GW1-2022-00980_Well Construction - GW1_20220107

Feb 151995;43p ClealwaterWell Drilling 828-622-7241 PA
• ,YI •ti�,
WE i-r.UN�S�tT�3CTIUN�) (;qj�{(;W�l) lFnr Iniernnt Use Only:
1,vkcltCnntrartorinrormirilan;
rxc►rt ten es•at r
tvtlt t:011
11trXIM Name
k � ry fr, to.
?tCWell Cnnnactott'_enifientirnMunI r SIN UNMIlia t
ft. ft. 1 in. G
t,mipnnyNamr. I` tNNBR C NC�R ■
V\•r(�1 J J w 7A DIA TM
MA SAL -_
:!.1Vet1 C.nantrnMion Permit S: —...,..__.,.r, -• H, � in.
id.0 n11 n17drrnAle It'e1f rimsinicom pin nas(l.u.1l1G Cranny,Salle,parloner-,cir..) _ •• _. _ _,.._
3,IYO,I IV(check well nge): n, lit.
Wa Well: ^��• D ASIATURttEA A to.
Agriculhtral imiciPAt/Publia () tt_ E+• in.
CretxnrrnutltTleatiug(Conlinggttppty) midentintWnlerSupply(singic) ft• �(ti
htduxtrial/(`ommercinl Residcnrial Water Supple(shared) 1S�y OUT
irti Dg lion r. r� ul. VAftA7yt t► n r
Non�YnttrSupplyf`Yrll: _ !.:.� t rmA
©Recoveryn retina (if:
i1'n Rt:cbargcE](lrwindwatet Remediarian AW11fGRAV6L PAferStorageandRcrnvcr}• [)SnlinityBarrierAcent'crTrat nswrinwotcrDrainagerimental Teelumingy 133ubsidenct:Control
Crenthermal(Closed Loop) �7'rncct xi). i.1,1 OG t4
�� t< tl.e PROM 1Y►
thowi Ill
�icrnhcnnal(ttcatinjiACna[inR Rcasnil Ott>cr(cx 18p in uttdor fE21 Rttnarks) tr_ ' R, r .gyp 't •4•- `__-•
A.11Ate Utelt(s)Completed; Well lol/ __T _____ —
it. Ld)R•
((SO.Wei i..araNnn; Ckv
-
i�.tcilit�:r13,•.t,cs?tatrtr, fa�tility i[h1(mf:gmplleahlr.) _n' R" —T '
r yri nt nddre�.,r'i+)•,and? J -
(.'aunty NMOT Mealifientinn W Pits) --_. ..---.--•••-.-------•- •� ���.`,�"- -._--
SI>,t,atftudr and lnnRlntde in deRrorslminnteslseennds nr Accimnl drgt•res: •_'• '•--'�e-••• •'
0,tell fretd,one hOnnl;I cu♦r1q.. l 0 , 12,[;�..-ration:
6.ls(are)the well(q,­ manent or arrrmporary tuna nrCe,lredlWeliCa,tmator Pete
/i',,lpning+Nh';%,rnr,1 he,wRp tn)tlf••that thr u¢11(Aj Hm heatO r.•oM.rtnwe l All ocim"Amn:r•
7.1,tbisarrpalrtonntxistin>;wrli: Vex or Nn k:%+U1SA.tie,K.'aZC.Ills/anil.rA,YCACf17C.'.02119Ye�lC�nrlsndinuSrnMrlorA.t mill shot 0.
lJtbil i,,•n rcllair..trlllmtknnum,onll.lnnsrmr.9lrnt irf1G>I,nnllnorn,Jtajrinin A..•rinlruY gfthc top;r nj!1r!r rrrnnl home hnas ptnmMdrd tntlti:well ntNMt.
r':;Mir r lllh'r f)(M.rn;rft;.t'{'tYf/Mt(7Y fM l!M harR nflbt�•fraro. �.,}'yije diaRnm or lidditfortnl Wdl dirt 1b,
R.Erne GrnnrnhclliPT or t ltroed La►np Geothermal Wcltx havinK the some l,+xr ntea'usr.ilu:hack of this page to provide additional ivell alto deliflils or weit
1-10MOnmrinn,nn)h I GW_l is nreded, t'nrticatu TOTAL NUMBER of aclis congtnicAinit drIMIs. YOU may also atteeh adllit(nnal pages if noMMy,
drilled: I TA i1tiiTRtlGT10NS
'►.lmaf wetlrleptTt below1"A.r Tend s sew(e: t @, __(R.) y,h;t, �'or aM echo: Submit this 1brtn�vitltin,3Q do}s or complrlinn of tt'r1t
Irernrrth/plc,t•rlleli,rnlid.nilt,•ffi,�rh!Iif�,l/lnlJlle-d(n11/1f1'''nod e�iA,10(1') cnnstrUclinnto The fWlowing:
1(I.Stolle waterltwel belaw top of rnsittg: _ v (ft.) Division n(W4ter Resoiweea,Infla mailon Processing Unit,
1J'MV4tr,•hn'eLiv.-A,nucRr/ng,rrv- .^^ t 1617 Mall Service Center,Weigh.NC27fi99•I617
1 i.itorchote diamntcr: UL (ln.) 2,tit,Ear Ewlection Wells: En addition to sending the form to die addretis in 24a
1?.Well cnnttnmetlnn fnethod: almye,also suhmii one copy of this'form within 30 days of eomplettiort of writ
`/ '— --• cnat.5trtictinn m the foltnming_
0 C.near,rotary•,e.6k,direct rntalm,e(c.)
DIW.don of Water Rranur'ces.Underground injection Cantle)Program,
t Oi WATT R St;PPE 1'WFAA-S EN LV: TT_—� 763A Ma It Nerviee Center,Ratelp,NC 276094636
13A.Yield(gpm) _ _Mothad of lest; 2•11, For / t r SdDDI do faj9SNOR Wego: In udd$ion to minding the&ttm to
the address(es) above; also submii one copy of this form wtlltin 30 days of
1-1h.))INnreetion type. Amount, r)Mpletion of Weil ennatructton to the county heaitlt depanment of the:enunty
"'Mire cortsirnctrd.
North CnmlinnDepnnmcntoftin.•1.cinmertal(,irrnllty-Divinulnof Water ROMIRe9 Rev ked 74-2016