GW1-2022-03381_Well Construction - GW1_20220314

828-622-7241 p.1
F'ob 1510 05:43p Clearwater Well Drilling
WEiLI.CUTS U(:A'=999ORD MR-4) Fnr lntcmai Llsc n __---
ROOT WOM31110A.
A J O - P N in -----
iv It C�rnUraatx tVA1Rr;, p, tf• -
0.
Well C'nnlmtlore"tlfrcaiinnrdnmber S. 111FR 91P1C of m Walk) A
e I OOMMr n, m
rt, � a, M tAL
OUOqi'an+lv+nrNamr. �t . LRC D!t'.t7R'l'1 �tA t.
7..Well C:orntruction Permit 1/: y. � in.
I.I.rr 01!n/ydt+nblu rwll rnntrnralnq prt+nutt(J+a Ur1.Comply,MO.,,W M EV,ar,1 _
=.1Yt:it the(ehcek Wcn
WA let-Saoptywell- — ^t7 To x
Agrictdturni E)Muni4oVPublic Q a. n, '�'•
t3crtthcrtnal(I•IentinWcooling supply) caident(ot Water Suppty(sint t:) R te. to
indu¢triatlCotnmerainl Residenttat WAWSuppie+(shared; lIr -
n �.IN
TT
Rnmlitnoiofricqlnrt egSr irftpa rpgtru lSrll_ r^�]GRaroKntvncdrtyrm tcrRcrnc�a[itm ._ 1r--
s�.1S+.A-N--fin-1ti..GR7A YRLfR".
t
tion Wct;
uifce PA fa
uiFctOr9c pad ttcnvt Osolillity Bonier
z a'►ra,•�—�--N-
-s--
ON
AquiterTcst uStntmwotCrPreinngc
4perhncnlal'Falmnloo [iSuttildena;Cnnlrol a• a
Gcoihermai(Closed Loop} �!'rncer Rttt. Ltx
CientGannnl(HcatinrlCaolinR ttea»nlOthcrtaxpinin undo tx?.1 Rematks� -at^'tt �� arY�e8r3lr!!�nc.
d,pail:Wdl(s)Comptctett: Well IDY
R.
a- v--»-i--Y" - q a.
1•ecil$y;rfx„ ►t(a����p�. faeiiiiy tD1f pfopptioatdr.) _
-V.
AI 'col Iul roe,City 1d 7.71+
Conncy Pnteellctcmircrtio+sNn nix aM� MAR 1 4 �09i
( I
-Rh.Latitude and longitude in degs<tiorslmi++utes/seennds orflccimnt drRrcrc; -----
(ii ricld.one tatnonit 11;eniiiefcnt) ',{�.Certi inn!
mot►----
f,b(are)the well(s) Permnnent or t..P'rinporary n e nrGenliicit lemvnmor Vote
l 11pning ilge rntnr.l hrmApextoji+tlun Air nVA(j war(ray`)rtmamrrrri A aannfmrcr
%.tw this Arepotrtannesivtingwell: Dyes or 10 n�rlll.s�f�`r,rf'n7C.?lndortSA+YCACA?C.'.l+ItulWdlf:rnsrrnrnon5tnndnmfc miff Ant a
!J'U+h•iti•;>rcpnlr.,/iNuntknannitrllruM.art+ctttair(/bn4nlipnm+drJptnialb;•nn+nr.•nfnc� rnppnf/lt/rrcrvarhnsercnpmtyNdevfmr/talvrll+twger.
r.{vrrir r+nri.r J f rcmnrr�.xcnrn rmnuifm hnr'IC n flhfa jam+.
7:1_site Magriitn or oddlMMI iwellddiilts:
R.tror GerytrotmOPT or Cltwed-1Ar#p Cerdhermnt Welty having the scone 1'tm omy nsr.the latch of this page to provide addilicnal%twit alto details or well
ci!nMnretlnn,oniL t CTW 1 is needed, rndic+tte TOTAL NUMBER otwols c.+lnstniction unttits. You may alto attach adttitionai pliitta if neceisnry.
drilled:
--'..._
ry T111gt Well death 11RIntr land surface. 24a. )rer all We1la: Submit this tout lviebin 30 doss of completion of well
t��rm+daplc�rNl.au�rnl:dyrrh.•jaij(unnt(oramMa-d(r�17q(r'ngd; I(N}� cmt.smainn if)the foilo►ring:
tn.$ratio wnerr Irvgt tiRlow top orrAmpg. --,_ _. (ft.) Dlvir ito ofWater lltmurt es,InfimmppQn l'trocmbg Unlit
{j'arUerGet:i!rr'rhulrtcprin nsr.".'1 1b17MOB&nlr;Center,Raleigh,MC27►89-Ib17
i t,tiorehote rlfafneter: _(ln j 2,th Igor 1p(prrinn� J,,n Ii►addition to sending do form to flit nddi+dty!it 70
I2 Well cnnttrpcNon mrthnd• /L,(11(A above,also submit one copy of;ails foul-[thin 30 days or MinplWan of Well
(i r..oast,mtaq•.r.•+bk,dtrn+,•t prM6,ate.) ---^•--•- enns►nietinn to the following:
1t�f3At WA7' R Rt.tfi►t 4 WEA IS oN1.v: Division of Wattr 1ttRainus.Undcrgronnd Tqf r .Ion Control Program,
M36 Mail 3ervi-,Cemr,Ratetgh.WC 2709..167G
134.Vir:ld
(8Pm) il"ad of te91: 24G J�or WRIA,.r SuRWE M 1p c1Hon WNts: In addition to sumling the ibmi to
the pddress(cQ abova also submit one copy of ibis form within 3(t days of
t,tb•tlkintrctrnn type: ,AMonnt. atmplction of Iva%:nMuuction'to The;nutty Width depfflMni of thr cant),
where consime rd.
tbmr Ci1M.+ Tto+fl+Cnrotintt SJCpngatcn[.1►r:rniroamn:M)Qua111v.ni�isran oPtironfr ncJqurrti¢
Reviaotf2 2�-ZniF
i