GW1-2022-01040_Well Construction - GW1_20220107

Feb 1519 05;43p Clearwater Well Drilling 828-622-7241 P.1 .
WELL CO1,T R�7�TION RECORA�GW a.� For inicmni Use Only;
1.WrllfAntr•actorInformation: _
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Wdl Cothtraclof Name tt fy,
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vt:Well C'mmclor redificalinn Nomber 0T1 fER CA4IIVti for tna10-cased vralht tDR LtVFdt n e
CO3��1s �n l L trBOM m PIAMETLR r1tCKNBaS MATERIAL
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Cnmpnrw Nnmc r�('� ~16.LNNBR CASING OR TltRiHG thermal cMlatlaca
2.Well Conntruetion Permit#: WT •-D 1 yv U a � M -tn nuMCTnt rntctav�ss MAtFJUAL
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3.WrlI Ilse(rhetk well list)_
Water Supp y I+I Well: FROM
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AgriculhtratMrmicipollPuhlic () p, tt in.
Crcaherntal(1•leating/Cooling Supply) Residential Water Supply(singic) ft. fL in.
lndustrial/Commercia) Residential Water Supply(shared) •18 GROIff
ifrl°alion 'NROIM TO MATERIAL BM"AC kW M nI&AMDUNT
ft,
Non WnterSupplywril: t+, �-
Monitoring Recovery o• fu
injection Well:
ft. R-
Aquirer Recharge E3Qroundwatcr Remcdialien
19-SANISlGitAVBLPACK ifa ble
AquifL'rStorage and Rccovery E)Snlilllty Barrier ON TO MAT IAL >attrU►CCMSLV7MLihton
Aquifer Test []StnrmwatcrDrainage
Lxpefte>ntal Technology [jSubsidenec Control f+ n•
i Geothermal(Closed Lwp) 13TtacrA 20,p1Lti.T.l[VC LOG IxUaeb additionsidmialfwaismUl
-PROM To lira RlrTM rcX7.larrilam mWro14t olrtetrpaet -_
Geothermal McatingpCooling Return) 0ther(ex lain under N2.1 Remarks) re. to
.i-hate Wells)Completed: — Well IDtI
fr- 2a
5u Well Location:
P:+cilih:'flxmcrMamc Facility iDii(ifMpnc:tBlr.) M ft. _
N17 r On fr,
Physical Address,City,qnd 7' 0
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21.REMARKS
County Parcel Identification No.Q N) —
Sh-Latitude and longitude in degrees/minutes/seconds or decimal degrees:
01 well ficld,one lat+lang is xufiieicntl O + ;!2,Ce1'ti fAtinn: PitNP SECTION
035�ao.�Qy ) 0a . (e Io W l r iflilH`��(":,�;(less � T�
F.Is(arc)mewell(s) crmnnent or ©ITempnrary :4 6n;fc iinaWallContractor Drnc
I?v ojLming rh+.v,.nrw,I herrhv vailljy that Ar tw:l/(.j was fxroz)crmsrmOM h?accnrAryce
?.ly this a repairtm an existing well: OVes or (*No r:tlr 1.SA.'VY_'Af.7 o1(7.0100 ar i5A NCAC 01C•'.0100 Wi tt Cnnslnrrrirar SlaadarA.%rmrl that a
fr'thh L.n rrlaoiC fi)!ourkrtaum urlf.oasrractimr i>:farvnalinn rn+d rsp£oin the rxrmr'c r Irhu caPv r!f!lris rervrrd hag hem proMed to the well nMtex,
mwir Under i,2(remark.%seritan or rm the had afth0ffnrn+. 23.Site diagram or additional well detaits:
R.Par Genprohr/DP1 or Gloved Loop Geothermal Well.having thr came fort may LISP,the back.of this page to provide additional well site details or well
Lxm!tlniction,o k•I C. '-t is ceded. l'ad'^ c TOTAL NUMBER of,vrlls cormnrclion details. You may also attach additional pages ifnecemary.
aril{,ttl_�
ji la mEaAI..)<TMy^►{'R1117 TONS
9.Totat well depth NOW land surfacc: ___ft-) 24a. For Al) WO1s; Submit this form within 30 days of completion of well
Far nnhiplr w.Nl.o fi,r a/id:plla�ifdi,�irrnr(esamnlu-3(all!!P'ondi00� ennstrnrtiorl to the fd101sing:
1u•Rtntic water level below top of rasing: _ (ft.) Division o(Water Resources,Information Processing Unit,
?!awler•r evr.!!s Bhdty casing,me..'- 1617 Mall Service Center,Raleigh.NC 27699-1617
%rehole diameter: (in.) UK For lillieetiog}'GIs: In addition to sending the form to the addmm in 24a
t2 Well ennstrnel[nR metdrtd: alcove,also submit one copy of this form within 30 days of completion of well
0c.mL c••, on rank - construction to the following:
tf• *3 ,¢irwt push,ctc,l
i'OR WATER tCt:PP1.4'WF,LLS ONLY: Division of Water IReacurceS,Underground injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
13s.Yield(gpta) Method of test: 24c. For Witter Supply&inlet Hon Wellt: In addition to sending the form to
the nddress(cs) above; also submit one ccpy of this form within 30 days of
13h.Dtsinfecnnn type: Amormf: completion of well construction to the cormty health department of the county
where constructed.
I°+mnGVt'-I NorthCnrolinnDep rimentofvi-ionmcntalquailty-Divisionof water Pewoareac Revfsed2-22-2016