GW1-2022-01093_Well Construction - GW1_20220107

Fi,b 1519 05;43p Clearwater We11 Drilling 828-622-724 1 P'1
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'WAContraelor informatlon --_-- -'--
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3.Will I lie(chick well list):
1Valn•Suptt(yWc11: ^'ti.s T u� ustt a u.
Agrictdttlrnt v(tmicipaUPuh{ic (l rt_ ft.
Cretxnerntal(Heariogcoollrto pply) �Residentint Water suppiv(single) ft. r�U �—in•
(ndusttiat/Commercial �JoRasideliftl Water Supply(shared) 18 G Oi1T
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Supp4r Well: rt" h• -
Recovery u, ft.
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chatgr• [3firotindwatet Remediminn " VEL PA Li[aCn6ni Barrier "Paoirragc and Rc/:nvcrl• �. >Y
Aquit'CrTr st nstnnnwatcrDra ltago
Experimental Tcc lool(py 13Suhsidcnce Cotnrot �n. ft.
Crenthermal(Clowd Lrmp) O7Yneex 30. N
k UPtN1MC)enthemmal(RcatinigCoolinp,Rcnirn) [3()thcr(ex lip lin underf121 Remarks)Su.Well I,orattnn:.0 e_-F+e MG�C� tit tV-1ccility.Th'ner Mamo FAC1.1ityith(I(If.1p ilea/h///)���/r.)' Yn _
fhvairn, 1 AdHrce.Cirl• and.Zip t, 1/! n• [r. - 12
Cauuty iratcol[ctcntificntitm No.(PN) -- —�-. —
5b.Latitude and tongitiode in degrees/minutmNecands or dechnnl degrees: --
(ii�wlt fielrlbnne 1nt4nngiasuifielant) O r ;4,4,1,eention:1s( m)thewell(A)tlrertnnnent or OrrrmporarvCrrtlfitdWellCtxl DMe
1 x.rr�mint,•+Ntv.;brna l Irerehprmltlfj�thnr'Jlir twll(aj trvrc McnJ rrM.rrrtM.ri�rl N+rnrcvtrA�ltt:r
:.1,t1ti.a repair to nit existing well: nXcv nr No x•Jrp l.SA.ti W'QX-0/06 M'MA MCAC Or•n,DO rNerl('onnnirftalr Mmlardr mid thin I.
ry7 AiS;)repair..Gllmrrknm"Iw'1.ronstmc7imtip;A,mnlinaV.'rrplobf11.•unlnreoPhu el'ptrnflh!frrrnrdAmohmpmvidwflnNM,weflnealor.
r:;Mrr mrder Of remarks•uou),t nr rM 11m Aar'k a(flrl.•.Tnrnr' �;} Site dfpRnm or atMltlartaf Wa11 details:
R.I%ar GenproheMPT or Closed-hump Geothermal Welts having tile.sane. 1'nu may tisn live back of this page(o provide additlonill Ivell Rite demik or well
mmir erinn, GW1 ismcded, (IKticuto TOTAL NUMBFRoflvcns constrvcxiondelails. You may also Mach additional pAgcgIfnoerwary•
drifluts_,„`_ I , Oi11S
7.Totat welt Acpth below land surface: __(R,) 2,1U• (nr pq yyr)iy. Submit tkia form�vitltin ?0 daps of completion of well
I br acre/!lpl:n•rNc lifrnr/A!pflrr tfdi�'erenr(vnmph•-d(n�l(Irl'mrd<�n?!nn'j- COMITPt:iitnl to the follolving;
10.9tndt:wa"Icvel bctnp.top of emglog: (ft.) Division a(Water Rtmitrcm%Infolmnadon Pru-ming Unit,
11 xnler Amellxnlnlvncafing,Inc• t1 1617lMoff Service Center,Raleigh,NC274"-1617
I I-ilorchote diameter: -(lo.) 2.tlt.Fpr infection WY llp: In addition to Sending the forlat to the addma in 24n
17_Well consinicilon method: ubnve,also submit one copy of this form within 30 days of completion of well
----. mostmetinn to the following
0a.nuge•,rotary.r+bk,Orcet pttt+h,ctc.l
Dlvislon of Water Rracut cev,Underground injection Con")Program,
IY>il WATER S1,:PP1,V WF.I,1 q tN I,V. t(,t6 Matl4ervirx Ccntc,RwrcfgA,NC 274094636
131.Virld(opal) [Method of lest: t 24% t r ' t'r Snnnly&ia)oction'Wel(t+: 1n uddilloo to 5rmding tht:faun to
(, tire nddress(cs) above also submit.one copy of this form wldlin 30 days of
1.3h,l/kinfeetion type: hpo _ 0. Ammmt: T m mpletion of+veil co,muuctlon to the connty bcabh department of the onunty
- 'hare con511mcmd,
°"'"'(1WI NonhCnmlinnDepnomem,oftin-9adamrnmlC,tn]I1iy-Division or WaterRamureca RSvfgeA �Q-Z8IF