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Home My WebLink AboutGW1--00516_Well Construction - GW1_20240118 SC i i WELL RECORD 'For Internal Use ONLY: I ' 1 :r tuE�'st CONSTRUCTION "Chi:Corm.,:an h.es,:,i I'mvingle car tmiltilile was e - I.We'd Contractor Information: l I - I � ,.l 1 14-WATER ZONES I ('►Z:J�Meadows FROM I TO DESCRIPTION; _ _ ____ Well Contractor Name 0' ft. 2113-A 0• I it- I I t !§.:3Si:CAs'4 z; c aiEressedx:l ;Ofti�ir+ {sisp^:icaait NC Well Contractor Certification Number «--• r r ;� -� e4v'•r• _i-_sa. £i:_STzi� a '{'r a 1_-'•' -- _� Clearwater Well Drilling Inc. /- n. I ft• I (a if in. 1 - I i)i/C ---i ay /s, Q 1 lit,uroii R CtfBic+C.Criss 4-8t;;v(gtvtlteriint3 tlesed-?ooP) Corrarg_.usrc ��12 /U /L ! FROM 1 Tv ?rL1.Ni-:P_ . ..ii -'FSS :-*.i.'.TY3iRi C.W LZ;Conss2r'S:ta.7l r'- ant i'i __.--_— i ! List all applicable twit conrirrctiou permits((.e.County,State,Parlance,ele)� ft. I it_I la- 3 3.Well Use(check red!ts:v): ly-hC l ri � ` .- —_---.---$ r.:....- -_ i- iilrBtCr:ttr�--ly art---�-^ - - - 1(.kk#'.i t:Y_ I:: _ULt:+#L•ai 4 iv,—al..cl; t Fiitt ai,., 7.1.M,I.Ypl__tgt. .t C1ASrricuiiural G'�iutticipaiPubiic 1- it, ! i6 C n• I l -a n 1t_ticu:ei[tc-rk:aiictdiwY,%et„rasl?,uru,el :aes:riwi:aas=aice,�si;lri±,iae::,i�i ti l y r ! ! I L1Inuti n-tat Co t:atoTt:isi Cite=:di:niiai Water Supply(shared) I: Fran, r_r.s t as. s , -_, - me+z_-rsr,,,-,`etia,a -rr I it: iZ?° Tr. 1 Pi ;'l lai/' L i I Nun-Water Stlntaly Wait ��_ - i i .... : .. _ _ tm.,. .: 11 Z. i t I 1UAntiif r itechwrt'e Gti:on!1a'ater Remediution i- 9.SAZ•;C.-Rc Ci rT i7JtK:'f lP an.Siri`i :t c;:_^i TO r ..a._l�s�:lL ^.ZF^,cr:ct��:. .raj [ !r!it 11Siifr?:.,Nr' vntt v±q•ilutm, .=�.niati•j•.u :i.Y...:•i5 Ir - as . t°• ! . . , lL i l - ! 1 i 1cr.:i9-71:e .^::::cn u-al.rrII:irum: ii- _,.... . . -.._._'_� ....�.. i ULa 'tlii t ht) li't:iumWy i-.iStatc;hicacc :undo. "' : - L i �rt.`_i-A1-1 7.a4 v%nii�t -.-.k+•i.EYvii'Sint.:i.-...s!i?-.-- .." 1 i. ».,.�.., ,.,.. . •'... ------ --I i ua,rea:ur.,u.:ar ta,aar3ati.....:AN ,!- Ccv_.i___j-iv_____--t_ "'•-ncril}n_�Lcuct!r�:u r.�r�x�,l:�.aan/./:�aw}p»+._:�c..i..e_._-i i nT_f•r:21-5.T. `c'-j---�.t._••r:li:,ar'--.-.-. .-_.,!!tal..�...r-an.....-...-.•_'�i r�i«. .` tt _-!t0� '• i.5e21)/d7- ( 1�//!_. ....._._.___•_. 4..::1` :1.si3�Completed /�1 L_ :r'4ii:i i -- --- -------•..... s-��if-----`_i_. / ..(if_• r -3 -=.,,xAi-_.-Th'. Cook eo��s ichon �Z��: l- - _ --- - 1ii /in %sot i =� 1 a = racitir- Ftt... __ t t `. - .-'.,; r„^'yg'� ti y /I.. Kama _rainy i;! nlf^ i�l l a i a✓aa l r & .7 F�7c Jr ! v %DGU2Ccf f Physical Addrass,City,and Zip i 21.REMARKS r - `� ldc :Ct`a. Ce,•nry T'ar,;1 riiltieatii;a N .(PIN)) l LR:`_,�• and Longitude in de Fes/tilinuteslseconds or decimal degrees: Sb.Latitude g degrees/minutes/seconds 2Z.Cert'fica' n: j (if well field.one latlong is sufficient) _� 2 C •c.J ,51/Y N /1/Jl ` T J 6 IN rJ Sip w...c of Codified Well Cerara:ter mate 6.Is(are)I.heirell(s): rkfie.rmanent or oTemporary By signing this form.1 hereby Fero(•that the well(s)w (were)constructed in accordance wide 154 NC•LC 02C.0100 er 15d NCAC 02C.0200 i€•11 Construction te:do-�ten)that a 7.is this a repair to an exis litg wail: El Yes or k:0 copy of this record has kw proeidcd to thel iced of ncr. i!tt:ii is',rem,ir,frll ow<s-.-a 1,41,..riiisr:;i'ca Ai:.-:iei.•7ii?i,.-.xi?-p!aht 0;e e:di,r afthe repair under#2l remarks section or on the hack of ihisform. 23.Site diagram or;additional.well details: You may use the bock of this page to provide a ditional Well site details or well 8.Number of IrPlie a tt a'nit, CCrli'tl w iiine details. i iiu may alit!iittoc.-4 ad.-Hiirn.0 riage;it-necessary. For multiple injeciinn or ton-water supply welts ONLY with the SOME construction,you can SLltrilk oi;e j6m. o.-i'na• a t below Lan a - _- I- 24n. Far Ail Wells: Submit this fame within 30 days of completion of well �i 4y;i!<.ept-1 d surface:tee: .,,��'?'_� l- ? Formulti_ile arils list all death-•iri_ft�r= (cram�tr_ (2.yn0-nri iri:rnn•i construction to tins following: tti.&tat:e rawer ic elbeiawtepiofcasiag: q0 (it.) ilivif.lerti:i- `__c: ),-a?:t?stilaarr.r.:_i=zt!'_•-':ir..>:tle_tii, If miter level is above=tng,use"4-" 1 1617 Mail Service Center,,Ratsig L.NC 27649-16t7 /��` 1 2nt. For Enka-ion asrp!r�. i::arldaine:t,!so.;_til,.fiei!trot t_the.nrt,•i,_a i.-•i.ia 1 F..%:.:Borehole CZ7:tZF.i:i: - � �V tl'�•l - - .• � -� c_ ._ • / V iafti . . above corm within 10 ti+1ys of cr�L•tltl!'4i !1 of well I'll.Well construction method: also submit a copy of This econstni:t1Oa to the following. (i.e.eager,iu!ary,cable,direet posit,etc) Division vision of;z;gur E_agn::ys iindt:g as rc t't:•i.tiho:C,,: r)5? su oas, ---- _. t i a;Molt Su;viM rid er.ri:;leigit,NC 7-9 -:c 6 FOR a:. iz.SUPPLY ELtSit. :. /�U/. i i 1 ;s; i(;tr Water Fztr.pir i::inrtiln Lticil3t its s Elenameld::t cr:;lids the;Iota la i 13a.Yr+t:s toluti ' 1 'tcetuui of se. -. __ I the addiessles: above. also alb:nit inn copy rf thin;form .::lion 31) days of 1 I completion a:-.-et?r.lrictrd,:idol i.-ti a i:Cisi:t- inaiiil dOpirtil,t,r air Out Lviiliiy 1--_—...-i9'" J=id tom;___.�_...__ ___ •,��:_____. -i tt_a-i):(,:a:A nstractrd. Aim tii.-[ rifilth Carciiaut 1ie.-tsmticnt aiF:vicattmt,e anti\azurai Resources-Division.h tiatter Qt. Rut/C.-al inn.20i3 • Sri C.DuLohdi CDmiluchen itsrfit certitithat the abaaereferented well via grouted in awlearanc in WO. sillcea1y ANA DES cant c as &1 3 Canmetkar Qat OntogirweLpLer---. l lidght Casing Detlitt.:Z.L.--