GW1-2022-06462_Well Construction - GW1_20220527

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oll Conlrnvtor CvNia�x,tlan Alnmtser ,
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Qcoihunnal MenfinglCooiing Supply) riRcsidontial Wntor St ppiy(single) A, R, In,
lndualdaveorrimorciol E)llasldoullnl Water Supply(ohnred) �-
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Aqulfcr Morago and Rvcovory rJ9alinity Barrier 3 P- p M� "`ct? 1t tnu
Aquifer Test [:)8ton1119tdar Dmin;r w n. R� •fa��
tixporlmvnlal Technology rjBubsldoneo Control 41, A.
Gootlmnnal(Closed Ixop) (3Tmeer
j� illmlhcmtal tontin f.'aolin Rontm) fSthar c,c iain under 02) Romania w '� ' t
�f 4.Onto Well(s)Completed: 1Vc11 till! v R era Q'
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5n,Wall Losntiant co-
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r lib.Witudo and tonghudo in dogma+llnlnutcgfgas o>?Ils nr tlucimal degrom. �•-»»�•--- �----�
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i' 7,lu thlo n repnh'to 11n 0XIMI1(11vollt Dew Ot' Na rdth 19A MCAC MAW or'isA NCIC QC.0200.011 Co,utrtrrilon&ni+dards and,hn,it
1/thls is n rrparr,nll out knauu n ell rnstarnrdlosl itplbrlantfua Mid cvpinhl the,Ianlra gf the ON'orthts recent/to liras psvr�ldcd to IN ssv+U 01,Yrtr,
rolsair ender 1121 rommrt,socUnn or on the Wrch gr1hisfunu' 23,:Ste diagram or Additional 1Y411 deta1na:
ll,ror Caoprotlo)n1'T or Closed-Loop Ueollternlal Walls hlrvin)p the santc You muy use the tuck or this pngo to provide additionnl well site dctuils or well
F constniciloil,Only I MV-1 Is ncedcd, indicate TOTAL NUMBER of Walla conotatetlon drtalis. You may also nnrclt additional poID pccoeaary,
}� drlllad;,,.,,•„�..,._,_._,�.,,,,_,,,,,...._,�,,.._,.,__,•: s�t��' per' �
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9,Total well depth below land surfncat ,,,��_r (R.) 2rlp, t� �li� i�t submil ihia R+rirt Withint.,at),'�iuy�+'oP rnt�rlv�tinn of wall
h'nr asaNlph,utdrs 11s1 all dePIAT pfdlobroal lavrauryld•,M•t1�M1'rsnd 2 111f109 coltstruotlon to tho followhia:
10.untie"alter 1oYei below top of eotling: ��) f 4 �(ft.) Vivigiott of Willer Hootily a,Wrnrnintion G°MM1111a Unit,
Uuwier halal is arnJIV rlsshig I1re"t" 1617 Mall service t onler,ltaltigh,idC 2'tM-Ial7
11.1lorel►ole tilnm leterl 24b.jgtJW=flati WAl in addition In undhig the farm to sic addlieos in 24a
Rota nbovo,also oulimit one copy or imo f aim within 30 days or completion or well
1.0 Well cot rt,wbi, ircetpodt aanainiotion to the fallowinn:
(i.u,nulyes,rotary,ushle,dls+cet push,cis.)
C ,�,,.,..•_.,,._,ti.,..o..d Division of iYatcr Rezoum ea,1i1;1dcrgratand 1rdaetton Coatgal Frop;ram,
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FOR WATRIA SIMP1,Y WELLS ONINt 1636 Mail service C:outer,Rnlelgb,NC 276904636
13o,'�ield(flint) �U�� a 510111ad of test: I� 34�0, ¢ 31131 111t i L3 1t in addition to sanding tile Fenn to
1ho Odross(sa) above, also submit ono copy of 11111) flan within all days or
13b.Tlfalnfeetloil typo: �'E''J A,uouiNt 1: 7t9, completion of wall conatniciion to Clio county lsealllr d,spwllrrctu of the county
where constructed.
Pont)OW-1 1401111 C'orollna Dopaninent of Environnlsntal Quality•Dlvislon orWmer Rcsosrcce Revised 2-12-t016
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