GW1--03000_Well Construction - GW1_20240520

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1.Well Cantrsetae'information: i
David Belcher
�N7ogg11 s antcaotor Memo E4.WATER aO'ES
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NC Well Contractor Certification Number Lt. E fr.
Aqua iJrilB.Inc. LS.darn.•camp•for multi-ma we Ifs)ORLINEN(r
�ampanyName eR Ls,,<„—. I J dt° °- r-7 if cLe°° SDP)2 11 9 ,
WellCOrietrueHanpssanit#:—�r�.� I16.INNER CAMS OETO! o�t :rataletet d.t000a �i
List all applicable we!ho,utructiou permits(i e.ow,C,um State,*Kowa,ste,J SR03d It. 1 " t7 t1l07Ept�L
I Well Use(dock well else): 6� tt.,
�.. f�fo 5r in.
Water Supply Wet - L.EC121rEN —_
d.;Agriculturalili, FROM �o mtAme�s �LmrstzE astttstNpse meraauae
'"unitapaUPublie ffr in.
*;Geothermal(Reatinglcooling Supply) rititesidential Water Supply(single)
It Industrial/CommercialResidential Water Supply [�
' 'Lri i=Hon (shared) 1 ae.diem l� I
Non-Water Supply Weft: -_. . •
- I sg > _-- `-t_.
f:Monitoring Q fr. �5 p, t7}�pj+e A �^ Watwo AMOUNT
IIgleotton'tTetB: !Recovery et. IL
' �B
, Aquifer Recharge s"rroundwaterkentediatis!n it.
Aquifer Stomp and Recovery Salinity Barrier lira 9 Irlarr P (frap ire)
Agwtfer Test s . -r..¢ae 2112 >I�O
�StormwaterDrainage r_- ..ito
Ettperimental Technology OSuitsidence Control h`"-`
Geothermal(Closed Loop) Lt'
Geothermal eats Coo E3'ilacer i O.,tDREGI.IIEIGI MO attach additional rE!eete
Return) Other( lain under#21 Remarks) ' MGM 46— ii" n "ewsror► asaenk oho mt
4.Imete wooCentpleted _;� �/ e #M _ a - so 1 � �
5 Well Loudon:
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reo
. L fZQ^f� e�r'�9 1� "` fie` a
acihty1OwneriVeme _ 1121 tY�
Faculty LW liftapplicable) 'I Y rl CI 70 a:
Physical Address,City,and?.r lU ys-
a.
fit rt.
d o 311.El,_Al3tdtl
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?areal tdontificatlon No.tP1N)
S6n.lLatitalda� .�'". � .
awaitSeldom yby tes/e¢sto mda air ales3nda11 alragr B �,�
5°ggilre ea WOO) Perlman= or oTanprayarry AyiatureofCtrti ? Ca.eadtt DateI `�u
3.Ito Weimar to an enlisting well: `Yea as �1'sira i WMAm,I path ise list lb waft ow l eo�epreeted lie 11ae.e.fe.ro
ftdahna Alioat known wdlcaesauctlol �vti'AMC9t2C.OlesIPMIMICYeANSIIiR�wctionSonde*a+dthetat Pep* *imam. aim?euptaG!Me mum of Glee agllt mom!km beaapeoliYfa i>•IManvxer.
Jribk eam'tW►ll out neaten or el1c contraction
action thtr,Po�n,
8.)Pil' M.foist sra iwellM is
awl
Closeiiwop Geotlsermnl Weguo having the name Yon seethe be die pi pi �ottlrlde Whited well eke detail...,or well
�4 mid Uinta TOTAL NUMBER of wells construction details. Yea Ray oho anmds additional pipe if necessary,
i.gle8al�wdi sumivlaTMI.11fal�4 TVIT ISP,
arnor/Olewh j t ) ---� .._..�_,o(ffk.) @® ou,All Wrlle Milt this fioatn within 30 days of(temptation of well
0'and 2Q100)
construction to the followiow
I Mob
weir helmet;of zaatn t 70 QG�
anew ten"4° ll J vletati of mat Isrr&8caoatesa t,➢eaP®umvteHou�1iQaeeosing IIuIt
1L>teahideentatttae I+ill7 iirl Eatrvese Conk re 'alelgh,IJc 29 1163i9
2,91e.1F 'll it addition to sending the form to the address in 24a
�� � � aatavep ais nap Si tlua fiat within 30 days of completion of wall.
�4,abhb area push.
/ coa:Btrdreaimt to the following
DER wat s lIP6'i,l' ''''.,L.LS .....t --- --'"i— —s Mks e[N a r'iareas,Fir d irgrasund 111g:elan Control Prevent;
flds S Mallbribe Cane,Malicigb,NC27699-fl696
lliit,Ykid(gpyy-L .._ Method e1 treat:
p`A. , 2Qe.3or Wedir bear&IWO&u g; t la ed Belo.,to sending the than to
3w►�hidlele�t)ppa 7�Goo the adaliess( is onto copy of ehls form within 30 days of
Amooat^_j. I _ completion of well constnmdoa to thy enunty sealth department of the count
were a;orstructed. y