GW1-2022-01016_Well Construction - GW1_20220107

Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 PA
WELL CONSTRUCTION RF.CORA{GW-I) For Internal Use Only.
1. 11 Contractor information: C
14.WANE ZONES
Well Contragtx Nal"t IRON TO AESCRIMON
tt ff.
.alLa7—A
//V''C:Well
A(Canttap(a�rCatificotionNumber {�1/� - 5.OIT ER CASING emotd•casedwells 0RL(NMt (fa i ebte
�JC �` �eM � ..�1 tl i' PROM
tr. T ,c fl. DtA1NC'r6R in. UICKMESS MATERIAL
CnmptnyName �—=f 16`UYMERC INGuORTURINC thorMatelos44" V
2.Well Construction Permit#: 1 V' "C"1 FROM I TO DIAMMTR I TRICKMS ATEMAL
i.i.rt nt!app(icnAl�well ennrinrdion permtlr(l.e.MIC.C:annly.S1d1e,trdrtanry etc.) ft. ft. I in.
3•Well Ilse(check will use): n, R.
Wa ter 3appiyWell: 17.I5C EN
FROM I TO I DIAMETPt I SI.OTME I THICKNESS I MATERIAL
Agricultural Municipal/Public 0 fr. A. in.
Geothermal(l3eating(Cooling Supply) Residential Water Supply(single) fl ft. fn.
bzdustriallC,ommercial Residential Water Supply(shared) I&GROU i
(tTinatiDn LROM TO MATERIAL ts'NtrI.ACEMCVTMETItOR&AMOUNT
N011-WOCr Supply Neil: tt. ft. tfY1;
r!Aquifer
itoring Rccovery tt. ft. Y L
on ell:Aquifer Recharge QGroundwater Remcdiation ft. ft
19.SA RAVEL PACK f o licabit
Storag'e Md Rcrovery []Salinity Barrier t>ROM To DtATt7t1 L FJ{TH CEMENTMCTHOD
rerTcsi OSmimwaterDrainage n_ to.
Iixperimentai Technology [3Suhsidence Control ft. ft.
Geothennal(Closed Loop) Tracer 20.DRILLING LOG aitai h addi c 1 i a
FROM TO 'CAUTION eolar.hsV1aeo soWrMkt raMsiwstc.
C'ieotltcnnal(Hcatin soling Rentrn) Uther(ex lain utx(cr 1921 Remarks) �
4,Date Well(s)Completed. S"A Well ID11 \S ft. tt.
Su.Wtll i.nrnHnn:
rf. fkareaTi
�12"�p P inn ft. ft. _
;. .
95-IiLty fhimM�{ame .n2 Facility[Dr!(ifapplieahlr) ft. R ^
Ph sirn l ArdrcsCi y,and lip rt R
h ie J 21.REMARKS
C.auntY Parcel idcmitieAtipn Na.(PTN)
Sh.Latitude And longitude in degrees/mimites/seconds or decimal degrees:
(ii well rreld,one rat%ng in%o icicnt) 0 1 ifitAtion:
6.IsNarc)the wdl(s)&Permanent or ©ITemporary Signmmc of cenined well Contmclor D»tc
l;v.uf,•ning do (lawn,I herrhv trrfifj+Mot the 1"(..)war/worn/ermrrrtOM in drenrdance
7.i.s this it repair to an existing well: Dyes or No with l.fA.V!'A(.'OT.C.Ol00 or 13A NCAC 01C.•.02M IMrli Consmirmnr Srandarda Paul Am d
lftblr is<:repair.fit!ma hie N'n null eeutarrucvinn lrforma,loamt, .rlrlain the nonra.nrthe top),gM11T h'ctrrd has hem pMl'h*din the well miner.
re.7air under A11 roman-.ut:Ilnn or an tilt:hark of tldv fern,. 23.Site diagram or additional aeil details:
R-For Geoprohe/DPT or Clrtsed-Loup Geothermal Wells having the same 1'ou may use the back of this page to provide additional well site details or well
c*nsimation,only I Cv%k,.l is needed. tndicatc TOTAL.NtIM813R or�cclls construction details. You may also attach additional pages if necessary.
drilled-.
�..... � c� �MM�(,INSTRUCUI S
9,lrolat well depth Imlow land surface: JU J _(fE•) 24% �'or An W�t)is: Submit this form within 30 days of completion of well
Far reultiple tt•rOs by n11 depth,fdi�¢rent(rsantnl�3(n114C1'find 2@100') Cons) aion to the foilolring:
I0,StaGe water level below top of coring: (ft.) Division of Water Resources,Information Processing Unit,
!1'xnt,rrtuvi:rlsnlvtvrcasing,vac` "L 1617 Mail Service Center,Raleigh,NC27699-1617
IL Boreholedinmeter: l� i Uh.For laiecHan WNis: In addition to sending the forth to the address in 24a
i2 Welt construction mt tht►d: p lJ above,also submit one copy of this form within 30 days of completion of well
--r construction to the following:
(i C.mtgc mtuy.a-il k,girct;'t pwb,etc.)
Division of Water Resourcee.Underground injection Contra)Program,
E13a.Virldw
SUPPLY PPLY WELLS
ELLLS ONLY: i636 Moil Service Center,Ratelgh,NC 27b99-1636
tn} �-tCMethod of test: 24c, For Water Spndv&FalecHdn Wdlr. in addition to sending the form to
the addresses) above; also submit:one copy of this fomr within 30 days of
on type: ,:� Amount: completion of well construction to the county health department of the county
where constmeted.
I+ono Gw-I Nash Cnml(rm I)cpnnmrnt of lin.•imnmarml O+eatitp-r)tvisu,n of Water Raganrces Rrvrsed2-22.2016