GW1-2021-04568_Well Construction - GW1_20210429

Feb 1519 06;43p ClearwaterVVell Drilling 828-622-7241 PA
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x.Well Constrnelion Permit ii: D To ouatttrAn Tt/
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3.1Ydl iric(Ckd+vela use):
Water Supply Weis: 17 Tate tors NAat.
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Geotheretnti(Hentiawcooling Supply) KRe sidential Water supply(single) tt, fi In.
industrial/Coretnercls) OResidemiai Water Supply(shared) lx .
irti ation T taA L 'tt
Non 111 arts Suppip well.- fl. R•
hionitoring 1311ccomy p, fL
injection Well: n. R
uifer Red law DuranndwaterRenwdiatim 19 S Qip/t7tAYB1.PAblel
AgaiferStgMandRocovely E),SalinityBArrier t+etoM c st�rtttrnwu
Aquifer Test [)Stotntwatsr Drainage n
Experimental Tcetlnolelgy
bsidencc Control 0- R'
Geothenttal(Closed Loop) T(acer ,illtli•LiIVG LOC otyrarn .ee
C3eotttennal p dr n odr 21 Reaks}Rx Mow— —1ro
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rat;lily'fhtrterName . FAdlity +fapplicabic) n• [t. .
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Pent Address,City,and Zip n I _ �OAll
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Cauuty 4 parcel rdcmitfmtitm No.(PIM
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C+b.i.atitude and longiltade in degreedadmites/secandsor decimal degrem 5ecb,0n
(ii%va field,one bttiot%in sufficient) 2. flan: ®�NR
350�'25 ,l f�R
Dot
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d.la(am)the wells per"I tanam or DT mporary £ignalarc ifiod WdlCantraemr
llv at}mlag+Irht,iorm,I hrnd�r c�mflfy Owt fire nr.+R(x}mts firare)ttatdnVdnd fA aeroerAe!rcr
7.1nthisarepatrtoanedidagwoM 0Ycs or ONO adtb/SANr.'AC'b2f.A/ODar1SA+Y(AC OX.'.I11(JDWefl4realrndarYtaadaratemrrld�a+a
/rids is a repair.fill the nmnirc'?r0m uMjY nfrGtr n mid bop b&w PM'*d m rls:well mu r.
r,•mlr render All remarks sewn or on rla:bard afthisfana, 1,L gW 619prpllln or additional wdl detaga:
S.For Gmprohe/I1PF or Clnta•d-Crop Geotbermr►1 Weill having the same You may use the back of tills page to provide adds i0 ill wtil site delailh or well
17.
Wnstntctian,only I OW-1 is loaded Indicate TOTAL NUMBER of wells epny i dHals. you may also tdtach addiftottal paltces if TanCCesa
deiltad: ---
9.3f4tat well deptA lklow land satAtcttiT,. ,.._. TJ� (D•) 24a, par AN Weis: Submit thkq form tvilltin 30 days of compledion of well
JMr m+dtlpre wells fist aI;Arpfb,ifdWeat{etaarpk 3(g1J!/Q'nnd cLAr!Qt)9 conWMion to the f(11101villg:
In.Static wratterlevel below tap of easing: (ft) D£visioa orWater Inc ourns.lnibrtnadoat ProeAmft Ualt,
*Waler kerel Is Aloe cmfni,.+ae - 1617 Man Smrviee Ceater,Rel ilb.WC276994617
li.lloneltoipdittmeter: 1I (in.) 21b.FQr(aicctiow Well In edditio6 to sending the fault to da addim in 24a
shove,also submit one copy of this form wNhin 30 days of mnplodale of Weil
IZ.Wei;constntellas lnetlmd: construction to the foliwAnx I
(i c.auger,m4up,cat!k.4'�ract petit,itc.)
Division ofWater Reaaurot%Undctgroand iDJeetMa CORtral Program.
FOR WATER£+t-'PMVVVELLSONLY: n 16M Mail Service Center,RAtelgtt.MC27699.11636
13a.Yield(peal) Metbad of tesC mot', j4e.par Woler Cuy&FilkCIon We(Itr in addaloo to sending the tram to
the addrgss(cs) above, also submit one copy of 116 font wiUtin 30 days of
13b.Disinfection types Amount: comptetioa of.veil construction to the eoanty health depOntent of the county
share contracted.
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Fann GW-I North C amlintt t)apnremont of iinvlmamcoLN awtity-Divistan Qf Water Rc/aucas t2GvixeA 2-Y1 2016
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