HomeMy WebLinkAboutGW1--00789_Well Construction - GW1_20240131 . ._.
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Elkitamattmili tac_micamo . . . .For Intern:11On Only:. , .
1:Well CORbletattilblrollli051
David Belcher
14.WATBR _ .Mel ,
)Well PentorterNeme FROM . . To . usalsorrtoo,
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4594-A c 915 a 717' n' II Cli5Ai et-ca4iirs)
NC Well CoatrartorCalifiration Number •
. 11.4.OUTER CARING(far rti•emoed war)OR LINER Of Tbia Aqua till,Inc., _
-mom TO . .mimeo Totelemits ormorm.
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Comply Name 0 ft'. 9,2:it 1:4V`u• SOU/ . PI/C
16.INNERPASING PR MONO l
FRO TO °
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2.Well ConetracdonPen A
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&gall ayllgabla wall canttnieganpandla a.OtC,au*Rory Varian%etc ft. R.&We Un(clieckwelluiti ri. R. ,Irs. . .--
Water Supply Well: ......—__ im.scapiw
atom .notaniTia - MONE= IvIAT21441.
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cil;Geothermal Monthly/Cooling Supply) ' 'ittesidential Water Supply(Biagio In.
It Industriel/Commendel tilainIdantill Water Soppy Owed) ing.awur .
It=..41lost
nom TO KATERTAiu EMPLACEMENVIIISIROID 4 AmoUtir
Not-Water Supply Welk. O R. 4:20 ft*_ odirle, Amr Cyi. Ts. 4, lit-Irak
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FROM TO . . tivozoiro.1 . __ . ONIPLAcialiENTRICMOD •1111AquIferTit '''- ostizmwatartabloge . . ,.
I ...' .Amadei Teekitokigy E3Subadence Control • R,
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Alt,Geothennel(Closed Loop) Dhow 20..1; Coo
DREILINtril Mho elffidesel dads ifurronoTO
Jai Ottothcend .4,; ling Itictutn) riether(explelnunder 021&marks) -FROM . --
it staecturnolv wen lareero.alums bowels rim 051
4.Date Well0Comgetelt 1-41g'.24 WAIN®- - ft° .67 Ech inr colt*/ So:I
Sa.Weil Losaffent 67 ft• vs ft. li
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1RAr 14.;nithrD1 699700M MIN 2$.10PRIARtel. , .. n.o.:cs.•-•:,,c '
County a
PAreel Identification Wei(PIN) .
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8b.Latitude and hingltude In drgateehithuteekeconde or*dad&WM I
Orwell Silt oat loll*it seabird)
M.Cetlifiestiont ,ss.;
96°:241 liVi 0" N $® -I' 143,1"
- ' .• - _ "i, • 145..14.
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a treireMeWOMEaferinigelit or tptimporary Signature ofCerlified Well Contactor
,• , : _ lIy a(rdag fliVana;I fine A p.semi flotilla wallt.).tsias(Were),catirtrueted(NI:wards=
7.1le Mk a ropahrto ea attleting well: ,:1011ttai OP 11.b.,O - With ISA MCAC0IC.010D or ISA NCAC 01C.0100 5§71Consoutticua Staadardrand Ada •rale 1 ro-NAM!1 ou I&Omura I I conftradlan. . ',,•Mood opfala ilia!Mare ethe coNolihis rood ko bffolProddellea ea twkilinuner• . -
revalkaulti WI retrarkeallan anal thibatheIkkflirra.
213.Otte 111-.si--•:,:,:i or midland rail hide:
8.For Goaprohder oe athed.Laspraothirind'girds having tha gut You raw tad the.back.of Mk page to*Me additional wall*Metall,Of loll
sionstnutikat.only'I OW4 le needed. Intlicate.TafAL NUMBER-Owe& constroctiondStalk You gay aho attach addidocal pages idneecuary.
drilled; .-
AultRitarrroinaNarttelleriONS 1.
"utilweli*Pa bdaliiii .
miligaire.) 24z.Pler Mt Welke -Wendt this&On Within 30 days of contykdon of well.
Fbmallpletvellallstallilapiki reliffamekroallge410200'=MIDI- • ocaustraction.to tie Mowing 1 '
10.Statlowater lied Meta*of castor 50 (ft) Midden of Warr Retioureet11,kniermaffon Price:dm Uidtg
gm&lave I la alawacerinagn wen
MD Mall!Watt Centerg Welsh,PIC 2761014317 .
IL 12orehola diameters i- (4.) I .
'24b%glititigaziONNO: .1A addition to,,sending the&int to the addrese in 24a
above,also=kink one copy of this than will&30 days,or eompletiOn of well.
12.Welt construcifen nuthcia (Lk/ kr conettuction to the Billowing.
ea.awn team cable,dfriat pedh do
- ---,...., 101vielon of Water llesourees,Undimmed litelecflonConkal Mirage,
FOR VA' '1111PPLY WELLS ONLY:
1835 ItIellikrelee Center,Elidelghg NC 276994631
Wallet
On,Thilten) in _. ,Method off tech SAktilzot_ Mc.Kor-Wtdet.Ounitis linkatitse.yl/ En.addition to sending thithien to
the addtese(m)-above, abo submit one copy of this fimn.vdthIn.30.days of .
13ballsitection type:.„tint 7C% . mum. th _ItAilv- .. completion of well construction,to tht4cesay health,department of the.county
-'. 'whets Collimated 1
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