GW1-2022-01047_Well Construction - GW1_20220107

Feb 1519 05;43p Clearwater Well Drilling 828-622-7241 p''I
WELL CONSTRIRJCTION 12EC0RD(GW-11 For lntemni Use nly:
Yell�aeMr infifrmntfon:
►�A�/,(� ItWATERZONES
Well Conmot Nara To nE m
fr. tt.
1/N�C:W01 Contracwor a C,ettifrcation,NQu.. f A l �/1 1 ( IS Ti F.R CA iNG Potmn1A cued wells ORLI?1ER n t X��l `� V v�\ r ) l `�� M�M ft. � {y TO Df ` !l 8 M TERtAL
Company Namn _
I6.WNER CASING OR TUHJNG ehartntl etrstd too
2.Well Construction Per mii#: "rRo To DIAMETER THtC1QYE55 MATEfUA
idst all applicable well cnmimcilalt parr»ps(Le.l!!C.Cmrrrty,Stale,Parianra,cut,.) ft, fle ' In.
3.1Ye11 INC(cheek well use): tt. ft. in.
NA trs Strppiy We11: �17,SCREEN
!�±ft �
Agricultural )MunicipaUPuhlic AA FAJ" TO D METM SWT.UM THICKNESS MATERIAL
Geothermal(Iieating/Cooling Supply) evidential Water Supply(single) fL in.
tndustriallCommereial 13ftesidentialWaterSupply(shared) &GROUT
iRi"at10n FROM T. MATE UAL tnNrLACP.MERT?IR77t D&AMOV)
Non'Vl'merSupplvWrll: r+. fa
Monitoring Recovery ft. ft.
Injection Well:
Aqu)fa Reduargc �GroundwatcrRcmediatfnn ff. R
19.SAND/GRAVELPACK in t k
:Aquifer Storage and Recnvcry [)$alinity Barrier yPROM To4f, 'ATMIAL flti!•LACEM8tVT 61C1 t(on
Aquifer Test QSa mwater Drainap n.Experimental Technology [JSubsidence Control &
Geothermal(Closed Lrlap) �Traccr .DRILLING LOG aitachstldl tdatwrtsifneema
FROM TO Dili N cotur.hArd rwe/rrxk r raIn star etc.
Cieothennal(Hcatin oolinf Rearm) Other(ex lain under#21 Remark:$) tt tost<
4,Date�VeJI(s)Completed: l� �i WcI11DH � rr. S ft a ft.
Sa.Well i,nrntion• RGre, l_JC
�ZOJV 1( Q�-S 13 n. Ttc
I: 'lity:r()c+v,tryfamc FaSliy(t�[h!(ifapplkabfc) n.
7✓6 l�.V 30
ia�t A�,City,and Zip --
xl.aMARKS
County Panel Idewifieation No.(PNJ
4,AIR SECTION
.it).Latitude and longitude in degrees/minutes/seconds or decimal drgrcas: L6.H.,
i.wen r�one lamong is suiriclent) C t r
a'= , era s�� .2. erti cation:
6.Ware)the well(s)1�(6 ©
!"nu tent or Tempnrary Sipnn Certified Well Contractor Date
TT�� uu nprning rhrs•.lbrnr,J hemhv rrrrlfj:tAol Me ovdI(..)war/were)ermsrrrrered in amardarce
7.le this it repair to an existing well: E)Ycs or No a�irlr lSA.vt:'AC.'42C.D10t1 or 15A NCAC 02C.01(t0 Well Cnmsterwhon Slandarda mart chat a
I,r'ddr is:r re7rair,fill aarknawa uv11 euecrraclirm informallna rd rrpinirr ire aanrre n(fhe tapv nflhle rernrd Aar been proMed in tha Well Axwrr.
r:aair raider t 11 remarkr.rartion or as Me hark of lhiv farm,
23.Site diagram or additional v►'eil details:
R.Per Genprohe/DPT or Closed-Loop Geothermal Welts having the same 1'ou may use the tack of this page to provide additionad well site details or well
t:rmstnrctinn,onh•I GW-I is needed. Indicate TOTAL NUMBER orwrlls construction details. You may also attach additional pages if necessary.
drilled: IIRM AI.IN1,%FRJ1caQNS
9.;1'etai well depth below rand surface: 0 lK _44 24.% for Ail WNIs: Submit this form within 30 days of completion of well
lcrnrnhipreHrN.cUvatidTrlcrjrf�ercn)(fatale-3n1Jll/Cr'a/nd� )p0') cnnatr don to the following:
III•Static Water lr:vel below top of Iasi erg: VL V (ft.) Division of Water Resottrecs,Information Processing Unit,
)(fresh".lac4 is 1Tl4tvJ crtring,Inc '••�^�I�( 1617 Mail Service Ceirter,Raleigh,NC 274"-1617
I l_%reholediameter- UL U (tn.)
,�-/� 1rib,For 1r►iceNon Welts: In addition to sending the form to the addrepal in?An
12.Well ennstntetian method: u�G►`'F almve.also submit one copy of this`form within 30 days of completion of well
0 a ate e-,ratify. construction to the following:
6• t'uY,a�Fk,direst push,etc,)
fY3R WA7 RR SCPPr,V WF,1.LS t(N�l!Y: Division of Water Resources,Underground injection Comm)Program,
1636 Mail Service Center,RAtetg6,NC 2%W11G36
13a.Yietd(gpm) I. 64ethntl of test: V� 24C.I(or Water SunDly&falection WellIn addition to sumling the form to
the oddress(es) above; also submiCone copy of this form within 30 days of
13h,Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Forni OW-t North emriinn oepnnment of 1?nvininmontal Orrality-Drvsmn of Water rto:rources Revised 2-22 Ztrl R