GW1-2022-01070_Well Construction - GW1_20220107

Feb 151905,43p Clearwater Wall Drilling 828-622-7241 P•1
WELL CONSMMON RF.CORR„ (GW-l) For Intemnl Use Only:
1,Wpq CR tr"tnr innfo�rmaOffonnl: I t 1
mead.1.:S ._,1�L]ls 3 WA BONES - -
tvell(.rnitraaa Name raoN Tn DrstaurrraN
ft.
�I"Well Cnln�natn�nr Ccttiftoaninn NtrtnFa ' F��I �� ( S OUtTrE CA ING Ocar mnT ed weUa)OR LIMiltanlicabt!
I+ROAt TO DiAl1TZvTCR 'rtl[CKNE9S MATERfA
71 it. y let
Cumpnny Namc ® !� �, c� 16.INNER CASING OR Ttf G d wepal closed-too
2.Well Construction Permit#: PROM I TO ouMETER THtticlsEss MATERIAL
i,1.rr all applicnbfe wrll nmrttudfmt pa&tiGt(i.e.(/![;.Canrxy,State,IraNanro,clr..)
3.Well 11SC(Cheep Well nSC)_
Water Supply Well:
Agl'iCUltllral FROM TO DIAMERM SttOTSM THIC ffW ATRIAL
.umicipol/Public U fr, ft. is
Geothermal(1ilatittg/Coolit►g Supply) esidential Water Supply(single) ft. tt in.
fndusirial/Commereial Residential Water Supply(shared) GROUT
Irrigation FROM 4o MA S LtL EMPLAC CVTMETHO +4 MOUNT
lYnn-�ti'nfcr Supply well: tr. !L
Monitoring Recovery
injection Well:
ft. It.
Aquifer Recbetge QCiroundwater Remcdiatirm i4 SlIND/GtLIYBL PACK [a di ble
!Aquif%Storage and Rccovcry 0salinity 13atrier MOKA
TO 5I IAL IIVtPLACr.INBNTMLTItpn
Aquifer Test E]SmnnwaterDrainage Experimental Teehnology C)Sultsidence Control ft.
Gcothettnal(C)tssed Loop) DTraccr 20.DRILLING LOC tdtschmdditionallc)teetsifmonsa
FROMTO PESCRiPr10N tatar.twrdrres, r ratnlim.etr.l
Geothermal(Hcetin ooiilnt Return) ^7 Other ex lain under#21 RcmlRrl:s) u, ft
Ta Fr
4.Date lWe►I(s)CotseQl1cted: �/-��.�i�t'�+ Well 1D# r ft. / tL
S,h./Wyell Lontiofn. �Vt tJu�C 1 ft �ifjQ
ie
l�:utilih:'(lettcrlL�mc . I;atilitylDit(ifapplicab)r.) h' �
4ra
P iral Address r`ity,and 7.iP �V(`Q, f4 1L
&�� 21.REMARKS •-
County ftmel Wntifieation No.(PiN)
• !;O.SECTION
Sh.Latitude Rod longitudr in degrees/minutes/seconds or decimal degrees: H li L`ltlt'Jt `; iiU� QI I
01 welt rreid,ore lat%ng is sufficient j C ` C ? 1�-
lien:
N DA 1--ly 0� w rZ-1b -2�� ZL -0=�= .
6.NO-)the well(s)dkerronnent or OTemporary signs+ CeniRea Well Can tmemr Date
Jtv arming silk j trm,I ht:trhv rwrlfy ilia:Urr mdl(m)war(were)cTmoraNed in"Wrdmice
7.is this a repair to an existing well: Oyes or ON. kith 13AV•Ar..'VC.0/00 Or*15A NC-AC 02C.0200 Well C,mmirnon Slandarde a ml ihm a
;r'rhn ix-)Mlmir..pll olydkMIM nt4l,ronrrrnctiaa infon w,/on n sin lhr.amure orthe rapt'"fifth reelod hat hem pMlq"to the weft Atvier.
r•,Wir under A21 rcmarkf.rcrf1M1 or art Use hark aflijb jams. 23-Site diagram or additional we"details:
R.For GenprobeRiPT or CIIIset1-l.nnp Geothermal Wtlls having the same 1'sw may use the back of this page to provide additional well site details or well
a?nsimetion,only I CTW,.j is needed. fndicato TOTAL NUMBER of-l-ells construclion details. You may also Mach additional pages if necessety.
drillul:
--..-_. -- ^r� IRLM117TAI,iNSTR MQNS
?,T-301 well depth below land surface;, �,LL'.J (R,) 1�Ia. for�YV)ts: Submit tltia form within 30 dins of completion of well
17r mulliPle"TAr 1A1 all d.pth,idi,�'war rrxamph-t@200'aud i@100) 24a. or A to the fallowing:
l0.Static water level below top of casing: (ft.) Division of Water Rtsuurea,information Processing Unit
If warm laic!Is aN)VO cming•Fixr
1617 Mail Service Center,Raleigh,1VC27699-16t7
11.Borehole diameter. (I tY((in�,j/� 2tb.For Injection Wells: Lr addition to sending the form to the address ill 24a
Q.Well construction method. % V 1 CL W-ove,also submit one copy of this form within 30 days of completion of well
(i a mrge-,mruq.athlc,dire+,+pus4,�e,l
—�— construction to the following:
Division of Water Resnurce%Underground Injection Contra)Program,
[MFOR WATER SUPPLY WELLS ONLY: Q� 1636 Mail Service Centnr,Raleigh,NC 2709-1636
s.Yield(gpm) Methad of tesC 1d 24C. Par Water Sandy&lfatection Welts: In addition tosanding the form to
the addresses) above, also submit one copy of ibis form within 30 days �f
b.Disinfection type: Amount: completion of well construction to;the eonnty health depattmeni of the county
where constructed.
I urn GW.t Noah CSunlinn A)cpnnmrnt of tin.ironmcrtll Qsanty-Divismn oP Water Rayourcaa Revisal2-22-2a 16