GW1-2022-09792_Well Construction - GW1_20221027

l='ab 1619 05;43p Clearwater Well Drilling 82M22 7241 p.1 .
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• .natrattnr informat[on:
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CnnTPnny'Name �i ft. in.'
2-Weli CONtrnclion Ptrntit#: ( �p ^IR IWfVBR CA.$ t�R 7UAtfr tbptrleltt 4—ff
1.l rt rrll appii,nhle wc11 cansrrttnr/aAparrl7Rs p-r.111C,Corrxty,Stab f/arram c,rrsj M 7p Du t MA[rL
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WatelrSapplweli: 17.SC N
Agricultural mom I to t M b A rcrwttas AT841A4 tlnicipnl/Publia i1 0. tq trh
C Mhcrmal OleatinWConling Supply) MesidenGal Water fiupph'(s4iSle)
indirstriaUC.Ommercial R• t4 in.
r1itesidential Walcr Supply(shAMI) la lrri ration
MAM 170 1.
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Adrn»taring Recovery
Nee-tion Well: ft• t
Aquifer Rocbar$c E3Gronndwator Rcmediatintl t1,. R.
Aquifirr STOrflpC Mri tZcr;OVCfp E3SnUnity Ret:'i®r f4•SAN11/ORAVEL PA n -
AquiferTrst - � 1 G ffititrtd lV8lY7MtTuw,
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Lxperimentni Tenlivolov [390 dcncc COPIMl it, p
Gcotbetmal((.'Dosed Lapp) 070wer 211 DRILLIM Lt)C shall
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d,Matt WeJI(s)Cnrnpicted,�;Q��"�� Welt I N Ft. 3 r it
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zl.REMARK4
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Pnrcet tdcatillenlinn Na(PIHt}
Wb-1 I OcIdde nod►on91tafte In degt'rrs Mlnates/secoadSordedmal dr reec;
(iiwettficltl,nnc}BtO(n,,n�g/ies�n']f3iricnt) �i 21 �%/� Iti+ut'ir,uw?c,:+r �-,.�;�.•
30 r 1 I O� ?1 O t3 i O V m2. t CirtinD:
fi.ls(nrt)the Wtll A a Jql ^�._�
() Permanent or MT&wpnrarg Siline-16-fit esniIrtedwet!c mtrnarar pure
+.IN this R repair to an fO•r4m(n8(I!herrhv mnihi Mar the t.Acl!(..)nw,&",)ranatrmcdin aUshrdahce
existing well: �X¢s or No RINI MA S'C_'.tC 021.0100 or 1SA NCAC 02C-'.11211P Well Carrrtrararvn Sroxdardc rntd rhm.r
I,rrher it a rclralr./111 nuFdmwnn rvull nanrrrta rrro.Atjarvrtalra am e+plain fbr.aware rrjrhu c*")ynfUr.+.c rccnrrl hasheul pMt7ddtvvlM the well ruvltrs.
""Mr uarlcr k xl rumr7rk�.rccgmr orngll2 hart rlirlxlnnn.
R For Groprnhe/DP1 or CiTrsed-Loup Getphet mat y}'tlla having the sRttte 23.Site diagratp or T+tldkional well ddalb:
MOSIMUllan,nAlt 1 CTW-1 is ncrdctl. rndicalu TQTAI.AtLItNBF.1L nrwrils }SOD IneY usr the brick of this pogo to pgbvide additional watt silo dt7ails or well
driltut: M ____� ..� constnsctint}<klails. You tMyniSO eftacb additional paM ifaj;CCM y.
` Total twit tkpi)y �Dc, �1�14#1TJAi 1 '�l�t s U1VS
belt}ty land surface:
Far Mrfll/rlc svelte litr all rly,Ilu•if nfJe„mr tr:anola-3�1aa•orrrt c(Zi taa) --�' 1 2&. herAN Welts; Suhmit this fours within 30 days of etmrpleatin of well
10.Stotlr.venter irvel below tap of rasing:^ consltttctian to the foliolcing;
1J'+rararlrrellvaFavycy'tYng,uae (ft) Division ofWater Resources,laihrination pmeessieq iJnit,
1 i.lkirchotediameter: �� 1617 blab Service Center,Itateigit.NC27699-1617
/�/n�) / Z11 Fnr twiertinn lYelis: to addition to fandin I Z Wei;cOnstnictla t method: , O T -�1/r +dtnve,also submit one cagy of this form within 3ac clfOrap
tU Ihg lj:UMtst in Well
tic.mra� raryty �,ie fro t prrelL,Ke.} —- --* annskuctinn to the following `� ok �rm of Well
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W TEA RSt PPl .1,11 SONLY: Division ofWaterHetlfwrrxi,UndeiQlUnd Inji Bd�'DdlralRrogrnm,
tr,36 mallSarvicc CePaII R4101 014C 7709-1636
NtthOdoftevt: ,- &ice 1,or WRter Snnd.& Jn uddillnn to 5antiirJg 11tC iINJit IlisJafettlan type; to
the addMess(CS) MOM a1So submit one ropy of thin form within 3Q days nF
.Amount. 0hmptetion of well rnnstrue6on to the colmtj hr+alth
Whom comoillanra, dappnmont Of►ho cOunty
tram+(R4'.I
NNth CnmlimTikpnrtmMht rtf t9n irrinmcEtai Qrurllty-Ait,iswn of VJmer Roymtrcac
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