GW1-2022-03370_Well Construction - GW1_20220314

Feb 151905:43p Clearwater WellDrilling 828-622-72.41 P.1
Ei.L CQxd jJC'!f ION 1<LECORI�(GWJ) Fnr Intemni Usc On : �
t. c Irnntraetrtr tnf !ton:
arLAI, -
WellVnnnna��clpxNatne FttOts 7n DESf,RlPribN
`•1�-Well Cnnhanor Catifieplinn Nt ber nq_ s t)lfl R C 411VR tt7a ttrelir t]R I.iVER a
li Do r UROM 7tf DfA TUMMIES MA�rmw'
VVV \ ft, IrA fi. DIXfie
Cna>lf+rny Nsma n, A� 1b.'MN$R CA31NC OR TiBINC thermri t t
?-Welt Conlitruetittn Permit#: SW
m otw rnacwn N�trwAt
i.irl all aly+limhle well rnnarnalnn pernt/tr Alt rAf.ConaJy,Swe,KrrM.rer dr..}'�-T' f6 [4 �•
3.1yr11 tfsc(chcrh we usey
1VotoSupptyr>tyell: '17 SCRB N
LNdwifial/C.orninerci,11
culhtral _MOM f0 o A T. HI. 6M W RIAL
tmicipal/Pitbkic (� �. e. fees
hcrmel(tTcatittglCtxrlittggugplq) Rtwidendhi Water Sullpiy(single) R. fe. in
esidcntiat Water.supply(Shared) 0
otion K T a Rat.on 1%,rater Supply Well: fl, 'Z'!`� r` i
Monitorins Rcw,, ry ft. ft.
nicetintt Well;
iAquif4-Rtxdtat#C 0(ironndwater Rcmed'talion u R
Atlui(crStOtagOMdRtxrtvcry 19,3
Sflitfi 13ntriet ANTWRAYSLPACK [ tdo
D tY Rp�[' n L 1lLACEM8NTM�7tidNt
AquiterTeo QStarmwaterDrttinngc M M
Lxperimental Techunlogy []SuAsidence Comm A. e.
Geothermal(Clnccd Loop) DRAM ,DR1t.L LOC togelt _
CieothermatlKcatin lira Rotum) Other(ex aintmdcr!!21 RCmarlts' FRQM To inter, ioWtee4Jy(fr.ataMttetptte:l
It.
A,pate:Wow)Completed: 'AV-___z Well im � R. O ft: am—
MC'00u)eA�
I4tcilitl;r(lxnct}lama Facility Wo(ifappliealtlr.) I
fLt� Ohl t�l�ll 11���op P sicnl Adrtma;;,(^�.a+id T.iP [t _ ^
21.ffMARKS
County
llaroel identification No.(8R3) -
' r;,e
fib.P nfitude nod longitude in dcRfcos/mintrteslsecandsorilccimnt degrees;
(it well rield one inmong in tufrieftnt) 6 r ' t[ ificnlioA:
+.ls(arelrne well(s) amanaRe or ©ftrmpotxty :ipnat nrC.ctttli ICantraewr fJnte
j� Bu hl'" ,•thl.� am,.I hirmApewito+IJmt rhr nrdr(4 was(ro:)crmnmrrul lip acrnrdmrce
7.,s this x repair loan existing well., Oves or n a•Jlh/SA lCif(!lt7.f.()In0 nr tS�r YCAG tl?!_',U211D 1Vr.0<:.nsln+crrnn 3tnnrlarr/a mrd rhar rr
!j'r/rt.isorc�rair,,A//ourAnawnuy!lrYMalprcYtnrrirtfnrntatlpn /d plafrr/hzrran+mnfrhe cnpDrrflhicrrrorr!/rQCAPCnpmrNdoffrithewcl/mutter.
r•}gtrjr anrr;•r�12!rrmnrtcc.rctalryn nrnnt/n�hnrk n/'Oth fain+.
23_Site detAeftta or ntMltlwmt vretl eletaiis:
R.Ror Genprofic/11PTor C'ireoecl-inap Geothermal Welk having the name Vim may use the bttek of this page to provide additiGrnd well situ ddwils to wr.If
unttsinictinn,only i GW-1 is needed. rndicatc'i'()WY M.NUM13F,R oh+rns omstruction tretnits. Yeu may atatt attach additional pages if timessarv.
drilled:�
9,.1•ntat well depth ttett►w land sutlace:
Fr.Pn+nhlplcxrget:ur1,drpncrifdljfercnt(orrtmnla.+(n�y!/lr n>rrt�tDtnp AN 2'*. ft Au WN19: Submk this f4m willtin 30(lays of complaion of well
con..gmion to the following:
10.Static wetter lcvgl Wow top of easing: ,,,,,� ft.
(/•xrrrr:riure!lrrrhrrroc'm9nh+,rr."r ( ) Division ofWaterRumirees,lrfitrmation Processing Unit,
I p 1617 idled Service Center,Rateigb,N(%2709-1617
ti.Doreholedinmettr.���(io•1
2t1t or lntcrtion Wdts; fit addition to sending the form to life nddrM in 24.1
12,Well construction method. 1(JE-1/1�1 nlmve,also submit one copy of this form-ilhin 30 dar. of a mpletlon of Weil
o t:.auge-,mmuy C&I"dl"%.t ip"h.ete.) - -� construction to the following:
L
YA7TR Arm V 1 LS ONLY: Divlslon ofWater RlBtnl a.tJndergl send trdjet:tloe Contra)Program,
I636 Man Service Cenm,Raleigh,PVC'27IM9.1636
eld(fipm) itZetht►ditf tec1: 21s» Nnr Vlrater 3nenft:Bt re;Mfr.:,.nr.rn�.
In addition to sanding the ibrnt to
sinfection e• the nddrcss(cs) above also submit'one copy of IW fort within 30 day', of
tYP ',-----..— Aletnm►t: tztmptCHOn of Well CDn.4lttraion W the CMMly k4lif depatlinien1 of the Col►nq•
where cottsimtxed.
I�nrn+Calk.1
1VnrthCarcilirm 1?ct nnmcat of i:mlmnmcnml O,nallt;-nivis all of Water Resources
_ _ Rrtrisal2 22-2a16

WON DAb r memo t Compton
Ilemby m tWy that the obcwe reftnced weR wo paned m aloe bx ao=dam v► th
all County Weil gales.
Weil twoear,r L 1
QmMuctIon: �i�KfGRI:
cashv Delft!
Shoo-
1