_Well Construction - GW1_20230327 (8)

Feb 1619 06:43p Clean/JahnWell Drilling - 828-622-7241 ' p,{
w> L�gnONRECORD GW 1) •.~".,••••.
{ For lntcntai rise Only:
I. lContrattor I fnrtuallon:
Well CrnlbsdocNm� ... li WA :''Z'roONESI I
tamer pt*a i
ilk A a ` ,ti
NCWe1leantratias Certification cmher H. a -"""^�-�
o Dn.( 1 ('n mom " .
Co YWaman. SmtgL
z.Well Colniraq�a Penult II: !a navER C en lr®taarmal )
lei sYRl1 opflJej/e tf� AellonpunfII.fOA VVIC Qmiwj.Sidle.YCNanrk ctr l �' t. U. numeral in. '
3.Writ lice(Oak well use): n,
Water Supply i<llehe la
Agrsctsltard unicipal/PlthHc tier efA1 MarginI�taltanima it-nano..
I�_Cl ltantol(HcaainglCooli Supply) 0 U. ie.
aB u(gl9l " Rd�ldentlal Water � �
I ndusltianCtmmeraial Resatautat Water
ill
lni.mica Supply(shared) ,
lVanlYuttrgup wNe11: To MA dal. FRArikcrt►ttirMISTROp+aAtanWIT"
1R kiatritorl
N Non dI: Oite aovery ti. fr.
AnuiferRecharge ClOroundwiderRcmedistion U.
',Aquifer Storage and Roomy E}saIizii y g D.SADFAYBL PACK btmf -
___:,i Aquifer Test EISMonwater Drainage
mowTo nto £ l.+crnt>xertecnton
1N rival itaelitid Technology Dsuttsitiencc control g a-
il Goothemml(Closed Loop) OTcacci X inn LOGiNae+
$111II aioal �.. r ;Return) t3t5dx ,.lain dmdcr>421 ltctatuks) Pacer TO
l
[tar �hw Ae�elike otwanalaiaweul,
tt. ft.4.Date Weals)Completed:t 1 2 3 Writ ID" _ 0 It. M (t. t t
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aa1t13lfiasuetVano . Faaililytf)ii(ifappliaablc) n. IL
PinIC Address,City,and rot
ill) r U. •
Comity
at sxwtetes ., ►. ry i 3
Psrcal idat ufka en Na(PIN}
SO)2eL ttdtudQ Ond,one is Itt do in degree fmitnttesisemmds or decimal degrees: Inf.:.�s;:y;� t - '1
NV7��kon ta �) tj I rift,^J%�+�
Mons
6.la(am/the wdt(scJinent or _ — 1 Z�
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7.is Utis a repalrto an existing (t t ves or it{p By mourn this fora,f Imrehr iaa t
Ifthtricv IJs AC die waft)xar oasis crntaipglid 6f aadthat dr
r rauarepvI Nl oiirbsasrs>aap.�,ut, Wain eapyo record AathennrlSANG�tC07C.O*Vier. ICav/nvakmS7aarlard*omldtoerr
^ sarOmWein*barkOf f rlar+mat XAC pla►hJlmilrr the Well nxotw
8.DorCe�robelDPTor 23 SiitetNagrainoradditlduml wen details:
8.ForGe Q d"LoupGeothermal Wells having the snare You may use the back of this page toprovitb
drilled:`" v I CiW.t is n , j p CC)TA idUMt3ER fwclts cotivtraeliottdetails. You o f addhional tMe11 file 's a''k11
aCq a1 may attach additional page&li'ntoeessary.
Tole%veil depth below land surface; ii,6►BMi73'a1,tt#S�RUt Q�
1,U'otal I'er fewatppalldva,irdo at fr..„pla-3i toe•mre dw.m
) 244 iS'or Aq WNta; Su)uuit this fbum within 20 days of completion or well
d0.Static 'level Mow cnnatractltm to the!idlO171llig;.
in.Stage water
level
top of eaaing: (II) Division of Water Resources„information P
rom:biassuing lag".
I L Borehole diameter: 1617 119a!Servit a Carter,R+tteigh,lYCa7 �fit'
"') 2Ala Far rsteiwon WMta-
12.Wen lraellon method:•
addition to sending the form to the address in 24n
fi G.hdrat about;also submit onemils pletion of well
aim push,
copy*? foist within 30 da of cunt
c°»sfttttdittn m the falitnuing: .
POP WATER st'i'ptptt v WELLS ONLY:
of Water Rtswraaa Undervalue]InJe tbn Control
Prog
13a.Yield(t;ztal) 1636Molt service Ceatar,Raleigh,NC2Tt 163t3 rams
—•—�_What'of test: 2:te.ire Water Simnly&ftikcJaa WNtc: In tab.ntatnfcctton the sdd addition to sanding Me flint to
tYP� Atttuttat: the add�of toed shove; also submit we copy or ibis tar within 30 days of
where coO►sttiteted tmtLst+ucon to the comity health dePabaesN of they
I
Perm C;W-I •
Noah Carolina Dapnemoncoflinviti ithUtte]QtellIty.Crivicratortinnar Rasme=
Reaiset2 22.2e16
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