GW1-2023-01161_Well Construction - GW1_20230126

Feb 1519 05,43p Clearwater Well Drilling 828-622-7241 p.1
WELL CONSTRUCTION RECORD(G'W 1) for Internal Use Only: .
t.Wc11(7nntrtattnrinfot�aatloa:
N.WA*EREONM
Well l'.awwofxmft PROM TO I Awcairnom
VC well
loL'(/a�nNat DF C�at�1ii,^f�ir,wtioft M`IDAM lS OUTER CASING MrtaNbeatad OR Lf.MMOSWAM
Canprmy Nana =h—_ R. fL
I M tMS11t CAI OR (mothommal cleaet-Ilsool
I Well Coretractiea Pertalt#: I�J�l (.0 • mots I To I Ifteatan I TNIC,6011M M L
Us,my arwiaaNe welt an"nomn pearfar(!a lAC Comfy,stada,Yarkwa.err_) in.
3.Wdl Ilse(check wdl use): n. h
WaMt-Srcp�Wcl1= t7. 1[N
^ � TD DIAM'a'rklt SWT T111CM639
E)MunkipaVPublic () R, R, ilk.
Geaheratal(Heating CoNing Supply} oRmidcritial Water Supply(single) flL & id,
[ndustrial/CommeMiai Residditial Water Supply(sharod) f+ROUr
{m attOn ROM 70 MATEM16 xM YT Dte
1YtatHater Supply W e11: ft. 7`C IL
rAq,f
ing Recovery ft. rcw
Injectiondl:
R n' R
$c fjGroundwtttcr Remcdistian
St 19.SANDMAV6L PAt7(
Mp Md p,=Ovcry f3swinity Basic MA IAL OH1' C BdvrIREraw
ctt E]Swtm vmff Dralttttgc rL ILental Technology [jSubsidenec Control tal(Closed Loop) jJTracer 20.DRILLM MOG tNtaehnal([i ooli lteftrm) MIMI
( in under#21 ReMMU) [773ft-
rO
a.Imte Wdl(s)Completed.•.�ula Well lDlll tt 4
Welll.ocaRnn: ft, rt
S ft - R
6aciltg'tl tdatnc n. rc faeil$y (ifgeplicable)
icni Addre t,City, nd 2- rt It_
. 31.1tlf:MARIGS Y
Couny
PAM61 fdemilication No.(PIN) ---------------
3b.Latitude and Ioappi mdt in degrees/mimtteslseeaudsordecinul degrees:
(ii we11 feekl,one tatlbng io autneirnt
b.Is(arc)the wctl(s)/Permanent or ®tTemporary Ural ofCxrt trd'veil Cca
!� Date
this a ie 4.14-weg NHa.rorm.I hefr.Ar cmfiA-Ara!the*% Wx)was hrarr/rxrv»atrad At accnrdetrtr
pair to as c7cistiog wdk Dyes of �No ■dlil I.S.t 1 C K'o2C.0100„r I JA NCAC 02C.02M Weir C..mrftrcninr Slnxdardr mnl,ho,,r
rnmir under rc ar&y y=f,wrll.:.uaarr ad.,fh"'"or""°Pei ��^Il,c rrtutn r orlhc taMv of(h"rrcml Aar bACa jlrprWd 1,l!the welt twkr.
� marl4x.rarMrrnrnwlhcborlol/hn.form.
23.Cite diagram or additional wen dtst�o
S.For GeoprohdDPT or Clumd-Loop GeOMWMi Wella having the came Vou they use the bw k of this pap So provide adds ioaal welt site dowlt tr well
❑nTwlTv'an,onlY 1 GW-1 is needed h4cato TOTAL NUMBER orwclls contraction details. You may also attach additional drii(ed pages if notx9sttry.
'`U$MfiT,t•il\C7 Gil(iY0 t
9.irotal Well below depth land sut'faec: go� J���1,,`` .
I�rsr nf4/liplc wrkctitf wirde�Ar l�&�rr rerotapkti s 'aotd:�tteory � ) 2"k ft Al Wt h: Submit this form within 30 days of comliction ar well
ro nstractlon to the following:.
t0.3tatic w�nler level below top t►traatag: 20/ "I"r'L'IVI is AJvtya cmh p.Me t�� (ft) Divitinn of Water Rettntrees.Information ProceniaR Unit,
i I-Borehole diataelcr M 1617 R Service Ceuta,"b.MC274M.1617
(in.}
!,1` 2rile Fnr ialertiow Wetla: In addition to sending the form to teo addpw in 74a
I2.Well Construction method: tom-+ above,Also submit one copy of this form within 30 days of oomPksion of Veil
0 C.nttge-,mtuy.cable,dir=PM,ew•) construction to the following:
[13b.
R WATER SCNPI_Y WEI,I,S ONL-Y: Division a Water Reeawma.Underground iglertloa Collars,Program.
r rJfi Mail Service Ceatera RAI*h,NC 2T699-1636
.Yield": MftW Of test* c1 2dc For Wrar Sanoly&fakctlon}YNtI: In addition to sanding the ram fi
t)tsiafeetlaR type: Amount the Mdress(es) above; also submitmac copy of this form within 30 days or
completion of well construction to the cotmty health deptttgnoM of the county
where twmtrected.
Pone City-1
tJarrh Camitrta Deportment of kinviroanteet et Qetanty.Divi-Mon of t SM Resources
Rev W2 22 2016