GW1--00779_Well Construction - GW1_20240131

628.622 7241 1,•1
Feb 151905:43p CleatwateY Wall Drilling . ..,....
•W E L cO TSTRVcTION RECORD(GW'•I1 For Nana!Otto Y=
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4VatcrSupp>,rWeq: re tact BMW . '
III Agricultural DMonielimilPnbHc () f R. la
Residential Wider StPP ty(single) tw ft. la.
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a tndusttiel►Commeto(a1 rigesidczdal Water Supply(shared) ; yR ' . .
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tYnn►�'ntRt'Supply►fell: it. fG ��
o m nritoringP Recovery
inseetirrn WWII 1 ' rt.
Ill!Aquifer ftceburgc CiQrrnmdwatcrRemedistion vet.eAC�,� iftol ' f
f8 �_t .�y 1 •ftt11� Groaraa amnion
JM AgnifirStorapt:end Recovery �5tilinity Barrier x±1 a. I' 1
a Aquifer'Fast fJStemtwaterDraipngoI •VI lixperimental Tedntnloay DSubaldence Control 0t a. ( '
HI Gcotitermtil(Closed Loop) Erma .MOW � { tom_ ..,nr w.t..,tinat
;111 Creolitennal ifantin_, .all ,_Return) 11 Other(explain material l!tweaks) , • t ft' i�b�,,,I [ j rixri-
1.Onto W II(s)Camplated; t-472 ,waits, TN( S._ j ' arauyt - _.____-
Ea Wes Location:: i -U.to 1 q Y •
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1=acilita:'Qn+tarlfnmc .
>:t+erlily iD>i(rfappiicable) l L
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Sb.Llitiwdn nod longitude in d cgroeS/mirtutesIsecondsordcc31nn1 degree .
(iPw,dl field,ono ltanorntinofficial) ' Car Br
` 3t nq N S I r G 1� todan:u w ,ttill ' `— —7A
,�,�( SYnaotarc ft7ntifmiWet Ctarmeror ( gala
fi.la{are}the welt(s)iY�P+9 tnat►ent op1Tca1Ftn1 Ary
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fp,.v}mtngurts(urn.,lhrre!vai/,(alAat,llra+w�t(� (k'ro+�J
7.Ili lids areplalrtn All Woke writ DU, oru No with 13AtiC'.1002C.0100or1SAN(4Cl)IC.0Xi0 eUCulaintaatr9Sodalde mil thare
fill.Isixarepair.fillopthin m1W�Agaoslrtut/nn4tAmwatwrw spfaa'th imum fabo U'f/lynf111rA record kasha";proa'iredlfrfhnwellmita
rtwair odor h21tamtrtt swam wan thc*ante his,(otal. 13.111to illturrantoretlditlonol well tietalla:
R.i!mrGeatfrntbe/ilPT or Closed-Loop GeaibeitNnlWditllavingtltaslimo l'ou may Imo Om buck of Atlantan tia prouts%addhlowsl well UUudetolIt or tvatl
uanstntrlinn,anly I GW 1 itnc Muted. ihdins%TOTALNUMBorv+clis c+)tx9Wclinllae'n'ts. Ydtt May nl oAIt&chaddlf+tatla tP»gesif'noca�ety.
drilled!,.. ,.., CI.
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9.x'etat+valldepeh iwiavr laud stttrMctt Z J iit) 21156 For All Wslis: Submit this two with! 30 loser of cotyledon oP well
Far multiple wellslatalietapfiatififfferetz pxamplo-Mufgrang Zeitun ainsituationsoMcIbilowAng: 1.
tap of L
III.Stale avatnrlevd bWowa i3lliU ( Q/� tf l t} i ivision ofWow Retnla'cts.lnib anion Processing Volt,
limnerlu.•ei/s.rtvivaWAring.tea"• tv*o t 1617 Mali Se Center,R telgb.PIC?t7d94-I6t?
It.lloieltotediametrt: _ t 0 {in.) 2517.Varlolo mien Wallas To sedation,to ttem[iiia the loon I)the ahem an?An
/�y� above,alb submit one copy of thIs Pbran within 38 days Al•amaplelltm of Watt
I2 Won construction a paid l �1<< - c nstruction1othefoittlit+hig:
tic,nes%wary.cable,dirostsub,etc.)
ilivielon orWater Reaatitaes•Undcttgrono,Injeettoa Coning Prepare,
KMWATER OV:PM_11 WRt LS ONLY: 0 1636 moll Servlaa Center,Ratetgb,NC 2709-l636
t3a.Vitld wag a� 'lathed of teat! Yet'. ci 244!kr Water Sum &W wal 31`addition
form to sanding
t Ih d�of
- to
Mc odtlross(cs)above, py
,Amtmar. c mp?ctlon of well consnmction to the comity health deltantnent of the county
a3A,1)Isinfecgan type_ %votive oonntracted.
aeon(W.l TlorthCtaolinnDerndmnnt.ditinuIronmuunlQuatits-Divisionoi*WatcrRamos Rained 2016