__20220311 (54)

Feb 1519 05:43p Clearwater Wsll Drilling 828.622-7241 p.1
WELL�O TbSTRUCTION$ECORD fGW-1) For Internal Use Only:
1.Wen Contractor information:
1 (?Q.C—DnaMS rilROM
WTERIONESo t atscatroot+ _
Well Caltraanor bteme D�— fr.
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V:Well Ce ntrum Certification Winnder I is tHTCER CAgtNt.(fee matfaoedwelhZOR LINER!a
I nq ODOM
It, t:.0.// UG _
Cnmrytny Name b,INNER CAMEO OR NG(geothermal clarrd4atp)
!Well ComMnelfonPeratft#: ZDZ(� DOD gC4 "Rom To DIAMETER TRIMMERS MATERIAL
fire n11 n/gilieahle well ennetraainn pwrrnhr(1 e.INC ly,Con Mete Var/meev,ed.) —'� y in.
3.Well DSc(Cheri(WOuse)_ A ft. M
— ^f7•S ,
Water Supply Well:
Agricultural
TO DIAMBTh9t IN.OT19>aE 711tCt4t656 AtelStfltfAl.
Vfunicipol/Public 0tt. n-
il in.
Geothermal(iicating/CoolingSupply) Ottaddential Water Supply(single) — ft. ft. in-
I industriai/Commercial fl Residential Water Supple(shared) 1& O•i. .
allirri,,orlon ITimrt to• `rnaftsaut. can bra&AMOUNT
Non-Wafer SupplyWell: y / ft. A. ,y� ��� L
A Monitoring °Recovery R. fr.
Mention Well:
ft. ft.
IPAquifer-Recharge QGronndwnter Rcmcdiatinn . — .
aIAqui fee Stgrnge'And Recovery Salini gamier /9, ;._SANff/GItTVBLPACiC(maif.pl,�..erhtej
�. ty mom to taA�llr. p!lirtwchtntanz*t'ruan
al,Aquitbr Test tcrmwatcr Drainage re. fr.
•
NI Experimental Technology OSubsidence Contort (I. ft.
MU Geothermal(Closed Loop) fTt:ncct ,,26,�)Rfl.L i LOC(tdtad►tW o itbtiflVaeaylx!ry1
•Geothermal(Reati),' •a • Return) >M a,cries,lain ander121 Remarks) — so a>LSi or to . t Zrotl/ ekt10arralasiayrlGt
7 _ tt- �7 f" ,s r
4.Date Wells)Completed: (_)q`'f� -Well Mil R' /!D(t• �i{ k —
,:. ei 1.nenttn (497Q» / ft',��I CeC
Jahn Lie �tf. 70rft•
I�:tcilth;'(Imter HerneFacility lDrl(.f;pplicabla a• R `,^• -. , .:e ;`./
i Jut( 6Act) aid Id fie Ar O. tr.
pity' ►Address,City,and Zip,
21.fEMARKS
County , V ' ":`-t' "'
t arcel ldentiticttiom i'To.(PiN) i .
Sh.Latitude and longitude in degrees/minutes/secnndsordeeimnt degrees:or well f� tct n�non-Walt) 0 7 i �� :!2.CertiP lion:
r N (2 4/ w
'.ls(are)the well(s) Permanent or )rrrmpOrRry Sloan c of 4atifird Well Convector pate
'C Au Aiming rhea limo.I kmhv cost&Met rhr nr./hS)was(en)amnrnaavl ha nunMnnce
;.in this A repair to an existing well: 13Yc9 or �tyo nul,1SA NCAC 02C.01/00 or ISA NCAC 172C.0200 Wet I[:.►rcimmon Smoking(owl ihm e
IJ'rli'i,.;>weir,AllmKd7MrnIrrIf.xnnslnccnniitJratati aartaptnire the swore of!hc eal!ie?flhfereardfinehrenprnrkTaitor/ttvrlimatt
Pqrair rmdcr(21 remark:asroon nron Mr hark al this form.
XL Site diagram or additional well details:
R.For Geoprohc/(illlT'nr Cln Md-Lnnp Geothermal Welts having the same I'm may use:Ike back of this page to provide addhknn!well site details or well
cenrinIctinn,only I GV'.1 is needed. Indicate TOTAL.NUMBER auras coastruclion rtrtails. You may also attach additional pages if necessary.
drilled: ..,,
O� �;PBIW l TAl.iitiSTRjcTEO, IS
Far
magpie
well depth below land surface: (0'•1 Ma.For all Wells: Submit this lbtm within 30 days of completion of well
Fnr m agpie wilt Mt nit drprlu idrfjuenr(rrannn/e--WOO'me7s@l tP)
constiuctioil to the following:
10.Stone water level below top of easing: (ft.) Division of Water
/ owe r1..n•l kosordeating,tar::• Resources,ceetoRaleigh,
Processing699-161 Unit,
/. 16171Hxit Service Caller,Ral h.NC27h94-Ibl'
1 i.ilorrholedinmmer. (in.)
2.th, orleicetio2.Wellx In addition to sending the form to the nddres l in 24a
12.Well construction method: rb fCtiti above,also submit one copy of this form within 30 days of completion of well
(i c.nug�,amnia.rank,direct midi.etc.)
Cnr>S1tncIt(i to the foliatvinQ�
FOR WATER SUPPL4 WELLS ONLY: Division ofWater Btaaurcea,Underground tnje tioa Control Program,
1fi36 Mail Service Comm;Raleigh,NC 2749-1636
13a.Yield( ) Method of tesp E/v Zit For Water Sanely&infecll_o,Wdt: in addition to sanding the ibrm to
r.Sh.11lsinfcetimh type: Amount: the nddtcss(es) above; also submit one copy of this form within 30 days of
completion of wail construction to the calmly health depttrlment of the county
where consmaamd.
I nru,CLV-t Nwrih C,enUnn Dcpnnment of t:e..irtinmcrral Qw.ariir-Divistnnof Wafer Rosnarces i e..�_,.........

MIA Driller So11-41rout Certlikatkin
,
Owner: JOkr\ Sbff IV- Well: V
Address; i3V LOAer AtLI
Pena; Z(9.- - 00b.-0 •
hemby certify that the above referenced well waa routed in appearance in aco3rdance with
all ConM well rules,
wen Driver 3 ..CA. /91119020/1-5: son
Calificate#7__Y137 Date G -1 4"7-1'
e_onstruction: Grout
Total
Casing TYPe.41.C.,___ Thidtness:,.David
Casing Deth; ' DePtirs9
Diameter:,
Weight/1U* ,
Height_
Drive Shoe;