GW1-2022-07070_Well Construction - GW1_20220729

828-622-724 1 % P,1
Feb 1619 05:43p Clearwater Well frilling ---------
WELL CONS' RUCTION pX-,CO n tGW-fl 1 [nr Inlcfnnl L)se duly;
1. 11 C.c+ntraelnr Information:
T _14,Vp—"A g•r)NES DESCRI T14ON
S - 70
r--------- rttc>•
SVr1l fnntraict+x Name fr, ft.
n,ift OR LI?IER if a ale
WelI Cnnlr CI Ccrtifioatinn Number r 1S.0 TrF.R CASih1G far motfbcaYed nLr m I MATERIAL
�q 1r� n /1PRAM Tf? DfApr3TiG
l 1t A \I\) L
Compnny Namr. /l I 16.INNFR t 1NC ORTt1 ofNAM1rTP�A wrmn THICKNESS MAT£n1AL
TO 2.Well Construction 1'erurit M. C7� ft• ft in•
i'Atal7 applicable 1Vel(t cnn.rrnrellolt paratitn(Le.U1C C.tnmry,Stale,Y.rrrnncc,
S.FV(11 U.Je(ched Well use); t�.SCReFN
WA ter SupplyNVell: mom To PIA ttt[1t SLorsys Tetrreevlrss MATERIAL
AsriculturalM+micipal/Puhlic
in.
Geothermal(I:leating/cooling Supply) esidentihl Water Supply(single) ft. tL
[ndusiriallCommercinl C]Residcntial Water Supply(shared) 1&GROUT M T'ERt L EMPLACBME. 14ffmo d AMOUNT
FROM TO
Novi-Water Supply Well- fu
Rccovery ft, �--
Nlanitoring -ft
'-
in,jectian Well: �G . B
AquifcrArcbat r ro+:ndwatcrRcmcdialinn T19 AN /GRAVfiLPhCK (fo li AWm )�f*(AC�i;�TMCT110n
� T1 MAT
!Aquifer Storage rindRcfovcr}' f3$a nity Barrier YrRPrf ft ft.
Aquifer Tcst �Sulrinwater IJrainagc
ICU
Experimental Technology [)5ubsidencc COtlTrn!
ft.
TCaF:er 2Q.DRl1.i.iNG LtJt; attachrl
Drrw1CR1 pt'1'IQt N��tnr.l��sr�t�k t raM shs,ate, ,
Geothermal(Closed Loop) � PROM TO
Gcnthennal{ltcating/Cooling Return E)Otber(explain under#21 Remarks) ft ft.
t.
� R.
Dare Vl'en(s)Cnmpie�ted ����//}}-�cWellIDN
/t„ t ft. h
Su (
.Well I" `aA 1 C©n� w� --
�l�l
S:+eillih/Jfl++,elllame �tFaaililv[Dil(ifap licablr.) _.
Em
Phill Add.Sl�.1 `it• qnd 7.iP
-
G J•
C;�unty Parse!ideT)iiflcntion No.(PIN)
Irlfenrt:sstien Pr :. Jn'
Sb.Latitude and longitude in degreesJminatestseennds or dceimnl drgree.s: pV;> iBOG
(ii,vcllfrcld,analat+InngiasniTicia+fi .� 1 22, ,e frcntion:
26
rC DatC
�.Is(are)the well(s) Pcrmnnent 01' OITempnrnry cnifiutW
Sip v ' cilCcmVartor
I1v xl}miap,tkix lbrm,I herrhv minify tour,111e 1vc11(y wag l94,anJ rrtstrtrcnxl A:neohrrlmee'e
7.1s this a repair to an existing wdl: Oves or [ No k,;th lS,t.tiC:'Af.'02C.11/011 or 1JA ryCAC.4) Cc.mvo Weli CnlrrlrncfMlr Slandatdc mtrf drat rr
If'ihis isn repair.fill ant(14K'n wrl!aan.dnleliml irtfnrmatinn rrrTcxprairt the rxrtanr nflhc an!?v gllhie n rort7 hap bran provided In the will!nwilar.
rRoir under AT.I remarks uwan nrortMo har:knflhlsf0nrl. 23-Site diagram or additional well details:
R.For Gee rohe/f)PT or Closed-Lon Geothermni Wells having the snore )roil may use the back.of this page to provide additional well site details or well
P P com9truction details. You may also attach additional pages if t1BCCS M'.
Lonstmctinn,only i CrVd-1 is nrcded. llldicoto TOTAL NUMBER of-,yells
drilluL_.._. (1RiwIITfAI litiS'iRt1 nNS
9,Total well depth below land surfacc: __ 7C)� _( .1 2•},y, fur All Wellc: Suhmit this form within 30 days of completion of well
1%rrnurlliplcwellvlistntid!pN.rifefffauntrermnnlu-3(n.200,"02@1001 constillctlonto the f01101ving:
16.349tie waterlev2l below top of casing:_ _(ft.) Divigion of Water Resources,Information Processing Unit,
If waterlural it irhova casing,rc+e•'1"` 1617 h7ail Service Center,ftfeiglt,NC27699-1611
1I-Borehotedinmeter• C+n.) 2.1b.Tor iniectio,0\Netts: In addition to sending the form to die nddrea in 24a
:ii,pove,fllso submit one copy of this form within 30 days of eomplrtion of well
I2.Well construction method: I �% l ,{ 1_ construction to the following;
0 a auge-,rotary,cablc,oir"t push,cm)
Division of Water Rrsnurces,llndergronnd inJtxtlon Control Program,
MR WATER St:PPLV WFLLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13n.Yield(Spin) htethnd of test.SipL T`1 24c, iuor Water Snndv&iafection Wells: In addition In sending the form to
t the address(es) above; also submit one rnpy of ibis form williin 30 days of
13h.Utsinfection type: — Amount: I completion of wall construction to the colml health department of the county
vlhcrc constnlcted,
I+ono Gw•"I North CamlinaDc-pnrunent of Iin0rdnmenml Quality-Divismriof Walcr Rnuanrcmc Rrvi%NU-22 Z016