GW1-2023-02315_Well Construction - GW1_20230331

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Feb 1619 06:43p CfeaiwaterWeli Drilling • 82$-022-7241 ' p.1
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ill Geetttemtal(Ilesting/Cooltag Supply) E}ResidmIaI Water Supply(single) a. ti. ia.
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■'Aquifer Recline ®Groundwater ltcmcdiation
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*'Aquifer Storage andRccenciy °Salinityl3wtia PROM 16 >�+� , IMVIACirvtsNT R17roA
al AquiferTest fstanaweterDraiege °- a,.
*Experimental Technology aSulesideneeControl it. ft.
7 Geothermal(Closed Loop) Erma 70 MULLING IOC Rita&:...r:_ .__ , '-'
Ill Geulgott fli oohing Retnml .Other fiatplain undos#21 Remarks)` (ix so y�,,��. _4 ria ari
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1_!late Well(s)Completed: Well 1Dg [:- D. l�% ft. 41, r-(I
Sa.Well i tttattina: S��.! A. 1� 1n
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ad Address,City,and Lip -r--- rt. s�: mAR 3 1 2023 _,
forth • v M.REMARKS
Panel Wemtiiwtian Na(P14 - ' 1 1
+b.!altitude and lonXllade is dcgtees/aa)nnte Iiecaads or decimal degreesrti
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6.Js(sec)the walks) anx or ©fl'entpormY sip nuc,i�oatl nut Wd Date
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1.Ilm Ubiaa repair toan*Whig wolf: nYes or No wiah Ili NCtCO2C.QjQO or J.fA.yCACO2C MOO Weil C.rm/rnainnStamlardcmnldara
Milit;sorepoir.fill melanoma goartvettonp agog plan the nannvethe toPynf1/uetruonlAapblaAplatildfn the wanner-
/VW Nder t21 remark srslMn(04411it back oflhisfoi '.
73.Site diagram or @Italian,wends adta:
8.Iror ce eproaerairT or'toast-Lmep Geothermal Wells baying the saute Vou may use tiro back of this page to prpytdo adtioormi Wet)silo debu7s tr will
comanectian,only I GW-I is needed. riidiaERo TOTAL NUMBER of walls construction detaiis. Yott ingotso attach additional pages ifaoce asy.
drilled.
p ., c�e�� �",�1RhV7TOTr INSTRUCTIONS`9.Taal VCR depth below band slalom (It) 21a. Oar At!Wells: Sahli*this ibtm within 30 days of completion of twit
Partrralepfc vekektr ollettpthriplarerant eeraxpp/a•3e2OD zuld ititl002,
consitoctiam to the followlog:.
1n.Stack water lova blow top elf mbar (ft) Divi slog of Water Retnrns.1dbrinaflo P
fmasr Ind isnlmeemitgmet �"t 1617 Mall SanteeCenter,Ra r Ueda,
l� ` � teiSb.AtC27699-1817
I I.$orenolediameter. LO (In.) • 21b,me..ma Wefts to:Whim)to
4Q •.._ swithincding the loonto m adpnn in well
1z well construction methods Il'•l�1 -j'�'`-y abnvt:,also submit titre copy of ills'form within 30 days of completion of g,eII
0 e.negc•,miry.cable,direct push,etc.) clynsttna7ion to the follotyittg;
let?R WATER SCP1nl.V WELLS ONLY: - Uivtsfon of Wetter Rettautl ,Ilndergroand Natoli Contra]Program.
ham r 1636 Malt Service Center,Raletglc,NC2:'7499.1636
lb 1131.Yield(gpit) r.Jl 1 Motbml of tarp q 24-e I nr Water 3artd tt y Se iutextlaan We In addi�tvn W sanding Mt fun to
tab,pisintiectian t the trddress(es) above,also subunit ono copy of Ms form whhin 30 days of
- - Atlount: completion of well mautenction to the county health depoojacat of the county
whore constructed.
Pam aw-l
a Nadi C.arolinn Quality_Divisional Water Resent=
fDapnrtmonenFa:ae-Lii:;hiatat Raine1222-2016