM111nI1Rnt or OTempnrnry Itaalu►r.nrCcor(ied Wall Contmtdar Dille Vt l v,diminJ,'+A+•r h,rna/4r.,, p wlvfj,/hnf wor u¢dl(A)Kwr!wm. ?)n unw--vil M m twOo.7Cr %•1+[h:ce repair to an existing well: Yr.!# nr woo op :+ril l.SA tiC',K n2f. n9C'AN,#11'rtll(rnt7nusimr!lnnllnrfc mitt AM4 ry'rile,ixnrepaid/lrn,tknm,,,,ocR.rnn..irn,ain,rirtjn,ronnilna ,dnap/nirr+br,rnlrurrfrhu tnppnfffrftreennlba'gw9lpto4*4inl'hc'wrilnmlm. „;xrrrraider tlfrnpiNicrxctrnprrMInn'h.1, nflbtx.(nrnr' ;i.SitedIpRraDorRddild lalivdlde lb, R.I-or Ceoprr,betarT or f attaed-t anp Geothermal Wetbt bavinq file slime 1'ml may ris+:true back of this page(o provide additional well Alto details or tuell rxtnvinn:Nnn,ent�I C,WI is needed rlltliciliti TOTAL NUMBF,Rofwr.11s c+'tnitlItAinn11CIMls. Yen may also Mthch60111 OTTRIPAgtClftlhCEQ9nly, IMMUJAUMMMUM `r•A)lai wsirtkpth Itct[Iw land 9urfoce:' v V (IF.y !14L.t, Submit ti1is thym Avitllin 30 days of compietian of well r"vrnntrwr:,,•rnoll,rnf;rdmr7+.r lfrh•((cr,wr{,anmph�+n?r/rr•n,rd.@.mn'l ritn�1111Ltintl to the fd101eing: ' I A,31Rtie wwtrr ltwt l helms top of eRAing- ,—. _�(ft.) Division of WdkRT Rmure*,Information P[wit tg Unit, !1'rrnMr trnrtt fx,atvtox crtc/ng,aarcrr��•II1f'(I 16t7 MIiR ServLee Center,Rsatetgh,NC 21k99.1617 1 i.ltorcttole dlaMetcrr ll� — in, ( ) ;t•th.Rnr IwlerNow WeLia: k,addition to sanding the Jbtor to Ate nQAIY>7{Y in 24n I T.1M rti rnnetnlelinn method: to oleo submit onr.copy of this form,vlibin 30 days of completlon of we.-It _— rauisatrtictinn to the fnilotvinir (, Ran-.mmn."*lit,dilut M1311,CIO S mt:WATER sc:Prr,v WEit.r�S n>,ll.tr: Division of Witter Reamirms.Underground Pnjtstion COMMI Program, {� 7f36 Mail Slervim..Center.RatCWh,NC 27F994636 Virld(gital) 3 D .--•iKemod of testAwl 2.iC, i , f SORDly_ NJOCIAn�V 11 In uddhioa to nunding the(hmt to till: nddress(es) tbovo, also subotif one copy of lbip flutn w(dlin 30 days of t�A_.Y1)tsin[irctlan lyQe��.^p�jjy1�!1.�. rnmplellon of ,ve11 carrstruction to Mr.cerrnh htuuin depanmrm of the tMunryrffhnr-- conattncltxl. Rnnn Cw.I Novh CAMlinn ,tX�nnmcni.art.rnlydnrttrrint qrrath;,-Divis,ao lit'Wetcr itnenlRcgs Raoised?.24-2M R