GW1-2021-03713_Well Construction - GW1_20210823

82"22-7241 P.1
f eb 1619 06:43p Clearwater Well DrUHng ••�•••�•
Y-L, L CONSTRUCTIfJN�tECO {GW--^�. i?nr intemat Use n►Y:
1.Welnr ntmc(or rm><alon:
ash -pie
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ivrll Cn`larac�ta+lYome " to �• ...�-
id.L.-_.r .........- tr• -....
yC Well Cnnpaaot lC,"fieealianpAhrtnFW `^ 4 �� ;l OAR '
C11v�r V�!(�.�C�- YV��' ` /t !' '1 nC nun TM TA °rt
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ComnrmyN,'.mc --b• RC � t
2.Well Conetruellon Permit it: N fa 1i'
1,1rt OrdrgVIM'bIa Nall rymimaUoI,parmxa p u U1C,co tw Sia1G F'1_4anh w.)
3.lVtJl Un(check wen litre): �17, tv to tlae ut.
WO ter supply races Tn
Agricultural �ItRunkipallPubiEo () �. 1i" in.
Creothcttnat(I.deatinglCatlin$Suppry) Reaidentiat Water Supply(single) � tt. .
hi
industriatlCommercial ttesidev"Watcr Supply(shatpd) - i1T h &
Miff
Ertl mion moat
r+• 1
1Nnn%lour Supply Well.- L
A4nnitori R<xovaty (c
tnjer.Hon dl: If. iL.
AquiterIteeltaw E3GrdnmdwptarRemcdiatltm 14 @BUPA
a ifcrSt satuli 13tlrti`e" M ° c wn
qu Qmpe tln4 Recovery � tY
Aquifer Trq []3tQrmWew Draitingc (L R.
EXPerimmiai Tceilnoingy [3SubSidencc Colnroi d-
Gcothermal(Closed Loop) QTteccr M LOG
Cienthcnnol t"io or Ret1m1) Other 0in undor A21 Remarks) tt. /J-7
k b me Wdl(s)Completed. Well iDY is
L Well LncntMn- R.
Fadiity Do fifallplic;ime)
r,eiliiy nt~�,cr mnc .
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Physicnl A n:sh,Clly,rmd{T�,ip � r �[ •►
nrace�s'n9 .
Cu+nty i'nece[rdeniitlmlion No.(PIN) _ . 1fi{�(C"s,�`• r'JRcJg�.t
rill.l.atltade attd t(mgitnde in degrWiJ ninuteOsecands or decitnnt drgreas: -— --
(ii 0oi1 field,ane Intgalfg iR 9ainalent) lion:
W _/D
oFCotlf+dd well tltntrnawr
6.ls(Rre)Mewdl(II) oes" or DTImm"rorY tfx �atc
Perma
7� v;dJ(Rmlt hP--khv.xrtffy that lhr.IVrR(aj Mns fxQ2)epNdrltlaQlrl Bf »MO!trr
:.lnthlsa repair toAnexittlagwell, C)Yes or Na .H,ISlN7;'AC.02('.OJODor1SA,VCAC•DX.'.Ol(It)WWCorrtfrnrrro+r3flande►drmr+lrhmn
+'f1,rr Lr a rc�olr;,n110J7t9fr+wn Nell Ua�xlmGiPa.r+n.nmalta�om ain rhe,uut,rr.n(U.r et'pu oflhis n!c od hor�ftm PMVOWin FM Wert OWW.
rr„gair under s:l remnrkc pzrtan or tM Ito:hark of Ih(kroml, a•L SW dyagrm or odffl4W of Wall dtm W.
10nu may use Ilec ba&of fhis page to provide adifiliomti well site dtltalia er well
8.For GeoprobeAlPT or Citoted-Limp GeotharMl Weih having the santc construetian drials. You Wray also attach eddirloml pages if atteeatm .
amaln+ctian,only I OW-1 is nec dcd. litd(mta VWAL NUMBER of wclis
r.7rotgtwcli depth Now inad surfic V"v t ) 2�1, For a Wells: submit�is�Iviagn 30 dap of compidion or weft
i%n�nrnlllplewr!lrl:valid.!pdte fAiBarrnr(rramplu-3fF;llrlP'mtd�n1f06'} cons;
ncti(mto the followbg:
10.Rtatla WAlhDr levhl below top of taxing: 0t) Division or Water Remwexet'lS&TInatlon Ptvee01M Unit,
y'enh:r'le1t:rlarrhnueCmtrtg,PAC"•"( Q ifil9MailSbrvcoCeatcr,Rates®h.A1Ca7ri9�9-Ifi17
11.Bonehotedlometar: © (in.) $4h.u,.r 1■Iettio■walla: In adeLtion to Anding the few to dle addloss in 240
m��� � ahawc,Biro submit one copy of this form wi1Mn 30 dtiys of txtnplatlon of wdl
12.Well camtrneffon method. ' 1) — - cicttrtmetion to the follWAttg:
f i C.miq=,ronry,enyie,iliravYpltSh, Divislotl ofVi mr Relloureest Unde ground tqf et'tlon Coatrid Program.
iYfft WA7't R&t pPf Y W S ONLY: i r,36 Molt Servirx Center;Rhleigit,NC 276904636
(gpmi r v otar G nets&taioet[oa WeL1s in add on to.Wndin8 the tbtm in
J13a.Yield Method or tit: _. 2.tc. ress(cs) abf
tltc ndQlessCcs) abnvq also suhtntt ttttc cope of this form whhh►30 days of
tab,Ulsin£ection type: m
o: Amo+o►r. coptallon of wall constsuc6m io the cotolty boom depafflunt of the coumq
----•--^--�--^'^ aAsase cosrettaeted.
Fann GW-1 NoAL Cumlfnn rmlloamonc of Envininaimml 13pailty•r>ivisfat of Wean•Rwmttcaa Rryi"P12 21 201 b