GW1-2022-07179_Well Construction - GW1_20220729

-` -- -- 828-622-7241 p,1
Feb 1519 05:43p GlearWater Well Drilling -^
WEX_L.CON$' LJCTION ,C�iRn tGW a.l j For Internal L)se Onty;
t. dlCnntraetnrinformatE
14.W ZONESWE)
no� o
Well ContracuxName ft. ft �
ry' ft.
for maTB-eased wells OR LMI� K a e
!..Well Cnntnctvr CedifioMion N++mter ^ 1 1 ', "S.pt1TF.R Cm41WA DTA 6R nttt�ctrnas ntATtsatwL
I i[�V j1 ,rROM G
._ 1 tr. ft. 1 in.
6.INNER CASING OR TIrBING rlwrmal etesed 1 MATrt11AL
CnrnpnnyNnmr. r•� 4 I � atAMErSa TAtCKNUS
t-V' '"PRL)yt TO
H. ft.
In.
2.4Yc11 Construction Permit M. .�..— --
i.lw all applicable wellemsrnfWanlarmirt 0.e.rJlr:,C.orerNy,Sla1c,Variance,ef...1 ft• in.
n.
3.NVdl Tlsc(check well list): "17.S=C
nIA STh1t. St4T9v.6 TNrCrrIrHSS MATidR1A1.
Water SupplyNVOI: atlt>titrt TO ft. in
AgriculturalMtmicfpal/Puhiic O ft
Geothermal(1•IeatirtgfCooling Supply) Residentiat Water Snpply(single) ft.
rndustrinllCommercinl Residential Water Supply(shared) t&C. OUTA rtsttt 5;ic CBMCKr?taTRon AMOUNT
FRpitt TO
irrigation -i ru fa
ikon Nvnter Supply Well.-
�4onitoring Recovery _
lnjcation Wdl: ft. R'
Aquifer Recharge 0t�•�(-,roun RAVBLPAeK ifsdwater Remediatinn Tri1TrLACEMENT NXTnon
G�1 r14,SA[3f1/G V We
Aquifer S1prr1FC and lZCCAVcr}' !.-•1`
((;;""'';;Salinity Barrier PROM 7` MAT IAL
.
Smrmwa ter Drainage
llquiter Test [)' fY.
r- ts a,
Experimental Tcchnoingy k.-t' idence Control zp,pRlT.T.TNG
rllw N t rsee
Geothemal(Closed Loop) Color. rc,
Gcothernial(i{catin ao[ing Rcn�eU Other(ex lain under fi2.1 Remarks) ft. ft -
WclllDtl
t,DatcWelils)Com feted: _ — rt -
5+1.Welll,nratlnn: ft. n.
G:+eiltt)![laa+erlfMe .. n �yyFacility[Do(if applicalrlr.) _
E__ t
P_..lf�1t11yc nI ArAres,City and 7ip
MARKS
Unit
C 1++++tv parcel idcntiitcation No.(PiN) DW0/80C3
!it).latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ie%vell field,one lat%ng is sufneicnt} C 2 recation:
b.ls(arc)the welt(s)b'ermnnent or ©1Tetnpnrary
Sittr+Mur nrcatlrLd c I rnrtrncta
Iry er�mm,rhtx.lirrm,I6rerehv c�ertffy Thal the+wdl(,)war M'�)rrxrorrrcred h'r acchrdnncr
7.is this a repair to an existing Well: ovas or 00 vlrh lS.t.�f`Ar..'o7.C.0101)or 1SA Y('AC 02C.f1200 Well C"11S1n+cr(on Sloadarrtr mvl char e
ennp r�fdtlr rrrnrrl has hem pmpideed it)dw well mmex.
l"rNs.i..)repair.fill nftrktrawa nvll.ronsrracnan i,lformailan coed explain the.ann're nrlhc i
"..pair tinder+af remarkx section or an lln:hark of rhtx jarnr• L3_Gite diagram or Additional Well 41101111s:
R.Far Geoprobe/i1PT or Closed-Loop Geothermal Wells having the same )'ou may use the back.of this page to provide additional well gild dt�Ails or wet]
mnsinictinn,only I GW1 is needed. 1'ndicefo TOTAI-NLIMBER or-,vrlls construction details. You may also attach additional pages if necrM111y.
drilled:__,.___ ) MITTAI NS
INSTRUCTIO
SLIF
9.Total well depth lxlow land surface: us (R•) 249. for ni! Wells: submit this form within 30 days of completion of%hell
For roiduplc wells uAt Ali d tprin ifdrfferew(rxmnnle-J0200'and 1001 comintetion to the follotring:
10.Static wittier level below top of rasing: (ft.) Division ofWarer Resources,information Processing Unit,
1fmnlerlcrrlLroVeveCP.ring,free •" 1617himil Service Ceuter,Rateigh.NC276"-t617
11.RorchotedinmeMr- tY'` Crn•) 24b.For(piection Welts+ b)addition to Sending the form to the oddrom in 248
above,also submit one copy of this form within 30 days of completltm of well
12.Well construction method: Y� cr+nstructioo to the following:
(i C.mrg ,rotary.silk,direst push,dc,) r
Division of Water Resources;Underground injection Control Program.
POR WATER 1qt:PP1_N'W.F,I.LS ONLY: 1636 Mail Service Centrr,Raleigh,NC 27�9-163ti
13%.Yield(gpm) Method of test: 1t^ 2itc, For Water Conpls&Talection Wells: In addition too sanding the form to
""— the addresses) above; also submit`one copy of this form within 30 deys of
13h.Disinfecrion type:_- _ _ Amount: completion of well construction t 'the cotmty health department of the county
where oxmsttncted.
I+orn+cm'.t North Cnmlinnt?cpnnmentof lim4rdnmcnnl Quality-Divis+onof Water RaWourc i ; Revised2-22 2of 6
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