GW1--06562_Well Construction - GW1_20241101

, • * -,:-, ,•
•,,,_=
,
,...%•
•Ltrliwiaw.alt Fon
WELL COESTRUCTDIRT DEC*•'),.`,0 (GW41 For Mein!Use 0n1y.
1.Well Contractor Information:
•
-..... :. .
- •.
, - Llitkij I-bally 243.WATER 001,403 .
•
Zell ii4ro-Ot-or Name FMK TO INISCHETION,
... '; •-"- 2 get i/9 -7/) ,t 7.r& otteld r e 7..677F-
• • NC Well Canhattat Cadification Minter 3 fie ft. cLetr•...r.z..at,-a./?...,._ _ r 6/44
IL GUNN 0(hr sage)OR raoste Of • ) •
Aqua Drat,Inc. DROSS I TO , I'BIAMINEK I :1,w,si : BIAVams. _ •
Company Name 0 ft.-IcAgt •1 6 d IL I cia 1 i
EM . fil
IC IR OR ksolknoll dosed4bo3
2.Well Condruction Permit 11: SCOW TO - mural THICKNESS I.HATEIKAL
List all applicable well cazertsudion pendia(Le_UIC Cows%Rate,Variance,dej ft.
3.Well Use(cheek well use): - ft. ft, ; to t C•t... c.„•• :_:.';• V
Wafar Supply Welk 27.SCUM .
- Mom ft. 20 ft. DrAfaitire. sure=Ai 1**ine tealitram
111•Agricultural Dimicipal/Public
. ,
gill Genthermal(Reating/C.00ling Supply) elniesidential Water Supply(single)
'10. If.11;;FA.4.Q1F-9.1i 7',?..Cir.-Ii:Pi.,:->.7,2 t..;544 •
.It Iminatrial/Calmnarclal Ditesidential Water Supply(shared)" foliation
Rosa To. NATENiss. ..i EMPLAKEMENTSISTKONA m•solirm
NoupWater Supply Well: _.,--it
- e it. • 6e4/04,:fr hiz,---,#liefedrle:
a Monitoring DResovay ft. ft.
action Well:
."I1111f1. •-•, a;0if;e:4.r Reg . • [D'aSan:wa at •
•q chare . .. nmdwaterRemedion F0R.O SMA NDftI MIVIL VAftC Sn(1•0 : .
- - StoapandRecovey . lintyBaader
281N.
eabb) 1EMENTTest DterDrah .
. _
•
M Experimattal Teclmology °Subsidence Contact ft. ft.•
.
A Geothermal(Closed Loop) DTmeer O.DOLLING LOO fettathedetteent Ants If raerwarr) - .
, . Geothermal aleatius/Coolinte Re, Other(caplaiamthm#21Reinzato ' 7
. 4.Date Well(s)Completed: 16. fil 4ifin,,[0,,, . ,57-ft• 3• LF/e- ,
Sa.Well Loa:adorn '-I
3.6".ft• 2... L 6 1)...47 A ., . ..
.•
fe. ft.
-
Facility/Oehler Nam* V, .I Fasilholilii(if appricable) • ft. .
R. , •
, , ,, :
-- .. ...
5 0‘ /ng., iLrk . '31'4/ Ilmi oq Ale. ft. ft.
. -
Physical Address,City.and Op a. it .
:
.
_ . _ ,
Vef yid Se17 2L REittiNKAI .. 1
"
• ._
., . „ ..
- .
• -•
Camay r: . Parcel Idantificalion Na.(PIN). .
O.Latitude and longitude in degreeslaudirotedseconds or dodged degrees: .1. .
•-, ; ! . .
(if wall rield.ana lainang is-sufficient)
rCertificatl. o I ,./ •
- firele 0;17 fee Off.// AS .eiv j2_ ..,i----.,,,..._.
..
- ..). /
dn'/--2-1-/-1.2-ct
."%t r7- . (
6.Nate)the well(s)SPermanent. •ar Elremparat - ..
y 13(gnaCwa area:OM Jell
....-..., .
By dviiiing fhb Jim,I bzreby that the wear)war(were)eozurnitikti ha where
7.is this a rapalrOain exIsting well: Difes or. :1t.^o ' * with 15.4N01C 02C MC I)or rthis it a repakfilI ant team welleaaretwittni qo npvISeA eAetoee02C0700Welife Compaction Stade*and dua a
svd!worsen .
?vale slider OM reread s seeders ewers the backgfildrieraL
23.Site Osman or addifinual weidehdh: ...
'8.For Geordie/DEE or Cllosed.Loap Geothermal Wells haVing the woe YOU VflY me the bark of this Page to Waldo additional well site details or well
eenstleatien.only 1 GW-i is needed.Indicate TOTAL NUMBER&wells • ccwshuilikm"au& You em also attach addii pages thlacaranYi 'drilled:: - •
, ,... FUEROTTAL lidEFRUCTIONS• • ,
9.Total vaellaleptb below land surface:. 1_5 .,
• -- - - - a) Zda.For AM Welke Submit.,thin then within.30 days of completion of well.
" Fort:W*1g svdb Ibt di depths Ifififferept(estrunge-3@21102(1)1614,- constniction to tho followiow 1.
•', ;:
10.Stailewater level below top of casino 622 4 ,_, •
(91 ,..,', 1111vision of Water Resettarces,lingtosatkos-Proetuoug
• litagerievelliabovearatngtew"+" (lc . ICU 12all fivitm Coater,Rada.PIC27,6994611 4
,...
1 •
IL Borehole'diameter: 0114 i / 24b.For Infeetton Wells: m addhim to sending tharWitin to the address in 24a
above,also submit one copy of this foam within 30.dayi,of completion of well
0 . cafe(Meet pus%etea
12.Weil eonstruotton. method: /4.V il/2 i-a/j, amstmetion to•the followinw ; -,
.e.cosi rota% ,
I , .
Nelda of Water Resources,linalergraund Italsetioa.Caritrol Program,
FOR WATER SUPPLY WELLS ONLY: i, lass wan Envie.Ceitero Reklalt.NC 27691).1636,.. AL i I
Oa.Weld(pm) / Method of ter&, .75/1 q 1 24e.Par Water gum&&Aralesitiort Waif; In addition to sending the foam to
the address(es).above,also Submit One copy of this forin Adak 30 days of •
Me.Dletakeden awe: H /it 7ds Ammota ' . MO t completion Of well consuuction to the county health&Spann*of the county
• Where constructed. I. '
I .
. ..
Farm 0W-I Narlh Carolina Mammon ofIlavironmenial Quality.•Division af Water ResouraW Revised 242400 •