GW1-2021-03557_Well Construction - GW1_20210823

F eb 1619 05:43p ClearwaterWeti Drilling 82$-622-7244 P
WELL CON§jNVCTION 12EC0 (GW^�1.. For internal Use n►y:
t•Wcll C,nntraett r Infbrmation:
LANES -
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'Veil CrnlUddtx Name to fe.
V1(C�Wcll C\/n1nC,naJ�g�or�rCeKi6cotron 1Wtmt'� �{�n DD
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OR 1 l lR 7tl[ t f6 in.
Cnmpnny Name 6.�SR CA$1NG OtR EM=— tbrraral etwed-too
2.tYdi Comtrnction Petattitlt:
S-31 M ,Y, ntuat!taR Ta MA[FAIAL
i,(aY rd!n/r/i11MAlu wall ennrrrper/aa porAlOs(<.w f11C,Calmly,S(af4 rierr"Ce,era) ft. 11t. In.
I Weil ihir(ched[vdl use): ft• � fn
watersp l Well- 17.m
ppy araoM TA n sL6r9tZB tctcrtas 18RtAt.
Agricultural DMunicipal/Pubfic f) aR, rt.
Geothcrtnat(I'ioating(Conting Supply) �Rcgidentinl Water Supply(single) tr ia.
tndusirial/C,ommercutl DResidenriat Wafer Supply(shared) 18.GRatPr .
irN ation rP MAT6 L sAs gR?t D4AMOO"
94091l►ntcrSupplywelis
A40nitoring Recovery
Injection Well:
Aquifer IteellW DGroundwater Remediatim
!9,if�K St SAMUGRAVBL
A PAC Ita h1e
t1u oMge Md Recovery E3Saiinity Balker OM MAT L ICnl1A r.N�Ka
AquiterTcq []StnnnwatcrDminagc
L'•'a'peritnental Technology E)Subsidence COIN n- a•
Geothermal(Closed Loop) Dander 2fF.f)RII.LiP(G LOG at►adt as
Caxrthermal Heatin Conlin Return) Other(explain undor 1i21 Remarks) tV0>K TO
44
4,hateWdl(s)Completed `T WclltlN/� v ft. ft. �' l
tw
5u.Well 1acaH rt_
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T� c� 96-- �t?6 u(t'
Facility:'(hvncrName )
kcility i00(ifappllcalk
n n_
Ph.1col Address,City,and 7.ip re -64
2t.RF.MARK.S
County Pared rdantification No.(PINT)
Sb.Latitude nod Ionolude in degr'eetlininutes/seconds or decimal degrees:
(�3 t
(ii%von Geld,one letgong iA sui6cicru) 22.Cemrication:
f,,la(src)the welt(s)�Pttrmnnent or ©tTemporarp :Mena ire nfCsrtifial WdlContrnwar DAIe
r 1:V a!}mlog 1)r1s,6)rnr. die 1uc8(4 mas(Warr)cvnrlraarrl nt accrordanrr
i.is this A repair to an existing wail: MYcs or oNo v frb 15.t.yC'tC 02C.010D nr 1SA NCAC.;07C.'.011/0 F'di CmuYrnrsinn SratrllarQe mn1 that c
Ir'ddsisnrgpolr.f111atrrbratvatwillanaarnulnni,(frirmallan rrlalon,fbatxt)1uxgfjbc topyn(l/darrxnrrihacbftwprotl&dmdwwerlowner.
repair rmder Gil ramnrkt sc u=ornn t1v harkofflux/bmi• IL Site diagram or additional well details:
8.For Geoprahc/DPT or Caned-i oap Geothermal Wells having fiesAme Tou may use the back of this page to provide additionni well silo derails or well
t MIT11ctian, N I OW-i is needed. l icata TO-fAL NUMBER or%.slls congtnmtion details. You may also attach additional pages ifn=waty,
dell{�:�-
9.Total'well depth below fan_d Surface; (R.) 2.4 I9r Alf Wells: Suhmh this form within 30 days of comptelion of well
tnrreulNplc�rrH.elisrnlid pllu fd�enart(Bran{ok-3(n�2!!l►'onrls�+li 1W) CnnYttMitmto the f0110ITiag:
statie wanes'levSl below top of easing: _(ft.) Division of Water Resources,lnibrmatlon Prwessing tlahlt,
if"VlffrAtr:l hrdviveawny,Inc"-•' 1617 Mail Service Center,Raldgb,A1C27699-16t7
Bomholed►ameter: (in.) 24b.T iwM-c'op Veils: i'n addition to sending the form to Ole allmvs in 249
12 Wet;rnnstrneflon method: above,sho submit one copy of this'lorm within 30 days of cornplado t of well
wnstmetion to the folrowinr,
t i C.auae-,mt;n,rabic,direct push,etc.)
Division ofV4ater Rrsaurce%Underground lq(ation COMM)ftogmM
POR WATER SCPPi V WELLS ONLY: 1 G36 Man Service Center,Raleigh,NC 2709-1636
13a.Yield(gpel) Method of test: .24c, lior Water Sppefv&laleetlan Wei In addition to sanding Itte form to
the nddrsss(cs) above, also submit one copy of this form within 34 days of
13h.Disinfection type, •Amouet: oDraptclion of weil constmcdon to the ema ty health department of the county
whore congirected.
VnnnC;W-i North CowifnnDep ronentoflin0rdrununalQtrdtity•Divis,nnof Water Rosonrems Reviged2Xldalb