GW1-2023-02453_Well Construction - GW1_20230404

Feb 151905:•43p ClearwaterWeliDrilling • 828-G22-7241 ` p./
WFLL C E TION RECORI (GW 11 For lntemai Wu Only: _ ' •
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1, 11 conirartm.1 fa•matton: .
it K a do 1 �1 W%T ZONESrra t ro nomurnott
Well f aurae&Name rR ft. j
CV\,1 ~. A 16 IR
VC Well Comeau Certification Hunter \,, ' f ng' tSQiPIBR NR(tbr GR Bt2krit llsta 1 IAL
CnmprmyNamn / r-t� s ���1 ,`� 16.!MIERC OR +ao+at
2.Well CtNwlraetion Permit#: J w '0 o> �� rt�fAt
list all applicable stall cr urnrolns pmmis(le.1J1C.Comwy,S,alr~Ymf oce•etch 0• ' it. in.
3.Well Ilse(cheek well use): •
n
WatcrSwppi Well: 17.SCRS
veoNt se n�AMM mums Qr1CtaV®a urat�G6
Agrkukural • enii:Mal/Public 0 tt• 11- ie.
Goo�theimal(Hcating/CadingSupply) Resideodal Water Suppl_y(single) ` O. to._
industrial/Commercial —
cadential Water Supp1 i(shared)
atom_ .
✓ aonf TO Mi I RaI c x1R7 DD&A1COUNT
Intuition �C- ''rrI y
Noe-Water tiuppiyti►tile 0 ic.AO
Monitoring QRecovery D. fc
njec on Well: n. it
Aquifer Rer liarre ©Groundwater RemcdioGun 119 9ANflIGRAVBLPACK
Aquifer Stompand Recovery °Salinity Barrio oM p �i
Aquifer Test riSteenwaterDrainage D. a.
Experimental Technology DSubsidame Contra{ - t1- R
Geothermal(Closed Loop) D7Yucer A pM,rtyc LOG(all rl)_
Geothermal(fi ling Reim) f Odmr(ettplain undo,d21 Remarks)
FROST TO �w! +)> . tlwati
d.fate Welts)Completed:2 7-l-Z ell IDN _minas . �\ 0 fL `C-'t�tic.0p,t- ;'` U
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doer+ Z IG vi,S = k0 i
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Zeal Address,City,tadz'.p \A' L ,�Vt' - it. e. .,.........„....„
i A.K. _ 2023
1�+llX�J� EMARKS
IIi7 .1ii:A1✓+I ' k4 ' .J2iiiJl li.l
Calory Parcel idomitiattion No.(PIN) rs�`'it's re;
Sb•i gtltude nod 1ongitade is degtoerfedmKesiseeards or decimal degrees: �( ,
(ii won flea one mtRongivanftiefent) !�r I
35 i ` 1e r 5�N ?• I 1 .4-1 "E.Ce Nowt
6.Nam)mewell(s1 Rermantni or DTearptrary Signal f Certified WeellCartrtctor vale
Au mong rhtr form I ae,ehv runt Aim Uur ward tear fwaam)erntmouod in aaaordaace
7.1n this a repalrto no exisdag well: 113Yes or OM rid.1Sa'Cda 02C.0100 or1SA NCACOOC.o2t0 WeliCanstszcstongasakatlx ail rlwr a
lithi lea repair f ll mubmxa well eroo etNm nil rmaitoaaul cep/ie the mum°ph iPPY ofllt leoud kobasPi eel d tnrha well ntwwp•
male render 12l rennulbsweat tweak back ofihk olm.
23.Site diagram or eddldonal well denial:
8.For Geoprot.e/DPT or©used-Leap Geothermal Wells baying the darts Vou may use Mc back of this Della t0 provide additional well Silo debbik cm well
centimclian.only 13W4 Is needed. int0eale TOTAL NUMBER of oils construction details. You may also attach additional pmlSes Ifnacessaty.
drilled;
h Total well depot below loud snlfwci~ l DS- .
Emeatagargammalus
m► q pp, Far All War SI Mi�this firm within 3D d town moor....u.rra.ile.r.�yde s um Cr:ampia-4el(1a•oagIJena? of rmnflaioo n£well
coot/actionlD 111C fOIIDiT(Ag;
10.Static water Ind below top of easing: (Q 0' ('R`) Division orWater Beeeatrcm.Information Processing Utdt,
puler larellr abate wring,ne","
t n\' 1617 Mail Sander Center,Rettig/6NC27dA9.1617
1 i.Bounahote dlutsete,: UG (to.} 2/6 War iwlertioyt Weitz To addition to amending tbt form to she addraia in 24a
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12.Well constriction method: above,also submit OMcopy of ibis form within 30 days of completion of well
It c.summany.cable,(net push,etc.) emllstrBrotiolt to the fO110arittg:
POR WATER t41;PP1,V yYg4.1o/ONLY:13R.Yield(mint 1 Division of Water SeefResources.0 nn Wallas tWa Control Program.
�! 1G36 Mali Service Center,Raleigh,NC276994636
Method of teal: C 24.e Far 4 r Water Sup &ralectien W fe addi3ta°to sanding the firm in
1 the addmss(cs) above.also submit one copy of this form wain 30 days of
tab Disinfection type: Antonin: completion of well construction to the comity health deppamacot of the county
where constructed.
Rams GW-I
Ner,1,UamlirmDapnr,n,ant of t:nNlroiipiatat Quarts:,-DiNsnnoYVVmer Itayaarces I Retjsed/224016

Wall Driller SsWilma Cordikadon
ev-i- %1 S NewWeJ1:
Perndt
I hereby certify that the above referenced in+ell w+ grouted in appearance in a,00aatlanoe with
all County Wall rules-
well
Cer a : a 1,13 -A _ Doe Grouted:
A,:cal: 3
Construction: Cry
Total Depth; tkOS- Type: ankALA-
g WC, Thickness:
Casing DePth: �1.C� : ..
WeIghtiThldc
Drive Shoe:
GPM: 1 .