HomeMy WebLinkAboutWI0100513_Well Construction Record (GW1)_20181119CleetWeter Well grilling
828-622-7241 P.1
WELLCONSTRUION
CORD
fartrap1UscONLY:
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Tile fmm r4nlewsd for finale Mnmltipla woe
1. Well Cnnsneear rnfermadon:
Josh Plemmons
NMI ConranorNemeR4137-A
W(tifxt tJp^I':.
no. H0t%80fingS, NC 28743
A1: W.li C.nnanm CmifiulitnNumber
Clearwater Well Drilling,
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on
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CAmPnmNmu
2. Well ConstrncnampertnRR: j��—"
luen/irgrpAnnNe nedp11mnls(19. Coldly. Sane
3. NVeR Use(checkwell ose)e
17 "`� -
rmrane<.InJrclbn,eml
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11. N
Walter buppiv Wes:
1_IASHadmml
ntiwrmat(HeRdng)Conling Supply)
0halustrIMICommernal
:Irrigation
ohlunicipaMblic
oltendeoval W.WSupply(single)
oftesidantiai water' ;apply (Ihood)
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f.
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west m
rr.
Ia
Nam -Water Sapply Well•
Qw0aftoring
ORacermy
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fc
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injection Wall:
DAquifer Recharge
DAquif"StoMe and Reoomy
nAquifer fiat
OExpMtruntal Technology
OGenthermnl(Closed Loop)
❑GmidwmlM Remcdistion
CSeliniry8anier
DSmrmwatm DMWo
Osubsideace Content
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4. ])Abe Weil(&) Campinede I JWas MN__
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So, Well lAeanon: I 1L ih
rlamw•
� Qlo(�9 �31071 D�DD
Psroal ld.edhrstlonNa. (PIN)
Sh. !Latitude and longitude in deRrces/minuter(teeoads er decimal degrees:
(irWiittRdd,.onnee n11I.M,R�is sufficc'es) a 2 ,'' "
03EZ + � ND3� ' Wr ja W
6. Is (Are) the wdl(a):*ermatent or DTemporary
7. Is this A repair so au asadnit wog: ❑Yea or
/(0fe tvn vefrarnlf mu Avmwn wellroNllbetmn mfnrmmkw amid
rr/v4rurderaa/ramorM.te<IMn nr nn the Mre#Mlh )hLf�(omx rd ,
R. Numher al well, comeweteted: ty,
For muhopte soeeam Or rren-wnrrr svpp(r"Aft ONI �w()Wr/JA r�
s'omo nor S
9. Total Weil depth hate, land smitam:l�
1+nrmdirple vellslinaAAo/nAv lJ�•rex (nrnmple-t�200'mrd2
fh
25. Ccrt7Rcad�oni 1f ' �/
Si NroofCmiAad Well Coummor Drld
l nlprtM$ IIAv /n•m, I Armey sartlify the$ the ten//6) was (mervi oo""rMd a arcnrdaorr
,,ob 1.TA NCAC 02C.O1&I tr 114 NGCOIC.0290 6aACosamffm Sad"' and thorn
nyry,tnhtrrrmnl1. Arm pmvddf m 11m W41 etrnm,
.23. Site dlugraen or additional well demur:
You may osc the hack ortit(s page to provide additional well site details or well
atnstnreiion demds. You mayalmadeehndd(Iienlel pages ifnec®nry.
SI18Mr1'TAL INSPUMONB
?An. For All Wells: Submit this form within 30 days of completion of well
conslmGion mite. following:
M SIRtk Meter bye[ balm top ofws(ng: (ft.)Division of Water Resout'aes, Information Ptecesdag Unit,
(funlorkwanease mtlnq,.rc' "t 1617 NW1 Aervkx Center, Raleigh, NC 27699-1617
1.1. Horebnle diametm L9 (rn.) M. h'ar Inleetion Wells ONLY: In addition m sandNR R!n flnm to the ednresx in
trs���, ,_..In ,,, 24a shove, also submit a aepy of this fmm within 30 days of completion of well
A2. Well construction method; �` t _, cnnwruetien to the following:
fi-e. engcr, mmry, cabs.. dhem Posh s10
MOO.. of Water Reourees. Underground Injection Control Pr»Rrann
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Scrviaa Centers RakiRh, NC 27699.1636
132, Ysdd (Rpm) Method assess. 7.4c Far Wester %—PNy & Injection W.R.
—" AAso submit me copy of this form within 30 dayaofoompletionof
73n. Dlalnfeed^n NPr. Amaszsro ,�,,.�_T ,sett eannn,nion to the merely licAb departmem of the camty WhM'
consnudod.
Moro Cs1Y-1 Noah Caroline Dsllmun HEOFFAsirarucmn sal h'amral Austere"-Dhvion nfllt rRamurces gndMdA rasa Tall