GW1-2022-09827_Well Construction - GW1_20221028

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828.622�7244 P,1
(=eh CiearwaterlNeliDrilling
WELL P Tg pN gFCO. G �_1 Fnr intemni use niy:
-1��ntracior,nformatton. '.•�---� � -- - —
p��OSi Tt: 20NES nascu'ON
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Well Tontreclor Name-
all "'
?IG Welk CnonclarCatl6cationWt lbe, 'lITFRC IIVG farRtfl trdb�I• Ifd r!
DI A 7L13 7n lt&4 MArCR1AL
Wt V V C/�-��` 9 v tc• H• in.
Caa,pnnyN una t ,r^� l�tb.INNER C 1NG tth4rtwl aoa MAITAIAL
?..!Yell Can»trncitnn Pertmit its + ft. ...� �•
i.tst all lyu/riknbla well caaclramiap purnrlts(lt:iIIG CplrlNy,Sml�Yarlttnrc; n• in.
�.tyell Ifie(check well nse). 17 SC N t ttssAATIMw-
O tt 61A
�Votel-SDpply�11ci1; PR n• TO �_ ;,�
SM
AgricnittErnl tglic}pnUPuhilc p
Gcathcrmal(-Teating/Conling Supply) Residential Water Suppig(A1181) "H•
Resi tt in.
[ndualfiaUCnmmerciaT dential Water Supply(shared) 19 Uur
.r MA't'BR L
Irri^ntion r,- fa
QQ
Non�lnler5,►pplyV►alt: tt. icy
AQnnitoring QRecovery
Injection Wcll: �— { tt -•
l ttiferltecltat c A GrorEndwaterRemedia(inn il $ � 19 9At!111lGRA.VRLPA. i[ IL �Hf'tr1G MSNTMtt:rn�n
Aquifer Storga and Recovers 0snunity BlInier _FROM tX n.
AquiAtTest r3Stni'Mater Drainage
Experimental Tccluloingy
5ubsidenec Control fol. H"
MINIMUM 11
0cotbarrnal(Closed Loop) �I'cacer 2a RIIJ. C Lt]EC ac6 ail mtee t
_ a �-
'' Cicothalnal tHeatin CaolinR R�+m}dQ�ert`alP>ain under t121 Remarks)_
4.Ilatc.Watl(s)Completed-- .Wc1l lAti � r
C)D m
OI n. .V
So.Welll,ncntlnv:
E^,ct1 'rtult:errtama p=111y mil(W.,oplfcabfc) n -
ft, k-
Mysinni Address,Clay.and ZFia 21 MAlifi� r {
Coo, Patccl(dcntiticatian No.(Ptl+t)
5di.i.ntltude and lanRitude in degt ts/fiimiteS/secandsordccimnldegrees: i ��
Avell firlrt one latrinn tssnfliaic((n/It).. }� �] tC —�
gx. ,e t ptian; C ��
Try ✓�— .r.`�?lQiv�
tS.Is(arc)the well(s) permanent nr Urrempnrpry
Sip nture nfCrsllfirdWll)Coarraator --� Dtde
,�( �v tltmNg tttts loin,!ItRwhvrt�j:r1roP rhF null/x),ror fsvervJ crMAA+lY+x1 M nccn►t/MtCc
i.lit mis a repair ro an existing well: EjYm or [/Na ud�lt l SA 4L'.rf.'n2C.91t or lSA NCAC 02C Jl31tD Wulf ConsrevLwair S7axrlarrer/rod ohm•r
!S'O.cr;.nrapntn.l]llrntrknmon,calf.:n�anwtmrirtJu,7natFnn�it?�cr/rtntntbennrnrr.nfllm enptrnflh!errnirdhos7+cCApM►ddk�rltnfhew:�7fr :
teamr under:,21 rcatprkcstzrl4n nran tln:hock 4frl+Ixlorm• 2;.bite<tiagram or addlfionr+l Wall defplTA:
R.Poi Genpmhr/I/M or Getaed-1 ong Geothermal Wells having thr.same l'ou may use Ehc tack of this PABC to provide Addiettontd well site details or well
mnsln,clian,oniy I Cs\Y•1 isneeded. indicmoTP-rALNUMSFRrtr-,yells
wnstntciion 11crails. You mayalsn attach addlilonal pagos if Imemary
drillecl:�_._ EU, I
9:1;'atal-ell deptA rAlow land sdrracc: -(tt.) 24 bar A W 1 • Submit this norm within 30 da1 mplc
•s of eotioo of'Melt
1%coralf"pfcweilrlittnlidrtpgAviif-�crrnrre=.ple- r+IpO'p(n�dE@100� consimrAianto the rollov":
ln.81961.,Wtttet•ievel below top arsasipg: coo —..--.(ft) Divieiaa orWoter Remurcea,Infbrmatian Proemieg Unit,
!f wnler lust tsrdv,va cueing,met'^. ( G 1611T rt7a9 service Center,Raleigh,XC274994617
ti_Rolrhoiedlpmetcr: l 1' a —(In•) 2tir.Fnr lrcilrHon 4Ycila: to Adtlitiun to F
MdinS 11i4 Fnislr 14 drF oddr in 249
gitove,also submit one copy-of this fmm within 30 dayR of compledion of Well
12.WeIT constnietlan method:`y `^" t GIMMmelion to the fallowing:
(i C.Auger,nnnpj,cable,oirat pu,L,etc.)
_ Division orWgleT Rrelntrceg,Underground lgjectiun Gnnlrnl Program,
Ia61R WATER Sl:PI7 Y WELLS ONLY; Tfi34111a11:9crvttxCent�r,tr atciglgT(C a7M9 1Ci6
13%.Yield(gpfi) Met»nil of teak t xac,1?nr Water 1"Harl VAl In addition to sanding the form to
the ndilmss(es) above, also submit one copy of i1I19 form within 30 days nr
tab.Djunfeetlon typo: _— Ammmt completion of%Yell constluadon to the county Health dappolinent of the County
_ what'e cttnstrnctrd
FamlCW1 NanitCatnlimDLTnnmentaft•:nininMMtnlQunlEr!l-Divuaun11avja ftagmucec Ron". 42222616
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Wad Omer SON o"N"cam
owner
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