WI0100623_Geothermal Well Construction Record (GW1)_20210810

Feb 1519 05:43p .Clearwater Well Drilling
828-622-7241 P.
WELL CO),1§R"TION RECOR&(GW-a) For intcmnl Use Only.
1.Well CnntraetorInformation:
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ppON TQ apicit rrrON
Wolf C:ontraam Natna
4 3`1 - . lt. n.
vC:Wdi Cnntragor Catifiaation Number iS.OUTER CASING for tr ido-cased wells OR U NIOL if n e
j f ' PTAME7tGR 'rll[t]C}IP.BS MA'1'EItUL
h •J tr, tt. in.
CaatpenyNnmc
1 y L6.LNNERCA8ING(WTURING thtaunatelatedlao
Z.1Yc11 Constrnctinn Permit#: r `r -1—— 1` K To ouMcrna rntcvess MATEntAL
ft. Lt. In.
i.i.et all npplicnbla well cnnrtrtrrtlnn lwrmi/.r(l.a.111C;.C"mr/Ny,Sra1G Yrr•tance,crc:l
3.1Vt111tic(ehcett+vrl]tree}r n. ft. in.
Water mpply 1+ell:
L7.SCRBRN
FROM TO nIAMlirl;it SLOT9d.R THtCKNg96 TRRGI.
Agricultural E)Mltnicipapuhiic tt, fl. in.
Creahermal(1:leating/Cooling Supply) Residential Water Supply{single) tt. ft in.
ndustrial/Commercial C)Residential Water Supply(shared)
1a OUT
rInretion
iion O MArLRGL SMPAC6Mr.VrNWMODdAMO-UNT
nterSuppivW il:
oring Recovery
Well:
erRebargc E3GroundwatcrRen+edialinn
f9,S.1N11lGkAW$LPAC) ifs hle
Aquifer Storage and Recovery E)SaffnityBarrier pR011t 1yD MWTJORIAL r?ItrLACFMaIVTMCittOn
AquitcrTcst StonnwatcrDrainage r' ry•
i Experimental Technology 1Subsidence Control ft n•
Geothermal(Closed Loop) 13Traccr 2(F.DRIi.1.ING LOC man additional faneesa
V ETO OR tutor. mWroak t tall sire tttJ
Geothennni(HcatinWcooling Return) Otber(ex lain undcr N21 Remaics)
ft. ft
4,Date Well(s)completed; Well ID31__ft,
rt. h. d1( f+ue_Wrtl i ncatlna:
VWfr. ft.
teilit:t(!
av%cr Tlamv `'
l
1. iDi!(ifapplicnblr.) R
PI
ts'
ic/n I{A ddrc^cs,City,an4 7.ip
n, R-
1 4l1 isy{n l nl- 21.REMARK$
Clon(y parcel Identification No.(PiN)
CI,tf ll!Sit,l IUltr
5h.Latitude and longitude in degrees/minuteslseconds or decimal degrees;
i t field,Done tetq`ng is Rufiicicnt) o p 2.Certi 'on:
fi•Is(arc)the wells) Permanent ar DTemptrrary Sipn c of Certified Well Cantntwor fate
let.v in/j turn•.;trm,I Acerb%a+atYtf):rhat rhr iw.!)(.v)NWr hrarr)txrtesrnrNcd Nt acthrdancr
7.1.4 111is a repair to an existing Wen: Oves or W o rdih LIA SC'AC VC.OJ01)or'rSA N(,AC.07C.0204 Well Constenr ur)r 3ramdards and that a
J,t'rbfr ism rvpoir.f)l nurbenam w11-reoestrnclitnt iryfarmatirn.01d rsplain the tutnnr nfthc tal?v t!fdlr.'e rr,vrrdNoehAm pro tiled to t9ujwell owwr.
rc malr nailer,!.'(romrkv sccwB or rot Ifre hark.afllits.(ornr.
7.3.Site diaRraro or atlditforrel well de:Mils:
R.for Geoprohr/DPT or Closed-iAnp Geothermal Wells having the same 11011 may use the back,of this page to provide additional well site derails or well
ex?n slmctinn,only I GV•t is needed. rrtdic `TOTAI.NUMBER or\vrils tonstruchnn details. You may also attach additional pages if necessary.
SiF Ihe'Rttt„rljS l'Is
F-
7fotai•we0 deptlt
jj'&Pf land surface: 244 1F'or•fit,(( ells: Stlhlllit this form within 30 days of completion of welllrrnrvhrphwrll.c litt a!i d.:p/ltr ifdi,eront(esamp/s-9n100,Ond c tlr.d00j construction to the follo rin&
IA.Stone water level below top of taring-,r It.) Division of Water Resources,Information Processing Unit,J/e'nh r fern!is rrhrroe crrr/np,uac 1617 Allah Service Center,Raleigh.NC 27499-f S17
11.1)orcholediameMr: in.) 2th.For Infection)Wls: In addition to sending the form to rite nddreats in 248
12.WCO constructlon method:
above,also submit one copy of this form within 30 days of COMPIC60R of Well
i c.mtoc:,rotary.ailde,direct 1at5h,etc.)
construction to the following_
Rbl1 WATER St:PPf.Y WF.I.LS ONLY:
Lj
Division ofWater Resources.Unde'rgroulld Injection Own)Program,
1Gad Mail Service Center,Raleigh.NC 27699-1636
13a,Vittd(gpm) Method of test: 24C. Igor Wstcr-%ngV&fglactlon Welts: in addition 1d sending the rmm to
the arldress(es) above, also submitone copy of ibis formwithin 30 days of13A.Utsinfectton type: Amount:completion of%veil construction to the county health depatiment of the county
where constructed,
Faun Gw-I Writ Cnmlinn Olean ty•Divistan of Water ttasourat c ReviaeA 2 22 1Al b