GW1-2021-06855_Well Construction - GW1_20210429

Feb 1519 05,43p Clearwater Well Drilling ---
WE LCMEMMLOWN RMP GW For Internal Use ary.
i.Wdl C00ntraotnr Inforewlon: ryh*
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Will fiouuatxtx Name
.Mr.well enewidor c, tiftewen nhmrber y��� gt'S otlrsR I t,r+tl�t
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2-Well Comtruction remit i TO asAtarrnt TR
i laYal!airjflicnhlr ete11 crtetrtrnmhsn s c,01C,C ) H L. in
ttitaYi,.SYaiS Yarllarcr,rttr I
3.Well file(tisca well use)_ o' ft a�
water supply Well: 17.s
FROM AgricuIwral Monieipa!lpublEc (i O To it. f, +sttc tsa satttAt.
0=11-11tai(Hooling(Coollog Supply) Residential Water Supply(single) � n in.
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ladus1daVComeraW I csidrattiel vatcr supply(shared) t8 11T '
irrl noon r Asa et
IVcm 1Ynetr Supply 1ti elL^ 1a
A4aoitoting Recovery
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AquilerReei►atgc �Groundumterttemcdiation R.
A ifcrSt 19 S Y8L FAt;IC It o bee
qu We lard RecoMy Dsdinity Barrier attest trtcnwa
AqWfer Test Bunn ttwaief DrcloW rt AL
I"xperimefttal Tedutol(W 131Subsidenae Control ft, I•
Geothemtal(Closed Loop) D'ftaetx 20.DRILLING LOG
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ChxtWptnal HotlOrt in Rtxtttn) Other in undaf ffi21 Rcinasfcs) it. tt
4-'Wife U1411(s)Completed: well im
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1 acilillseth% NMr'o . Facility(DO ifalrplicahle) n, ft.S fr. fMl
Physical/MMs,City,and Zip n Q
(��•.��_�� :tt. ARKS
C:muty �i Nmal MmiIImtitm No.(KN)
.r+b.Latitude apt)lon]ltode in degrmdagnutesfsecondsor decimal degree
W"ali field,one lat%ng is"Rent) ;2.Certllicttfion:
Q3n2 psiC q 4 W
6.le(am)the wdt(R pexmaotnt or Drfemporary tignot efCkntPatDldtt^attrttatar Date
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1-IN this a rrpair to am adodog well: OYcs or r}No w0l)15A.lit.,C 0.2t.'_1t100 or 15A NC.AC•0?C.AX)0 Well E'rmtlnrcffo::Slaadarda aml thm,r
0r111h iv0 nv lr flll Mfrinnxn wcell e0twowcupe 0 aawlon 4ad eiloah 0 the MMM.gfAe tIvy aflIffs mewrl10.1k e0 PMh*d to thcWrdt ft ier.
Plash muter fi;I MMa*.vxthat or thr&t kofthlsfam. 2.L Sete diagram or addidwtal well deeaalls:
8.For Gtoprobr111PT or Clttt*&L mp CaeoMm east Wtita having the same Von may use Cite back of this page to provide additioeti well site daffiib or well
MY115tuction,onlu i GW1 is Heeded iitdicato TOT(A}L NUMt3ER of wills vMtruction drlails. You MAY 010 SIMich addiftanai pages if nta=251try.
9.Abtgt well*PM Now laud surfac 24 &C Ali Wtils; Submit this form within 30 days of eomplealoo or well
141r utolUpre-rat tier all Aaprh'Pf1o4row few wk-3(1i,100`and'a 100 j Cntl9ttUCttatt[oche fallow6tLt:
l0.9iPtic austral Joel br ow tap of easing: (ft.) Division ofWater itesut rw%luffirmation Processing dull,
t/'aoralten l if nhPra ctofitg erne L 107 Etta#&rvitc Center,Ratdgb,NC2<700-1617
I1.Boteltoitedrtimerer: �� (in.) 24b.For l.lectiea W W In addition to sanding tits two to the address in 24a
12 LVcii r1►netrttetttte tnethhd: rt� above.also submit one copy of this form wiQrin 30 days of compicalon of well
6 r.-sarimn,.oabk,dtm pith.dc.} Ct►f6ttnCtinn to the fatiowiog
Division ofWater Reanutiz%Unde"und lajwftn Control Program.
FbR WA'i'EIt t+Ci+i'[.Y'f�b,(F.1.L.'S ONLY: (fi3b Mail Service Cctaix;ItRtelgi.NC�'7�iw•1&tb
2 13o.Yield(gpatj Method or test; a 2se troy Water Basalt &ittioetlon Weir to addition to sondiag the[item to/ the fuldress(es) abova,also submit Dire copy of thin form witltin 30 days of
13b.Disinfection type: Amotwtx completion of well consftcxion to tbt cotmty health dC mnment of the county
ahme eaitstllteted.
ilmm C.W-1 AMrtli Ghmimn )epmtment of liavirciauwjtw Qrvoiy-rxvistpn of water Rusauee.s Redwi!2 22 tom