GW1-2021-03709_Well Construction - GW1_20210823

828.622 72Q't '
Feb 1519 45;43p Clearwater Well drilling
WE•,•T,L CQNc' TJG'�'ION)E2ECOR�{G�►��>�1 Fnr]n�emnl UQe only:
1.WOM'antrartor Information: _
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I.Well Cemstrnellnn Permit 9: '��' � ' °` � � in.
i.lrt all nF1r1lmble iw l comtrucrlon(Mrmttx(Lw(IK:,Connty,Stnlc,Yarfmn:v,curl i�
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Geothemai(HeatingIConifng Supply) tatd«►Nei Wwersupply(single) f rt.
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MnnitorinS Recovery
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' .aquifer StorpgC and Recovery �• � n•
Aquila Test awfinwater Dntinagc
Experimentai Techonla& 13Sultsidence Omni
Geothermal(Closed Loop) 137rncer xo.ORIt. L4C 1 .k. �l
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CiccNttralnal(Hoatinp�Cooiina�,2um1 at ( pain tutdcr 21 RcmWh) tt, fa
fit. f4 �'�G�.6"11
4-DateW01(s)Cmnpleted:, OAkWell lD)tl art. �� I 1
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h gt RpMARKS
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51).Latitade and langltude in degroujmimltesfsecands or decimal dt greas:
(it wec11 field,one:intJang is nnflicicnt) z K2-certin lion: — t! f
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A.b(are)the well(s }')MPermanent or DTempnrar ofntcof(kniliadweumnme mr °
FlIN fiWIn,i MW V V014+dial the ivdl(x)WW(Wm')1-TAWMI01"11 M aernrdnRcr
1.is thin a repair to an existing Swell: Xea or to
u ttfe 13.t vt.AL OX:.4100 or 15.4 NC.AC 02C.'.0100 Welt Cvtrstrnerfno SYnadctnlc mnl ehm a
It'tJtfr ix;r rcJtoir.f it merinmxm iedl aonunealrm b�ntmmion anti aspfan�lire an ohAee copy Of flits tavarl AachE'+O1/ffttVfdiNr IO the!well rttvr7rr
t 7nir Pader t•?f rema*sgermrl or oollm bad ojfhtx jam,. )X Me diagram or nd0don ti wall diteallse
R.For GmpraheMPT or CJosed-Long CeolbermAI Welts having the same 1'0u may else file brtak of this page to;provide additional well Alta details ar well
amOTnection.only{CTW-1.is needed. fitdimo TOTAL.NUMBER i')�9m+dinn tretails, You may Also aitech'Addi6tmal pAgec l'F11xt:�anl•
drilled: _ �)
9:TOR1 well depth below fend surface: `' _(0:) A,ta F,tAft-Welan: StIbmit this tbrm-.00tin 30 days of C"Pit:tilm of well
Narmuhirncr•rllciisiccllAeptltrrfAjBcrrnr(crampJr^9�TlMRtnd Jnn� rt►n9frilctiontn the fbl101iY>9
10.8tatir,water level below top of casing: (fit.) Division or Warr Reaonreclt,lnfbrmatlon Processing Unit,
/jemlerlr.Irl A'#*mv cming,erne-•- 1617 Mal Service Center,R41149h,NC276"-16i7
11-Borehole dismeter: ! _�On.) 24b.EK ju "tine Werra: it)addition to sending the form to the address in 24a
edmvr,also submit One copy of this form+within 30 days of
of well
12 Well construction tllethtcd• t ..., construction to the following
(i e.aeAL-,rcfney.onhle,direr t mall,cte.l
pivt,lon ofSlrater ReatwrceR,t)ndt:rgrognd Injection Control Program.
i OP WATER,%I.'M v Wt•LLS ONLY: 1 r,36 Daail Sa wle m cervix',RRtelp,n1C 7.7699.1636
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131.Yield(RPm) Met1►od of testa t�'��� zic.tsar Water Cumiu&iabtlon 1b'tlis: In uddit3on to s+mtling ittn fan fi
Me addirss(es) Abnve, also submit oric',copY Of this form within 30 drys er•
13h.nisiarectlon type: _ .Amount,. completion of well carnstrttexion to the c�nttiy health dG(ltlnmettt Of ihF tatunty
whore constmemd.
e non C.tb'..a Alorrh C rimfiannatinnmonc o(vi%v Ironmcnta1 Qemiliy-Divisim of Wooer Rc9onc en Re:vfwd 2 22-7016