GW1-2022-00933_Well Construction - GW1_20220107

828.622-7241 p'1
Feb 1519 05:43p Clearwater Well Drilling
WELL C011SMCTM uF[`ORD{GW-1<) {-Par Inlernni Use On y:
1.WcocontraeMr information:
rttoN SD a RiI'itON
Wdl Cantnatx Mamr �� tt. ft*
Vt:W t nnrr+tinrCatificalionNumber -IS 0"'TERC RING forma wells ORL1�110t Ifa
r�nM � Ot� A 'IIIf�r1tE MA'r�CRtAL ,
V
!4 t1. in,
Campnn_v Name L MER CA91NC OR fU0 thotrmai timed-tot
TOpN IC4MPS5 MAtrrUA�L
2.Well Construction Permit 9- ft. ft.. in.
LIV1 all niryslimb/e well cnnorriolan/Ramps(I.e.I/l(:CattMy.Stole,t!rrlance,00
ft. h• in.
3.Well llsc(cht'ctt swell list): 'p.scRB)sN
1 ater Supply Yell: ic ass A
ricultaral VO,rm Q�11 E)Mtmicipalipublic p R• g-
(lcoihcrnhal(irleatint;(Coolint;Supply) [311esidentinl Water 5uppiq(single) n, !a-
in.
industrial/Cornmoreiai JDResidential WaterSupply(shared) E, ROUT
F T MA R4tL baN `tr7r P A OU1ar
lrri^atio
Non Wnter Supply WPM- fr.
A4nnito:ing Recovery � G. _�__.
njtcfiom ct; fl. (t-
Aquifcr•ilechat(:c QCroundwntcrRemcdiafinn -19,SAND/GRAVEL ACK ire lbibkt
:AquMr Storage and Reeavery [3SnlinityBattier t>ROK !) A L GACEM1tE_ItTMICT110n
Aquit2rTcs1 J3StnrmwamrDr4inagc R' tl• —
Subsidencc b• e'
Experimental Technology Q• Control �---
Geothermal(Closed Loop) Traces RIGLi LOG a1lat h f r
FROM TO D eatpe. aMlbckfyp�At>•la�fu etc,
Geolitennal(ltcatio■ colin Return) (hher(ex lain under 071 Itemwks). ft- !L
�J� tr, ITT S. -1
a.pate We►I(s)Completed: -_Well IDN, R.
I._1 SG I
-
R.
SM.Well l,nrntllAn: I �R• O R.
Fadlih:'(tancr Hame Facility[Oil(if:gtp4ohle) _ --
r.� e sL 8b03 . ,t. R. ��•T
ash CI�II� (� reS� NC —
• R,
Pi .iraZVO
s,C' ip
• t s atCamity Pawl(dentificntion No.(M)
5b.l.ntilude and longitude in degrecs/mimrtcs/seconds or decimal degrees;
(it well field,are latganq is sucicnt) 22,fertific inn: SING UNIT
C ts(ncs:)the Well(q crmnnent- or DiTemporary Signal :of - flmwellC-11.0 nrac
'mot l,v x miag aide'pow.1 hRrPAY verf1h)Mal Ihr wJI(5)was fwan)MMOM O la auYMA'Tte
7.iy this a repair to An exiaNng srdl: Oyes or No rich l.$A YCpr.02C.A100 or 15,4 NCAC 02C.0200 Wet1!."I'srrnrnmr Standard.;ear!ehat'r
/J'flrrris:>repass. Nmrrkwnrvnreal/eonsinatimrirtformolkra�}rltcr Plain rh.•anrurcgfrha toptraJdtfTres/m/hac hem prorldaf 6 Ift we-'I mwwr.
r,pair under�21 remarks uxucn erns Urn hack afth Is.lam. 23.Site ttipptram or Additional swell death:
9-rror Gmprohe/tfPT or Clow. &I onp Geothermal Wells having the snme 1'aNt may use file back of this page to provide addiGomil►veil site details or we
ax nvtnictinn,only I CAA is needed, fridicale TOTAL NUMBER of wclis constnictinn details. You may also attach additional puges ifrtecessnry,
(() 1 RT it
9.'Pales weft depth below land surface; ----Aft-).-___ft-) 24a. For Ap Wells: Submit Ws form within 30 days of completion of well
1"rrar111ipreM•rNcliunlidrrh'trdi,[jercar(crnamla-7(n!Mip•aadi((lr(ln'J construction to thefoilolrTIE;
10,Shade water itwcl below top of casing: ____ _ __(f(•) Division of Water Resintrces,Information i'twessieg Unit,
11 a'nr,r hue!Js Nhnr r cots),as •" 1617 illitil Service Center,Raleigh.NC.276"-1617
1
t I-Rorchotc diameter: (in:) 2 th.FAr laigeliap,W&M It)artdition to sending the form to die addrems in 24,11
1 move,also submit one Cops Of tills form within 30 hays Of etrmpiONOR of Well
IZ,Well ronstruetinit method: I __., construction to the following:
0 c.ouge-,rnruy,fable,direct push,fie•)
Division of Water Rent urces.''Underground Injection Control Program,
MR WATER SCPP1-V QWEf.LS ONIM! 1636 Maul Service Center,Raleigh,NC 27609-1636
13A.Virld(gam) 0 14cthnd of test: lie, 110 Water Snpyjr&ED lilan Wells: In addition to sanding[he firm to
the addresses) above; also submit one copy of this form within 30 days Af
13h.tltsinfection type: _ Amount: eomptadnn of Wdl crnstrucdun!o the count' health department of the county
where constructed.
Flinn C,N•I North Cami(na oci nnmenr ni tiu.9ninmre,n1 Qnamy-Mouismnof Water Rosotucec Revfsod 2-22 Zol6