GW1--04933_Well Construction - GW1_20240816

829-822-7241 p.1
I.eb 1519 05;43p Cleetwatel Wan Drilling
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et,GnrumaorCMlftaettan Number t;it • •li C,. t t IAL
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z.WC% C:raixtrtietleri Permit 1Y: Krim", J. ,�_____- -- .-•-- •
i.la9 M1 nppJknNlu wall cnxrrraNleN puma{Tar,() Camiry,$M1a, • •" ir. b)' .__
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I aterSi5c(space well tise): -.— _..-- ,, ,.-.
yrjor -Tr i.3.,.-V 4&
Water Supply Well: --• _----
Agricultural uniefpnllPubNc („ tr —
Ckonicrroal(NeaiiogiCoollagaupply) cs niiol Water Supply(single) ft.
tndustrialUCommetotal nRcaidamiai WNW'S4lppiy(sharcrl) _r r",',gT }irTi r ii.t__
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Ire ion .•.--___.._-.--.--_________------ f, ----
Nan-Wnler Supply Welk -
QR°a°v°ry try _
•Monitor) ; IIN
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nlaari cr- __— -- n.
Aquifer iteebatgc 1:141rormdwnter Reicdistiu —
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Mr Aquifer SWARD md Recovery °5nliniry Bottles " �� O;T5; n, � �m aa _=tr _^ __
II Aquifer Tett OStmuwntcr Dreiilaec
Subeidencc Control '
iM Lxperlmeatal Technology Cb r yr �"'
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i�Geothermal(Clotted Loopy �'Pcacet „ 1,.. .,... f.::. �... -,�
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n_ Reinder Rcrnarks) r (t f° "
tientGcnnat(Keating/Cooling Regan t �' �01 - l •
faral
Watt 1>Yn -•T) / .I_V__LL, `_} . 1
t.natcwell(n)C�lrppiated: ����
Su.We11I.rNtatlt►n: �. 4 -- -
Fa (ktrierNanto IBM(if antioagie) n. a.
+. ti
��O J v lid Z ;.i, t -� fr. MO — .n1c��ct�a�rr7�
lapel M'ldra`c�r City,and Zip y A , Q (-
INNIIIII
Canary ?Mel khttadticaNtm NO.(PtTI) Ifr.�.",:7,•�.; _ , '`'1 ,,..,;,----
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Sh.Lentil&arid kmgittidelodegrepai 'imn&sccondsortitxiton;degrees:
Waal field,not Int)tarttt in s+itlINant) V. - 1 �\ y
5 ` CA 1 M ti"_✓� _ tp .15 W ! 1 Data /
a,., Rt.1,r Hint Well coe•
!t.Wart)ill!tYe11(R Par7TaDrrN or OTT4NItlinrarVW Appals 4(loam.I perrt►!r r,army OW!Ina-,wd41,4, M voitroweiro t H)oconnixt'r
Wall: OW* or INo nd,h?SA Pir'.1('n2C.#10Y or IS )n.u4(,600 WM off onfirm:imr 3tat vntr marl l .r
i.11n this►repair to Pm:wn canting u'r j? n,nr Minds n�nrd hnrbref pin+
fOod ljrl.lr iv:>retrain j1l1 put Mr•rm wen�en.rrn,ct(pn�p;,mwlaa cone .r(7lNn+16,•m)un-..(7hu
r,;xrir totter A21 nraantis wxrtrtn for fro tlni Mirk of MO,r0rm, to Ourrain or additional wall datalui:
TOM May rise flte back of thus pale to provid°additional wan silo detatk or well
R.for GeoprabelfPT or Qhaed-1.c1ng Geothermal Wetin having the sera r,mat.ructinn tlrinilc. Trott may also leach additional pages If memory.
cox nalroctien,only I GW.I is llcc<leii, indicate TOTAL NUMBER of wens r rnxtlrYt!('1 Laltl6
dallied:.__.............._ T- - ..." ;i; r ...r--
�( . OM 'baa. E'or An WN1l: Submit thin 1hRm IOW 30 days of completion of We
9.lfnwt trap Oc�iA ITrt(t1r Mild sarlHcc;�-..-�— .-- ._
Irmo,nfNec wells li.if all dep►lAtifvienon)frxaupio-.iCFA.201end%tiA TI r•r)rtsttitCl11R110dm minving.
111.Static water level below . " i tapof rpaing:.__ -_------(ft.) Dtvirlon o 'Water ltenaurers.laiiirarrtlon Prew�IrO ng Unit,
11«Wrrtarot lrr�ivrmscaslnR.)rac" 1617 Mail Sank*Caster,Raleigh,NC 3769'4-16I/
n �('
IL Borehole diameter: .L.J� I v (HO tab.Tii r t iUAj L la: In ardrition to Fending the 1bnrit dd p Pet(
in 2,411
iImyo,flIo submt) one copy of this Ibrnt within 30 days 12 Well cnsetrilt dtin method: _ annsttuction to the falitrwinrc
n e.Mrgm',matey.calla,dwelt push,etc.) 111vision of eaten geamttoest'Underground ta¢eetton Cortina Program,POR WATER$1.'PPuirvisLL.4fllvl,v; �_ 1fi36Mal Saralee ceotar,leitteigi,.Nc2'f�19-i1636
%! - C 2,ac, °uiy fneeltl c-fa eatlo,welly la additl wading
nn to ding the Ram to
1 je.Yi<id(itiiaJ, l l� Netball OF test: '• 1 i the odcl 4Ss(CS) aborts, also SUlmti. one copy of 1hla fbrm within 30 days of
Ammon ,o.iptetion of.vd1 Construction t»the comity heatth department of the county
13h,I)trinrccrlori type; ,xlt ct
ara crmnitand.
--.�... - ttwrr,e12-22-71)16
Fora)Ca-I Nail'CaMinn Dapnrlm •:u�t onl.or rrnnm,mtal Qnalitr-l)t.ienn or Water'Raawrrcm;

WdOW Saf-eivsat Cati °'
Owner: SeI
penrdtala—
I hereby ae iify that ihe above referenced well wm grouted in appearance'n acardanuewith
all county Well rules.
wit lift — l-`.
C,eititicareft: Dote
Con an: C
irout
Total Depth:
Casa*TYPe- b
Deptir_
Dig:: 19��SS
Drive Shoe:
GPM: