GW1-2022-00987_Well Construction - GW1_20220107

Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 p'1
WELL CONSTRUCTION RECOW3(GW-I) For internal Use Only.
l.Well C.nntraetor Information:
ao ��� f� IY3 1 11 1 ►Dy ' J �14 WATERLONES — -
TRON DESC
Well C:ontraelm Name 7n RnT/OxQ fe. ft.
/NC Well CnOnctor Certification Number S.OIITRR CASING frair m018smsed welt OR LNER ifa lie e
/ •I /l� `����(�_. ttROM M D1A 1 LR 'fll[(S(t( MAl'ERUL
Cm.npany Name +16.INNER CASING OR TtrR G thormaf ehned-1oa
2.Well Construction Permit M. t�I '� ��� "f7ao To I DIAMETER I THICK11CM5 MATERIAL
i.l.rr all nppiicnble wdf ennrrnrcrimr permiGr(Lr.!II(:.C.nrrnty,Stale,Variance,er-...)
N, ft.
3-IMI Use(cheek well use): f, tr. in
Wa ter supply Well: 17.SCRRE
FROM TA DIAM13TF1t SLOT 317.E THICKNPaiS MATERIAL
Agricultural owunicipal/Public 11 ft. ft.
Geothemal V.-Icating/Cooling Supply) esideotial Water Supply(single) R tL in.
tndusirial/Commercial bNesidential Water Supply(shared) 1&GRQ1Pt
Lrri^OtiOn _EWM- TO MATERIAL sNpLACEMCCrME77tOD&AaTOt1NT
Non N1'nicr Supply Wt.l: ft, A6 &
A1oniloring Recovery to ft.
injection Well: - '--"
Aquifu Rechalac QCroundwaterRemediation f4 ti
:Aquifer Storage and Recovery Qi trinity Barrier FROMh7If I TO L PACK MATFAIALle I EAMACEMENTMLTItOn
AquiterTcst DSwrinwaterDrainage
Experimental Technology [3Subsidralce Control fL fr.
Geothermal(Closed Loop) 13Traccr "20.DRIL qG LOG ItAlmfh additionalih rRpaw
RpRo>t eets riot.,roWrork a ratrr t1rr,yea
Cieathennal(Hearin oolinR Rcwm) C)ther(eXplain under f121 Rcmar c To DESCRWrIOx color.s) ` to ft. Is oil 4— V_+
.4.Date Well(s)Completed: Well IDY ft. -7CP V— n(4
Su.Well Larittinn:
�tJ(.�L1S ft. >ti r -
Ktcilih:'{)uncr lt�/n�c ,/{ (�try facility lod(tfaappll'iccAhlle) f A. &
�I-cJr...t,.t�t/t 1 l 1/ IJ1 ri-fv 2—tii� IA 6
Physiral Addrexs,City,and 7.ip �Jc ft. ft.
(
0 2�MARKS
Caunty `wt , Pnicel ideinifiemitm No.(PlNNi ---
Sh.Latitude end longitude in degrees/minutes/secoadsor decimal degrees:
(ii%vell Getd,one 110ong is sufl'ieictit) C t zz.rertlr firm:
035_�4 �,� _ � ems,a�Y - -a
6.ls(arc)the well(s)i7(IPLv manent or ©iTemporary Sign rc aMenrrred well Contractor Date
�T`� 1+ 2flmirtg d io.;hrm,I heirhv rrrtlj) chat Ar iw-11(a)waf(were]c7M nr.Jr/ ed inacwrd0.7cr
7.is this it repair to an existing well: E3vcs or NolSA.tir_',rC'p2C.4Jp11 nr i3A.YC,AC l)?l.',rt1(10 WeftC.rm.!nation Slatul0nlr cord char a
fTfhA ivy rcaafr,Tll rnahir un mefl eanarncnpn i>Ifnrmadrm a-n7 crpinin the Imunrre grlhu tap y gfUttc rvaad A=hem pmtKdef Infix,w,ril mmier.
r:r,wir render B 21 retnnrkr.vcrnarl or an Ifrr Merl of lhia.(ornr.
23.Site diagram or additional well details:
R.Par GenprohefDPT or Closed-Lorip Geothermal Wella having the same Vow may use the back of this page to provide additional well site details or well
tx?nslnrctinn,only I GVJ•1 is needed. 1'ndicatc TQ"fAl.NUMBER of�vclls axfstruction(retails. You may also attach additional pages if necesSiffy.
dri14u1:
- ... 3 5- U12M,fj, AL INMUMQNS
9.TOW well depth below land surface: ,00 24a. il'or All Wells: Suhntit this form within 30 days of completion of well
Sr'?oar1upirM.evvfitr(rridrpNcrfdrflcrenr(rrample-;@?1070'and 2@1001 constructioato the following:
10•Static water level below top of casing: (10 _ __, (ft.) Division of Water Resources,Information Processing Unit,
IJ xnlcr lace.Is nlvroa ctn/ng,we ; 1617 Nall Service Center,Raleigh.NC 27699-1617
l i_Rorchofe dinnickr. (In.) Zlh.For Inlectiop Weis: in addition to sending the form to die address in 24a
12 Well construction method- /� almve,also submit one copy of this form within 30 days of completion of well
--�—"`-' construction to the following:
(i c.auge-,rotary.c,•>[dc,dirtti ptish,eKe,l
Division of Water Resources.Underground Injection Control Program.
FMYRWATr,.R SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
m) Method of test: 2.1c.For Water SlipDly&iafe�on Wills: In:Addition to sending the form to
the addresses) above; also submit one copy of this loan within 30 days of
on type: Amount: completion of%veil construction to the county health department of the county
where constructed.
Pnmi GW-I North CAmlinn f>cpartmcnt of tin%irdnmcrml O1.a1i1v-f>ivismn nt Water Rcgources ReviseA 2-22 2of 6