GW1-2021-03605_Well Construction - GW1_20210823

828-622-72�41 P.
1
Feb 1519 45.43p Clearwater WsllDrilling -
W ELL CONSTRUCTION RECORD fGW 11 f nr Tntcrnni Uq0 Only:
1.tWdl ClntrRetor information: --
LUNE6
TO D RIIT1uN
ft.
tVr1}Crnttncitx Name fa '
11 - IL
MGM
VC WellCnnnaclnrCertifsaalfonNtnnbn• g,p>n'1'fyRCASING � a
ft'.
C.mltony N unc �IL L"Jilt CAGING OR 71)81Nti dtoraa! fired-loo `
PAM TO DIAM EA
2.Well Construction Permit M k
Uri all alydicable+Pall cmulMmlan parmax(l w l/lC.Cmrrery,stair;Varlrrnrc,air-)
R• R in.
3.1<Ydl Ike(check well nse): 17.SCRB N TH TsauL
water Supply Nell: ro
Agricultural DMunicipall"lie, () fr. it ut•
Geatltcrmal(kteatinglCooiftSupply) [teside.*1w torSupply(cinor.)
lndustriai/Commercial DResidential water Supply(shared) 1&CR01P! MATE L; ttMrLncetttt:Ms+ D6AMO
Fit" TO �
lrt) upon - i t,- tL _
:Yaw 1III Supply yc1L" (a
A4onitorin Recovery _ tt"
lnjccdnn 4d n. R
Aquifer Rec1►tu c dwntcr Remcdiatiun
$ f rotm l9 aN11lGkAVRL PACK a ffilt►t,nt 6tCr116D
Aquifer Storage and Recovery E3Snlmity Barrier ttvelt M r.
Aquifer Test [3Stnrmwatcr Drainage
tt n.
• Experimental Tceltttnlogy
5ubsidenee Control H• O.
Geothermal(Closed Loop) 13Traeei TOLD rater rmv nor ew
Geothermal Hcatin I Rctum) 130dicr ex fain trader021 Rernnrt s) /r• f A fi- C Y;
.4.dare Well(n)Comple1ed:55 Q 1 Well IDY _ R.
5u.Well LncRlinn:
r Fafllity IDN(ifmplicable) vy
Facilit�:Otvrtcr llama & "
PI t sicuI Add racN,City,and 7i QC
C:,uuly P.Mel wMification No.Q N)
51).Latitude and lonjiltude in dcgraWntlantestsecands or decimal dcgrevs:
(ii welt field,one latnong in sufficient) 6 f erti flow:
6.Is(are)the well(s) Permauent or DTemPorRry
siguoture ercailfial W ell caft mazer O
kti N}•nipgrlNr;n17r1•/hamFvoa+rlfl:
Owl'fha nvJ1(a)trar firmrrJ r•O1+Jtstatd In Owl0oncr
1 lr1r 13A tiCAC'02!.0100 or ASA N,'AC 42C,0210 wdl CrIm"ru+o Standmitr tnnl char e
7.is this it repairto an existing well: 13Yes or [NNo p,py nfJrtr rcrard haebxn provtriitd tnfhi w�:l1 n+vnrr.
lfrhJs i.�rcl,arr.,�l1 our known tvrlt.roeurva!!nn irlJnrmmion and rspfain the antra r!(i6a
rr:I G:/ramnrkr stsac»orrm 11re bark njlbls.jomt. 1,L Site dingnrm or additional Well ifmtlfs:
1'ou may use uta back of Ihis DI to provide additional Well site derails rn well
R.For GeoprohelllPT or Clttt:ed-Long Geotherreal Welh having the slime GSn911ttuinn ctNails. Yeu may also Wa+ch additional pages if nocesserY
uxtnstntction,only 1 OW-1 is needed. indicate TOTAL NUMBER of%vclls
driltecl:�__. _—_.. �rttttr�=�'�■*•�t'R„�tl(TiONs
IM
9.lrotal well depth below land surface: � (�•) 2flaW_clls: 3uhtnit tiffs form cvithin 30 days of cOmplrt(on of well
Few atnldple Wells lisrnlideplhxj,*fferrnr{pxnmph-IA1,!0•-ad 4,M) cong1tucAton10 the fO)lthVing:
10,static waterlevd h tow tap of egging: (ft) Division arVYater Resatmee%latbrmatlon P110040wg unit,
I(xwrer•lcrrrlsrrlvtvacuring.rru 1617 Mai ServieaCeater Ftstdgb.MC274"-1617
li.AonehoiediameMr. i iG ' _ �(in•) 2 fib.Fur Inlectiop ME: In addition to sending the feint Io the wNimis in 249
above,oleo submit one copy of this fown within 30 days of comple 01i of well
112.Well construction method: amstmetion tw the fattowingr
(i C.range•,mmy,r,*k,diro A push,etc,)
Division orWater Btactirca.Undcttgt ound igjtsttian CORD Program.
liR WATER S1,•PPI v VV�E11LLR ONLY: q 1fi36 Mall Servirx Cci.td,lZatofg4,TIC 2'7 ^1�6
13%.Yield(gpm) Qi Method of test. I 14C. Rnr V ter Rt>lolY&Inioetlon tYetlsr In addition ifs sending the feral to
the Rd I s(cs) above,also submu one copy of this fomt wlUtin 30 days of
Amount completion of wen enstsuction to the comity health deaf MeM of ft county
t3b.l)Isinfecttan type:_---- whare conattueted.
Form GW-I NorrltChmlinuDapnrlmentaftiuvirdnm:xanlqfrailty-tXvisinnoYWaDet'Roo ourcac
Re:vFmd2 22 2a1R