GW1-2022-01018_Well Construction - GW1_20220107

Feb 1519 05;43p Clearwater Well Drilling 828-622-724 1 P 1
WELL CONSMCTION RECORD(GW^a) Fnr]ntcrrinl UQe niy:
1. C,nntraetnr information: �._.._
14.WATE ZONES
•�y� TO
DPS Rlt'rION
Well f'ollwaclot Name rt ft,
VC Well CnntratlorrenificationN,nnber ���/�/� S.Ol1TERCA31NGformolHaasedttralbtORLITIFRtfa e
/ , k_(I Q ,� I y�I �1 1 _PRom TO D1AM.L?LR •MI[CKNP85 MA'rER1AL
Ib� 3'AT=�^S!---• 1 '(, 1/l. te: tt.
CempunyName (xOg I _ t)DI q — 16.INNER CASINCQR 11tRiN4 tlgrmatalosedloo
l� yt To p3AMLrF�i THICKNUS AiF.R1AL
2.Well Construction Permit 9: ie
i,1.11 all applicable wet!ennenreflnn parmlta(i.e.IN,,,Conwy,Sfolc,Variance,err..) •^
n.,
3.Well ii9c(chCek wdl nst):
�17,SCRE N
Wa ter Supply Iveli: FROM To mAMsrtat aurrsm Tnrcrwrtss ul.
Agricultural DMimicipol/Public (? ilt, N. in.
C;cahcrmal(f leating/Coctlisug Supply) Residential Water Supply(singlc) g, ti in•
Industrial/Commcreia) Residential Water Supply(shared) IS.GROUT
Irrl^anon Pam-- r0 MAT)ER1AL 6MKAC L`ir34wmol/&AItT0UNT
rr, fL r•�4LL�-�.-
Nnn�YntcrSupplywrll: e9p
Monitoring ®Recovery _ ts. R,
In)ccti�n We11:
fl. R-
Aquifer•Rechargc E30roundwaivrRenrcdiation 19.SANn/GkrtVBLPAC ifa b1c
Aquifer Storage Md Recovery 05,atinity Barrier FROM TO MAT Mi. sltRtwCOMSNTML 01.
AquiferTcst [jSmrmwatcrDrainage
Experimental Technology CJSubsidence Control A• n-
Ricotherinfil
cotheltnal(ClosedLoop) [3Trocct _xti.DWIJANGLOC attached onalahtels faoonsarvi
(Hcatin ooling Return) 0tber(ex lain under k21 Remarks) -pRnM To oLS mtm; � t Mrire.acd__
re. (r
a.i)ateWell(s)Completed _U_ai WclllM A (t. I
pr+u Well Location: lQ l R- (L �
it. w _
l lihc'(luncrNarne Facility MY(ifMplicablr.) n' R- T-
ULAL tau �C.�I.I.�� WC, ,t. R. JAN
t sisal Address,City,And Zi r4 R
2t.REMARHR
,r
CoutaY Parcel Identification No.(P1,1)
5h.l,atitude nod longitude in degrees/minutes/seconds orilecimal degrees:
field,one laMong is suiicicm)O � ( Y jag .Cen firn
ip CrHtni ntcd:
WcUCntreor Dde6.Is(arc)the welt(s)XPermanent or ©1Tcmpnrary
14v.v1pning 11jo."hrro,1 herrhvvertlfy that lfrr rw.l1(..f was(wmz)amsf1Vrfej in auhrdmnr
7.lnthisa repair toan existing well: OVes orj�No rirhl3A.tit'dC1n7,C..111011nrfSARCAC-07C.',l/100R'rftGrnolrnrtinnSlondardarmrilhmrr
fr'fhh•isa rcpoie.�l1 nuttvunwn uv4l,ronarncttan iryfarmalian rnrrlrrprain the rrnrrn'r nRhu [nlgr nflki,c fcry,nl hoc boat pMvidrr(m Uu wcU ntvtki.
r.;7olydnderr,?f rcmnrkrxcr!/furrrrrnrllrcfurrl•pfl/fix(arm.
23.Site Aiagram or additional well details:
R.Por GmproheMPT or Omed4arip Geothermal Wells having the same 1'ou may use the back.of this page to provide additional well site details cr well
"'ilnrctinn,only I GWA is needed. i•ridicato TOTAL NUMBER fir-k.rl(s constniclim details. You may also attach additional pages if neeossary.
9.T0921 well depth Now land surface —AIL) 2,Lv her Aft,Wells: Submit this fort within 30 days of t:omplelion of Weil
nee Mnlr ere If'A!Pn.. fdifJcrrnr(rsample- construction to the following;
ln.Rtotie water level below top of easing: LOD Division of Water Resources.Information Processing Unit,
fl s ahu icrr;r is rrl rru,,c2ring,trot"•"� 1617117a$Service Center,Raleigh.NC 274"-1619.
t1_RoreholediameMr: (in.j lob,Far 1aiectiop cos: In addition to sending the form to the ndlimis in 24a
12.1Weli construction method: atrove,also submit one copy of this ifonn within 30 days of completion of well
(i c.anger,mrtty.eabk,direct pineal,tte,) cimstruetion to the following:
11012 WATER Rt:i'Pi-V WF.t.L S ONLY: Division ofVltater Rraourcei,Underground injection Coats/]Program,
�f� 7636 Mail Service Center,Raleigh,NC 27699-1636
l3a.Vield(gpm) 3 Method of test: 2:1c. For Water Sunely&rgieetfon Welts: In addition to sunning the form to
the address(cs) above, also submit one copy of this form within 30 days of
r3A.DlsinfeCHnn tY1te: ,Amount: _ completion of well eonstruction to,the county health department of the county
where constructed.
I°Intl GW.I North Cnrolinn Depnnment of ta,.•imnmental rzivanty-Division of Water Reaoutrcec - Revised 2 22-201 b