GW1-2022-07176_Well Construction - GW1_20220729

828-622-7241 P•1
Feb 1519 05:43p Clearwater Well Drilling
WELL!Q N�MCTION RECORD{GW-1 l Fnr Internal Use Only:
1. r.11 ,nntraeMrinformat n ; — _.
A7'E LONES �t --
- 'rxett co m:scatrrm ---
W I Coil Name tr �•
7
ell Cnormout Ccrtific1ntion Ntanher 1• \ �//� ` Wn
S.OUTF,R CASING for unntA•tased wetly OR LfV13t if aIBMit 'rll[CKNBbS MAtER1AL
. tL Iin.
t:nmpnny Namn ^ ` �� t6.UYNER C/TO tNt 71ttDIAM dtarwl stoteA too
\y'yI� — TO D1AMC[EA TAtCl.7tf 55 NAtERiAL
2.Well Coumtrnetion Permit#: t M — k, In.
i.isr al(applirnble'wed eMwf?(CJiAn)ermltr ffe.Is"Cnnnly,Slalg lrarianec,ern j
p• R. an.
3-Wtil Ilse(check well use): _t7 yCRg N
water SUPPLY Well: uraoM ro TUAM tla °SLOTsM THICKNetBs rsituL
Agricultural �MtmicipallPuhlic U Ih. fl• in
Geahcrmal(1leating/Coating Supply) Residential Water Supply(single) R,
Industrial/Commercial n Residential Water Supply(shared) & OUT
�� •r MATERIAL 1tMM.AC ?ta DA AMOUNT
irrigation
Nan Water Supply Well: fr. -
AQnnitoring Recovery ft.
Injection Wdl: f�. R.
AquiferRecharFe E]CroundwatorRemediation 19.sA /GRAVBLPACI(ii[a IiaNe
Aqui ftr Storage and Recovery f3SalinityBarrier pabM To M T IAL IaYRLA BlVTMICTHOD
A,1uiterTcst PStnnnwatcrDrainage rL tr• —
Experimental Teohuology DSuhsidence Control ft. R'
Geothermal(Closed Loop) [)Tracer 20.BR111 LOG attach
-pttoy To DFS N mbr, k t raM rtre,ea t_—
Geothermal rHeatin Cooling Return) nOther(e plain under fl21 Remarks) 1 ft.
rt. it. 1
A.Slate 1'.'ell(s)Completed. `_t_ Well lop ,._ `A3, —
S�nAlDn
.`Welli,nentinn: ►�1(���il` �Qt� ft R
P:+eilitl:'Cktia,er llama Facility iDo(ifapplicahle)
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Physic.�Clty,
21.REMARKS
Coutuy �/ kt 2022
mel identiileation No.(PIN) 1111
Sb.i,Rti(ad e and longitude in degrees/minateslsecorids ordecimal degrees: ( trtt►btsn fiZC a
(ifsvellfieldCnnelaMnngitsufimicnii 0 `J C location �laJ�/aOG
C ls(arc)the well(s)MPcrmaneat or ©ITempnrary siQnnru I.rCrrrir"a we,IC r Dntc
T—,% \�pr`�_ J.cv.eillning r 4-fiorm,IlirrrA'vrwrrifyilral lltr ndIN xarr ArarJ crm�smnrvi in accvirdance
7.1.1 this a repair to an eybiting well: Oyes or No .,xi 15A.ti1.'AC'02C.0100 or 15A,VC.AC 02C.'.I1200 Well Cnnsrrnrrimr S1arnlarrlr mvl ihm n
/Trh&ix»repair.flY alithintvn iv.11 eoanniction ittfii.vna/ioa mut r���plain the noire nf$va copy rifl/rir rrvvrrrl has hear pmPlded tri the will nmier.
under rt 21 rcmarkv scrtlort ornn l/n:hark of mo form' 13-tiite fllaRrnum or additional well dthaiis:
R.For Genprohe/IIPT or Closed-t.nnp Geothermal Wells having the same VOU may use the back.of this page to provide additidmil well site details cw ive:ll
mrislntction,only I GW1 l is needed, rndicatc TOTAL NUMBER of wrlle constntction details. You may also attach additional pages if necessary.
9.Total welt depth below land surface: J J —(ft•) 241:j. ff AH Wells: Submit this form within 30 days of completion of well
bm'foliMplc-efts list all,&pd.ifdiferrnt rriannh- conitr action t0 the f01101ring:
10.Static wafer level below top of casing. �� Division of Water Resaurees,laibrmation Processing Unit,
1/'-ler lane!Is irhnve c'aring ir.w l RR 1617 Man Servkc Center,Raleigh,NC 2.74"-I fit 7
tl_liorchotediameter:� �? in. I
( ) 2lh.Far Itriection WeOs: Its addition to sending the form to due ad0c"in 24"
/� ,Q� above,also submit one copy of this.form within 30 days of eompletlare of Well
It Welt construction 1�—
method: Q 1_ constmiation to the following:
(i c,mtgc^,mnry,cable,Giret,K push,t9e,)
Division of W stet'Resources.Utider'ground Injection Control Program.
F6R WATER SUPPLY WELLS ONLY: 1636 Mail Servitx Center,RAlcigb,NC 7.76WI636
1311.Yield(gpm) _Methad of test: 24c, far Ylraler Cnndv&laiecHon Wells: In addition to sending the form to
the oddress(es) above, also submit one copy of this farm within 30 days of
13b.Disinfection type: Amount: completion of tvdl construction ti the county haallh deparrnnenl of the arum,
where constructed.
Punt Gv.'-1 North Cxmlinn fkTnnment of t invirdwilcmil Onall iv-Aivistnn of Water Reyonrem Revi iiM 2-22-201 R
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