GW1-2021-03558_Well Construction - GW1_20210823

tab 161905,43p Clearwaterwell Drilling 828r822-7241 P'1
W$�.I.CONS'TB ICTIQIV RECQ (GW^-J[ For Intemni Use nbn
�.wF crtntratenr inswmation:
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[nduslriai/l otmnercial aiiesidatial Water Supply(shared) igLGRG
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enla)Teclmolagy E)Sultaidcnw Comm
Geothermal(Closed Loop) OT(acesI TO
LOG
(ienahcrinnl Ht atin li [teLtm) ther in under#21 Rcmnr ) fZ I
A."Ate Wells)Completed: act C) Well RD#T- tr` -i oci t4
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(ii svott Rehr,MI:laNhtoB in sufricicnt) ,'' rti lion e ; ( 3'
Q35 O 1��3 �, 0 Con w&3�'' o�c�
A.Is(an:y the wcll(s)VPu•msncm or DTetrtltorary
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Mn atttnttul,Hlfi,(nrm,I h�hv amrljy roar the ttrlt fi�mtr 15perrJ caenntrrad A,aeanrAorcr
7.ititltisarepairtnanexisHagwell: OYos ornNo triGISANCACOX:.U10Or1SA:YCAC.07C..0100WdlCmulrr!rsimrYfahrktrde MVP rhmrr
��'d,Le;.:rrc�o1rf11lmukxawntvaR«onarrrurPoi,�rirvrmtnna+ularplarrrll,:»nrungJihc c++nnaftfilsr&ww1harM0pR»s*d10rhewd1ow*r.
r�ro1r rmdcr Gyd ramiltla xstlmt rq•tm tie:110r1.of141a_firrm.
2:1.Sfte d lagram or additional well dtt 1b.
S.For GaoprobeAlPT or Clmwd-1 nnp Geothermal Wells having the same ),on may use the back of this page to provide additional w4l site dtleai)s nr well
atrnsimatittn,only I C.W.1 is needt d. 1'ndit�[o TOTAL NUMBER of�vr11e cotntrlMion dclai►s, You all also atiaoh addiGemal pages ifnaes�ery.
drilled:
s ljMal&Llb§32I!'BONS
9.1'ota1-Imp ucRtp below land sulrtnco: � � (R.) 2.14 &C it w ils: Submit this form within 30 days of compladon of well
f%n�ntp►NlrleH•r2clivalfA«prftejd�e,.rnr(e�trmnM9¢!T101+'andsttTnlOrl9 conattaetitmto the follwitg:
M-Statie water levo behrw top OP essiog: (IE.) Division orwater Raw"*luffinnation Pmeassim Unit,
!J a nfur lrrn:11R wlvtve cmYng,tnc""• 1617 NO Sarrvice Center,FAklgb.PIC2709-1617
11.Noneltotedlaerettr: I� (in.) graft,&r Infection Wells: In addition to sending the form to elm adtlMa in 24n
12 Nett cmlatracfloto method- 1 y i Cam—' ` eve,also iubmil one copy of this form within 30 days of mmplealorr of well
(i c,m4(e',minty.mble,tliret.•t Ptuh,M.) --------.-••� Cnf8ltaCtian to the fof lOAting:
t(fR WATER ti[i�Pf Y WELi fi ON Dl�lon of Water Rtat mex,Underground tnjwftn Cowal Program,
teas Mail Sffvla Cemm•,Raleigh.MC 2709"11636
13a.Yield
(t,'Aa1) Metbetlorlest:—__9_ lie. toadditlett toe Rftgthe firm to
the addLmss(es) above, also subIWL one copy of 1W form within 30 days of
13A.ptafnfeetlon lype: ,Amount, GDeeptetion of well coawucaon tD the cotmty heah6 depnnment of The county
wham cowuaeted.
Farr M-I t kerb(]ttctifnn 1)epnttmonL ot'rin�irtinmcnmi Qrrttity-Dlvistnn oYtvater Rttsontt as Rt viaed2 22"201 b

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