_Well Construction - GW1_20230327 (5)

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Feb 1519 05:43p CiealwaterWel{Drilling 828-622-7241 ' P.1
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WELL CONEI'RUCTION RECORD(GW 11 For Internal Use Only;
1•W�cll Contrnstar I r To. nescawslats.4 WA TER
Well CotingotNom ft. ft.
�1cJ1 % J P. - ra
NC�Well Cennttrral°�,Certification Numberi `� (I R CASING for GRIMIER ra
�1 m V11w 4.1P,1•1 1,J h'I. !�nq ,ROM � l r _ o-u►tt�uau
Lf'' fr. " ht• nU Comp°°yNomaDINER
) (( [[
z.WAColbdrodlan Pewit © (� �_6 1� 3 `moo oil nut TKIs wt plid.
bt•
(Meth opptfasMe arlfcnnrrnrcrhn pervOrr(LeUIG Cornvy,Stale.Yartmrrn.cry) '
IWell lilt(chteb well use):
IL -- ft. la.
Water SrppyrWell: n• ly
i Agricultural �}ManloipniJPubilo ( it•
to nMtttta wit tllnoR ISe mewingMAMMAL
ill Geothaatel(licatinglCanling Supply) water supply(single) ' ii. b.3111 industrial/Commercial fferidestial
esidential Water Supply(abtred)
Irrigation & ourT "fie. iV roams aAliTO rr
Non-WaterSopplyWdi: /, ft. 020 rL f i f . mi if
ill Monitoring IrjRcoommy ft. ft.
., •., tel:
lit• , Ter Ret ¢ EiGroundwater Remediatinn • Is. RII
i'•9ulfg'SWrago led Recovery °Salinity Berries '"Moat9A6tD/f 1Rr\rBI.PAL7[Sii�e .. —
a AquiffrTett JStnnnwaterDminngc ty_ a.*re �aaAA
•experimental Tn lmology QSubsidenco Control ft.
In Geothermal(Closed Loop) Dom 2Q DRILLING LOC Nadi ..:!c__.•
•CIeo*itamal(Maim/Cooling Roan) IQalerfmtplain undat#21 Rt:minks) • tmer{>d TO -'--� ' t a4ar+r,.r.�.�i
! le- /y�,GO p, it- �n� it �T
a.!)ateWd1(a► IMed
_31 `I'o23 RI)DI _ /J 2 DPZJJUft°s
...Weil I-amtlna: 'Cat4VnitOOa) foN rt. f?3 d WY •
fr- rG Y1
�.ri5�n jC�-cam. ���3 ��S" ((/af�(
nl;fnal$y:Y)asmerNane . FinnylDilfifapplicable) f4 ft.
2"1 to ai re pA R •'. , �'i het;i.
nest,City,out Zip L[Q(��j Q q�/� MAR
/�U
Ind Add qz 3 )-1 l Q i 1 bb000 a . ri IL ;1�'1l lid
Corny Portal titamittontion No.(PIN) y r.'.'-
Sb.!Latitude and longitude in dtgreealmltmtestoteandsordddmal degrees: �n i t"� ,"O'es`
orsvettlel&armllatflonsinnrdliafent}
OaS` l •4 O 1 r 1 3 ,rI 22.#'e •. don: /J
6.Nary)the wdiI(i pt,rnettcat or (3(remporary tire°MMeolfa%IIContractor ppye
t 3¢mtng lklt•irm',l hereby tat/fy Awn Ike ntg(4 was i rere)atrwrvaed in armNirree
7.ie this a repair to fin=ham walk IYYc, or Jio A rh 13.4:Gala 02C4i00 or MA NCAC 02C.0.2f10 Well Ci ortmertnn Srmrdartb mil that a
lid*isotritt0 NlawrbmwnmaAawatmatonkrfomunfaaandaphintberxunr ophe (+ppal-fhll word karat pN►1fifed1,dtt wdtnwtter
mixdrander All reamer=yjtat Drat rbcbock ollhlajornt.
2.3.Site dlayata or additionaldealtdes:atLO:
8.Far Croprobel@PTor Closed-Loop Geothermal Wells books the same Von may use the back of this page to provide additional well unto deflj air wet)
atnatnusien only I GWl is needed. renew TOTAL.NUMBER°molls corlatrt>cti00 details. You ma ralso attach addltonal pages ifnoeeasaryr.
drilled:
go S • -,DOMJl rwr•Il rlt�t
'!.rots!Well*Ph below land lllrJ{reM OM 24o.for MI Wine: Submit this form within 30 days of completion of well
t•epmarskip✓wellel;.vdldapt6r raiifterrnt(traxrpia'Jr02171P-=I;6 10171 construction tonic following:. .
Itl.Stade water leypl below top of eaalrg= (ft) Division of Water Rtxrmreca,lefiu wagon Processing Unit,
1/xtutarlamvr!!s thine casing,tu''t nn "( i617 led!Service Center,tab NC276%-1617
II-flot>Lbote+iirtattfer: l!/ /� (in) 20.For fakcfiaA Wells: to addition to sending the fans to the address in 2An
--
- IZ Well construction mind: f•V/-caL l �'e,a�emit one copy of WLs fort within 30 days of completion of well
(I c.auger wary.fable,daort mob,eta,► r ` ^^ construction to the fallowing: .
non WATER SE'PPL1+WE L.4 ONLY: -• - j
Divialon of W ater Reseurce%Underground%Reda Control Program,
1636 Map serviceCenter,Ratelgb►NC27fi.It36
iMethod13a.Yield(gpat) OI Meth of tea !"`-[//�1� - 2 e For Wafer sunny&Iatec1loo W In adtiftiOo to sending the roan to
rah Disinfection type: Amount the tiddrest(es) ahoy;also suhotit ono,copy of thla fern within 30 days of
completion of well cwurmcoion to the comity health atinol cot of the county,
where constructed.
Perm CW.I North CmolireaDapmhnontof linvltniFir®ml gamily-Aivismnof Water Aromas Revtma2-22-2016