GW1-2023-02042_Well Construction - GW1_20230303

Feb 16 19 05:43p Clearwater Well Drilling • 8284322-7249 ,' p,I
—Y— ` ".rr'C1'IONRECMULGW
Inv Internal Use•n y:
I, ICatnlrnefor�loftiest/oat
\✓T/ 1 ^ r
ii
[
, - , ........„..,_._,......,......
mammon* Wt i NBS
..
. iWelt tt teettl t rt.
r) . =unit cora altirettzstraltrafgraterrijel IAL
, CUrINCIA-ey- V\J e,U, . ntlinst t, fi. k_i
10 z.Well Coetn(r ji Permit�: off( ` 16.wrrce CASING OR (ewteoneel t�C'
(Jet all 0 ,D3 tttta t To atltl ,71 'offilaable awlI osoan ellan pats*:at;l/YG CmwR Ventai t 014 - . ft. t L
t.
3.Well Mt(Clltek well al* n, k
IVO&Sapp(rAtell:
.Agricultural Q1KtotiaipnUPitblic To • -1.,. :-� .:•,. •enuasav= wta7Matu.
>r Gam: (HeatinglCooling Spply) esidandoi waters i s! A ft. ten
o M►'J( ttgte)
Residential Water Supply(Shared) ' *atom.
ill fret„'ton
YRdVa 7o s_arsan "___t. Inalruc"i sr Fo t17A;A minnow
Non-Water Suppi}'1►t3iC
ilr m. •. R ri. �- Q;Qif �-. m�VLQ C
njtcdoa I: p lit. re.
!•'' , Ter Rail °GroundwoterRemcdtalian O.
III'
'a 'StOragts told Recovery QSalit►ity Berries I SA IRL PACK
i Aquifer fat tteter rct�rsstxt
�crDteittttge n. a.
lIl `SperimentalTcdlttology cpSulaiddtceCammi n. O.
11 Iiiennel paned Loop) °Tc4cc W.MILLI LOG( . y.:i: -r if - - alermal(ittatinS�CoolinpRei dt�
m) �O (oxplainundot#21 Remarks) Ea& art
'L� w*Iuslalated:l�-Z �Z l ft � `� �`�''t-1�' �' e. 'r�
ItIIV ' S1 n RA) a ` ,L_. I.
:ti.cylLacettnat l 1, j (QUM' VQ h �= . .
gwner1 (� 1 L I RMial ' ti
r:+e3 © r(1SVlF���.ii�'11�g11icaMa) A.
Ie- V4 .
;ens addro_ c City and t t V e- 0',L 11 us IX1- . .-..•-''ry -, • ,j ',�'
® rt.
" v.•._ , •1_....ale. ! ; :,,
?t.ontwAREts
Catnap Pnwet tdootit3clationt�to.(PIN) --WAR S 20•
(ir nit titude and tonglinde in drR�dinimticstseroodtordcchnalttcgtees: trif 7-r: •��:ng;.!•,"
' a (��� d .Ce :ton; �e,.3"n'di.�lu:.✓L"
v �
ti
6.Islets)tee walks,4!J•Permanent or 1C3ifempont7 .Si tine of Certain!Well Contractor
+•re ibis a repair-to An rsLdng wry: Xes O! No BP 'jmai'ti dm/Am,.I hexhl,017 IAvr the wet auF:Nor)coso ea re At netejealEr
Gd+ isamink fill makol nrrwaflemsarearte :t t,madoniain rhu wins eihe 4aPJ INwith Lti NW rdholis�ednr MA N doAC 2Cwe atoser. auertnvcrin�r SYmclatds and rfrma
mom.router RN atmaalsstal M1t era adic bock of thrsform, marlin do tall mwa17
&For Gcop iNrltPT or Clost!d-Lut 23.Site a Syr
eanatnllstlxyrbe t GW.ssmed- a, f GesliernalMaobayingtheacmc Vtluhilt'as* left �beckcl p provldo>�ti�1l well lit,"%al a•toll
:trilled'
ndit�lo TOTAL 1VIJM it arwctts cWtttrtaciinn details. Yotr mapr also attach additional pleas;tfrte Dy
9,Total below land sterilise~ l� PTAL li►iiirMIK IO
Pare,.uNrFr ust[vors�mv...ai'-us !mil asp
.�--,a ��,r�, t .+a wr.aa mann mts id ,within 30 d
commotion Iodic fallowing: days of completion of well
3teter Ievsl be use
top of ,
la.St fur a lls�rar:retws►a use^.- •• (ft.) Divlsbn op Water Resources.Information raj vast,
' 1617 Matt Saralee Center,ii ttegb,N C�l761J-lay r
r�
IL soadnienieer: (in.)
Iz:Well IetrOctI a tf`-+try..- -
14b.Per inferno, : In addition to sanding the loan to Ilse address in Me
method: V P above,oho submit otte copyof deb fume width 30 days of complatiOt!of Well
(`` :mot:` +bracttneG,etcJ �•- cof!<ilhdionto the follawinp: ,
POI WATERS PPLY WELLS ONLY: •
lAlalstoa(rWeteP gtlsAitrC!&,iittd
n, ir>a6 NMI writes Center,nol[nd Injection Control Program,I3a.YlelA(�) MttgtOuartters MLU �►�,1tEC2�9�t636
Zile.Par Water corals&br,acilar Welt& in addition to
landing ihe amp.DpctnfeLmpn Amtllost: the adthest(cs) above,also submit one Copy*of this Ram 30 ley to
—valli. completion of well consists:don to the s of
. Whereconeitttcied ►y Ialaallh dCptepgsrq of the county