GW1-2022-03374_Well Construction - GW1_20220314

Feh 15 1905:43p ClearWaterWellDriliing 828-6227241 P'1
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WELL CgNjg0,TCTION RECORD(9W-1) Far intandi Use on
I-YVtjl Canto ttttr Inionnaflon:
HUL �1J WAT TANO
p"e •rA
1VeD Cnilindtx Naine tr• ft-
uzMx_Nd
Ntmiler6r[e,. .�_. V G
R. r. ,—( WKER CABINC OR Ttit'elsl`TC tttor ad s
o TatC" NA11E1t1AL
L Well Corlatrnetion Pernili S: ra IFL in.
0'r,all n/grl&wHe well cmantaioli Cow?.scale,4`drWre.etr.;)
a.tyt•11 Ilse(cbe&wdl used
n•. R :�.
WiterSup ply Wcli: M rn Dh CDTTH
Agricultural QMlmicipaRtiblic U ia. t+-
Gentherrtitil Menti*Cooling SVpW ViRoidaft Water Supp)y(sitlgm) ft. iL fit.
industrinUC.ammarcitA Residential Water Supply(shared) R ROV1 -
irti orlon p O T MA RIAL sm C t:vrx+ ndA trI1N7'
`1nn 11t'nttr5upp1yV1e11: ZD /
Monitoring ®Retxrvery h. fc
gieetinn Well: f6 R
Aquifer•Recharge Qfronndwnter Romediaitinn
AS.►Nlf/CRAVRLPAfxC f bte
jAquifcrstoragcan4Rccovcrs' ElSarinityonnicl )rgo�t TO L trrwC tMZttron
AquiterTesl CSenrinweocrWido gc fL R•
i xperhncnial Tcchnnlagy [�Suttsidcnce Gammt A. R•
Gcatherinal(Cl(
Lri�1) �7'raccr �R1F. LOC ailtich f
Geothermal(HR"I lln Rewrn) Uther(cx lain under fi21 Rcmtu+cs) Mom To e0t0t'
- it. r� f
a.nit.wt,l(s)Cnmplated:�, well ift 70 rt, S rr.
%Well i ncntlnn•
awiz;me . 1anlilytDil(ifapptcahlo) n' R _
P' s;Mi Arates,Clt and aZ ft.
21.pFMARK3
•f�
MAK
(;,unty Panos:t[deatificttitns Ma.(Pill) 20 , --
rb.Latitude nod hmpittide in ticRrtxs/mimttcSlsrcnndsordceimnl drgrecr.
(ii Ivcll reel 1 one 1aNtang is snfficicm) ��• flralro ;
l -
l;.ls(am)the well(s) mnnent or ®i'1'tt'n111A1'ary itntnliteof(ettttrtlACMIMM, Ditto
7_ /:u at/mia�rlrtc;arm.!hrwhv rrrttjy that thr m l(O was over«)crmnrnrhul fit ace nrdarce
i.iy this s rrpair to an exiadngarft: r3Ycsi at Na n+rh)SA k'f it(.'02l .t)IDD nr JSA,VCAC.a?C',t)1DD Wilt<-:rtrtrtrcnmr Sfnmtamta mnl+hm e
lf'U+h is a rcpatr.f tl rnuknnira te,lt uana/ntctfrrn irtfarmolFan id nrprnh+lb-,maime gfnc� eal7)r nfNtfc rer nod Naer roar prm'lrtriito the wrll aw 'r.
rVolr raider 01 remark.smilat area 1hr.hark ojthh form. 23.Site diaRrrlta or additlormt ttrcll details:
A.r/or Genprn6clltD►Tar t:lnsed-iArip Geothernmt Wetrx having tha some 1,01,niey use i)tc back of this page to provide adfitMnal well rile details tw well
ctinstn+cgnn•only I CTW4 is neederl. 1•ndicate TOTAL NUMBER orur.11s ci)MItmuion(irtails- You may also attach additional pages;ifneemmy,
drilled: _• h(`IBMlT 1 wi.iihSTRI1C7101Y6
t.3'atat well depth balow land surface:„ t" ft1.) 2, , for yyelh: SnMnft tgia farm Within 30 days of cotnplt lion of«'eH
17r-10,17lc W&Litt M/drplha ifdr,j)'erenr(nrlannle-3@1l1D'oad<([Y110(1') conapttctinn to the faiiolslng:
ill.Static water level bcloTr top of tAsing; lob -(ft•) Ph ition of Water RCl Fureea,rtdbrmatiotl Proressieg Unit,
(i'xY,n r rn.e!1rerMtrucmvnA,t;; �� 1617Al Service Cater,Wltlgtl.NC270-t617
17.Rorteholediatnetcr. lY (in.)r Ilk FAr tarertinn Wdts: It)addition to mending the form to We Addrim in 24.1
12 1Ycll IX►nstrpet[nn method; �(sta' atmvo,also submit one copy of this forth teilhin 30 days of completion of Well
5 au �,m CI)Damclitln to the failowing
g t•vy.e<7ble,direct(mdi,eta)
Division oft�ater RtetslrimsMudergrlotind il�Aw Control Program,
F,L
ATER RL'r►M 1r 1�ljFij.S ONLY: crag Malt Service Cemrr,Raleigh,WC 294"..1636
eld(gpm) � ilZethwl of te¢eI � 2.1c.Ur Water Stir 1►&i iection Weirs: in addition to stmditig trot Ibrm to
the addrecs(es) abova also suhiftit sane copy of this form wiUtla 30 days of
infection type: Amount. ct+mptetion of well erinstrucdon to ibe coimty health department of the county
where consirumA
1
Fntm Cw-I 14t+A1tCntnlinn thTnnmeat of t:mircinmcrrll Q+,aniy•1)ivi5+nnof Wiuer n:asnnreee tteviipe 2 22-2t11 b