GW1-2022-00981_Well Construction - GW1_20220107

Feb 1519 05:43p Clearwater Well Drilling 828-622"724 p'T
WELL CQINk RUCTION RECORD(GW-i) I-
14se Only:
1,Well Contractor information: WATE111 ZONES
Wcii Contraaor Nalne r1mM Tn DESCRII'RON
`
ft. _ ---
NC Well Contractor Certification Nionber ^ is.OiTPF.R CASING floor malti4Ted we OR LINER ita faable
PROM TO DfAMLTLR I TIII(7ttlPBS MATEItUL
DVC
C.amttnny Name 16.INNER CASING OR TUBING thermal tloaeRdoo
2.Well Construction permit#: — (`A Most I TO DIAMETER I THICKNESS 1MATERIAL
410 all appfivable,veil Ca cirrictian parmitt ei.e.111G Colony,Stale,trariaac'o,elf.) ft. I it. In.
3.?Yell iiAc(check tvd]use):
n. te. in.
WatcrSapply Well: �11.SCRSEN
Agt'iCUltllral FROM TA DIAMSTFat SWTSIBE THICKNESS MATERIAL
�Mtmicipal/public (1 R, ti. in.
Geotttennal(Heating(Cooling supply) evidential Water Suppiv(single) R, iL in:
tndusnfiallCommerciai ORcsidential Water Supply(shared) 1&GROUT
Irr'F^atlOn yROM TO MATERIAL 1:MPLACEM&VT SIETItOp&AMOUNT ,•,
Non-I1'nter Supply Wrll: tr. tt f j'
M
onitoring Recovery t+, fr.
n Wei
fer RecharEc ©Qronndwatcr Rcmcdiation p. R.
�rStorAgeMdRcmvct� �Salinity[iarritx t9� ND1CINYELPAC To MA It AL flHrerTcst Q3tnimwaterDrainagc 7ALimental Technology [3Subsidence Control n. ft.
ernmal(Closed Leap) [3Tracer 20.DRILLING LOG; aitachad i onal ifneensaFT20kT TO DIiwS N mloaMrla®.+otUrocal rsla+iuermal(Hestia ootin Rcntrn) Olher(ex lain under B21 Remarks)
A.Date Well(s)Completed: Well IDY UQ ft. S— ft. f i /
� ��Sa.Well Lacatton R.
�: ft_
eah v
4 ' � (�t�iL_L�L 1_11G1L1,J.S h' R
t1, l ciilleiih-!flxlrcDr Name Facility Ilh1 fif111���anplliicnable) (](� R• R' � �•• ^ r .l
L�hn
r,ys'ral Address,City,and Zip — T ft. IL IAN7 20
4l.REMARKR
County Parcel idemification No.f r C�,S�-" QN
pi)
I Orr 1 U Will`
±b.Latitude and longitude in degrees/mimttes/seconds ordccimai degrees: "',11 II;',Fto
(ii avid!field,one letgang is slltl•ietent) r7 ''12.CertiG on:
���c,,,�lll� c�at3� w
6.Ware)the well(s) Permanent or Temporary Si a of Cenircvt Well Contractor fate
ati."'jg Ih1.r.l arm,1 herrAP cvniht that 1Ar twdl(.)was(were)co rtmc7a'1 in acmMo. r
7.is this it repair to an elsisfiog wdi- Oyes or [No with 1JA.vcAC 02C A/00 Or*15A MAC 02C•0200 Well Gonsrmrnrur tiraxrlar fa a ml that n
1,r'rhlrisorcpair.ft!I(nit knownnvllcoagnnbitnui!ortnal!onon rslrlainlhettaureortho eattyaft/11t prtiv1dedln the well tnwter.
repair render t;2 l rcmarlcs,+eronn or on t/n:Mr*of this farm.
23.Site diagram or additional%vil details:
R.For Cc»probdlfpT or Clamed-1,enp Geothermal Wells having the same 1'ou may use Iltc back.of this page to provide additional well site.details or well
txmeintctinn,only I GW-1 is needed. Indicate TOTAI.NUMBER of t.T:llc constructirnh details. You may also attach additional pages ifiteeessary.
drilled:•,__` ._.. VANIETAL iNffiTRUGT(ONS
h,Total well depot below innd surface: (R.► 44% Ivor All Wtils: Submit this form within 30 days of completion of well
Fnr txelliplc x•rt1.c lift nil detJllre�di�'erenr(gran?n1c-d(n�100'and 2 r�iTlnnq construction to the foilo►Ting:
10.Statie water level below top of casing: (h.) Division of Water Resources,Information Proeessivg Unit,
i)'Kv to fore!Js r lvtrs ctn?ng,the '•l 1617 b'la0 Service Center,Raleigh,NC 27699-1617
11_lioneholediaeteter: (Il I (in,j 7,11h.For laicrtion}Vdls: In addition to sending the form to the adilmm in 24a
12 !'ell constrnetioR method: ham._ Wmve,also submit one copy of this form within 30 days of completion of well
1 c.Wcli rut —•- construction to the following:
6. Try.cable,diret:t push,gym)
ErMORWATER S[PM.Ir'WEi S ONLY: Division ofwater Resources,Underground injection Contra)Program.
1636 Mail Service Center,Raleigh,NC 27699-1636
) Methad of test: 24e. For Water Supply&IRfeetion its in addition ter sanding the form to
the nddres*. s) above; also submit one copy of this form within 30 days of
n type: Amount: Completion of well construction to the ctntnty health department of the county
where constructed.
I tint(tlr'-I North Camlinailepnnment of lin•iroamrnrnt Qaoity-Division of twofer Ratratirces Reviser!2 22-2016