__20220311 (55)

R28.822 7241 - PI
Clear'Welet Wall Drilling
Feb 151�3 O6:�•�p
flcrnu ^J!� For iM'cmnt ilac n Y=
N ESL CO MINT1OT �-.. --'-�
1.!NI()outman-information:�r(m�a} _i N., """w^--
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WelltottraclaName... 111:.E._____ y -_ -� R. ! M1
Mr.{ rll Cnnharanit crtincotinnNambar ' \ r \ ^—r } 11F C• ,r u 11. , �.�11 � u►
1Lf 1 -"`-".n. I `lam' V _�_
c 'i s:rr.-ar , , - b arc
t�nrymy T tamn 4l�1 l e� o !�t ►;}s j-' to t:
?._Well Coomirnedon Permit II: r• fa. R-
t-Lrt ou nlgdm9ra..ail emetme,lnolwrmur i e.Mel CM+My,SMIr t,rrhmett,rtr.,l f tn.ft.
,"Well Ilse(chRrh well tarp -.,. _ —
Wirer Snpplq' ell: 1 — a in. _
•A ticuiturnl I:Woofeipid Public
III tkrxhermel(LteMiaglCanlinQ Supply) iwidemlal Witter SfapPbt(singlet R. O.
A tnrtusatiitlComme ciat oRclidcntiat Water Supply(Sbutzt) I w.,'t � �� j 1�„ Yi;�7 3SGI1 _,
r �r(( �/ t
NI itTlgminat .-'-• - -°---- --�- - t,. + '! ' ' 1 if 0(- ---_._- .
Non Wider RopptyWelk �_ f. ...--^—-- -
a Monitorin ac cry —- - -_ •�
111 Agoit'erRecharge r:ViroundwatesRcmedirntion 419 yRI.PQh (.. . .:
]�AquircrsfgtgAc MA tternvay °SaUnity Barrier 7.0.
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ntmwnter Drainage fit-
al
AgolitrTict - •
a I:xperltnentel TeelmnNlay JlSttbt idcnc' Comrnt _
10(fcrnbc m I(posed Loop) Draw n• 1e{ '' : ' o wtr,.•1•i_-;
Iud ..:.!7A._ ,. �. Jilt-_
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II rianthemtal(HeatinglCaolinkRatuto Other explafo unacr121 Rcfnar r!). / , Lint 1
Well IN tr, 0 a`
1.Hatt:Well(s)�tnpMta:ti:_�,.._,-,.^,,.�._..,_ - -- .� , �
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k 1000: �1) re
5n.W ill Lamina! r W , tpAC
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nettle ?rant; Facility iorEtiPtvpticnlriclf IVt 1
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4vsirniA rea.,Ciq�dut{?.it+ M1/ O.
_F'. A - MAR y 1 202/ --..
t;u,uty �---...-, Pntrcol Identification No.(P1 ) .------• --,-. --
!M.Ii fNgtrie nod iongilude in riegrats/tninittectscrondSQr llt:clmnl ttVVrO.% -•------ ..--...
ONO geld.ens tttIMnj IS 51imcm) C , a 4' i titian:
off_- 9q'(91 .3Q N CqA 5. la.Oa _ i ,� I -14-�
f^ time
li.l-s( el Mr wetl(aj4Pcrmnnnnt or �pn ' t t age afCxtdfirrf 'Memoriam
a spauta gm.paw.I hereby ev;trgt OM I1r uv14'J Inn(here)rfrrinrr eat ht oemMmrrr
7-in this a repair toan misting well: DTlex or Ilo d-ohi. Vile02C.9NN1ori. N!.AcVVf_MOOO.Oc.nstrnrnoaSinadnrf-rmut,ho,n
fffMr;s;:rl l,*fi►1m,sknAnTu.d)ennxtn,afnont/brinnitnnmuirspfoind,'inu,,rnrthe R"1tPnfr/lto1"1"1ha-rnnatt,.4nlnixlrarltntrnImvriw
writ it under C21 rcmMln a rtion or MI1110 burl;of Ilihlama• 21•Site disR ono or odditIOi 1 weildelafb:
Yon may
R.sear GmprnbefllP'1 or t imeed.lfinp Geothermal Welts timing the sumo usn.the back of Ibis pogo topttivIdoaddiIiototl atoll Sian dMaltt cm AVM/
eonst*tu:ttnn.<ni1 t OW-I is inflect, bulimic TOTAL.NUMBER ofwalls cx lntnaetian ttriaile. Yon may also attach ad llilonni P if necessary,
drilled __ ___^ I. �f n �AI,�•lw lQ1
17Ntot weft depth below land surface: � - _J(R.I 20. Ibnr welts• Submit this ibmt within 30 days of completion of well
Re multiple wrikMsitlld.frfkcifddramtrocimPi+-rOm'tom►4, 1°41 amxtroction iodic Miming:'..
111,Stade mew levti hem top of acing.. 0 v. ..,_ !8•) Wigton[Mgr Rcsmirees,Itdhrmatitin 1'r a asleg I)ntt,
If water level le mbar.fawn&itu:-•c, 16i7 MsII Strike Center,11tdlttigh,NC2769114617
11.not+mnMediameter: 1... (1n3 2,i11,For 1akelipp Waite hi addition to sending the form to die nddtmti in 24a
tics shave,also submit 000 copy of this form within 30�of completion of Well
17.!Yell construction mottled: 1 l,l r angtruefirm to sate following
0 a,mina rotary.rabic,direct push,W.)
._-..,.._- DP4Sinn o 1,ma Rf esfaus a..mane Rolnd elBdat NC l areal dram,
~FOR WATER firPM if WM-LS 041.Y:
13a.Yield(}lino),,_ I • - -,Method of teC1;.,.. A _- z.tc rnr Watt'Saimaa.tiatlI-n WSWmt in addition to sanding the th to
tits tufdress(es) above also Sabath one copy of thin W O within 30 days of
i3b.Disinfection tyQc Ammon: cmptetion of well cnnstsuctioit to the minty hadih dmmt of lhamini),_ -- - - t whom cnnstenotEJ.
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