GW1-2022-00985_Well Construction - GW1_20220107

Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 p•1
WELL CON§MCTION RECORA f GW-l) rPor intcmnl Use Only:
1.Wc)1 ntrattnr information:
� a14•WATEX ZONES ----
tvcllVognclorNante IRON to DESCRtrnON �_•
V . 1fCnntratlor Cent frcationnN,rmhta- i-S.-MuRCA3ING formol ptt2dwells OItLtVEB ifa icobic
4e - e �I b Ala) PROM TO DfAME7LR TtI IL�CNPSS MA7'ENIAL
tt, J
Cnmlxmy Name I r ' 16•UYNER CASING OR TUBING thormd timed4ce
2.Well Construction Permit M IV/��/ FROM I TO I DIAMETER I THIC:NM 1 .1111ATKA.UAL
ON't all n/yr/irnb/ec weN mncrrtrdial permitr(I.e.UIC Cntnary,Stale,Variance,cl ) �' ft• ft in.
4-
3.Wet(lrse(cheek well use): ° f` '°'
FA
Supply Well: n.scitta N
FROM TA DIAMETF,tt S[qT S1ZG THICKN6.SS MATERIAL
cultural municipal/public () rt. ft. w:
hermal(1•leating/Cooling Supply) esidential Water Supply(single) fa tL in.
strial/Commercial Residential Water Supply(share)) 18 GROUT
ation FROM TO MAWRiAL 6MP C t:VTM OD&AMDIDW
., r Supply N'rll: it. 20 Q
itoring Recovery U• Lr3�—it.
Injection Well:
ifer Recharge ©Croundwnter Remediatinn IU R
fer Storage and Recovery salinity(3articr 1iPROM
ftTYEL PACK RIATMIALe Yh1Tir10EM NTML7ItQa
ferTcst D.StonnwaterDrainagc
Experimental Teelmningy �Subsidcncc Control it ft.
hermal(Closed Locip) QTrnccr 20.iiRlm.iNC LOG attachmIldithmal ifaewp
FROM TO DESCRI N totpr,hrerittm.raWrockt ratne6c,ste.1 I
hctmal(Hcatin ooli, Renton) 0ther(explain underR21 Remarks) tt �D ft
4-pate Wells)Completed: �2_ Well IDt/ / ft. ft.
So.Well Larntlnn• ft. IL
r.
Va.
I 'tin;'(lat,cr?lame FatifityiO4(ifapplicahle) n• f`
� al R.
p meal ddreae,City,a It. ft-
h-FV aqwood
MARKrS
Claonty , parcel Identificetion No.(KNI _
Sh.Latitude Find longitude in degrees/minutes/seconds ordccimal dtprees:
(ifwcll field,one raMnng is sutlietcnt) , 2.CertiflrA tlOR:
A.IS(arc)the wdt(s)i� ©I
-eminent or Tempnrary Si@mm �foertintxl WellCtintmalor Date
'"T\\ liv )ruing r1ur.;ium,I herrhv rrrrlfj:char/tic iwU{.)waf(wire)crxrartrr.'red in occnrdance
7.la this a repair to an existing well: E3Ycs or No vith LSA Al:AC.'h?.C.0100 or 15A NCAC 02C.'.0210 Well C:arsmirnan Siondards mid ohm a
!f'ihie i.r:1 rclto(r.fill out known 1v411 aoesttticlon ittformadon aturesploin the.nurture orthe tnpy afthk trued hot heeh pMt9ded In the well nwner.
r."Iair raider t 21 remnrlrs xccrlmt Irma Utr hnrk of(hh forrtr.
23.Site diagram or additional well cletaills:
A.Cor GcoprohrMPT or Chtced-lAnp Geothermal Wells having the same Vou may use the back of this page to provide additional well site details or weil
Wnsiniction,only I GW-1 is needed. indicate TOTAL NUMBER of wells construdinin drtails. You.may also attach additional pages if necessary.
dril{u1:
gif lll�nAj.iNSTRIICTfONS
9,irotat well depth helow land surface;_ 5C:IPS an. for All Wells: Suhmit this form .vitltin 30 days of completion of well
1rr trruhiple H•r11.c liu n/i d.7rl/cv jddce•rr(rxananlu-3�n1P1I0'aud�it�.lnn') construction to the follotring:
IA.Statie water level below top of casing: (ft.) Division of Water Resources,information Processing Unil,
!f waler hare!1s tAive casing•rice`•" t 1617 A'lail Service Center,Raleigh.NC 29699-1617
1 L Boreholediametcr:, (in,j 2111.For Ialectian%Veils: In addition to sending the form to die address in 24,1
12.Well eanstrnetlnn method: n�VIA con form within also submit one copy of this for within 30days of completion of well
(i a Fin•c,ro, — construction m the fotlnwing
6. ray.athk,direct isit,cqc.)
Division ofWater Resources.Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service C'cnter,Rateigh,NC 27499-1636
13s.Yield(gpm) ltiethod of test: 24c. ifnr Water Runnly B.faicctlon Weilc: In addition to sanding the form to
the addresses) above, also submit one copy of this fomo within 30 days of
1.1h,91.0nfectlon type: Amount: completion of well construction to the county health department of the county
v!here constructed.
Vann Ow-I North Carolina Dcpnnmem of tin.•ironmcnt.•tl Qaalily-Division of Water Rosorrcac Rrvisetl<22-2e1 R