GW1-2021-01684_Well Construction - GW1_20210429

Feb 1519 05:43p Clearwater Wall Drilling 828-622-7241 p.1
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Rx Latitude and longitude in dcgtecrJminutestsecondsordedwail degrees -
(it%nett trcG,one latilbug in Sbilwcw) b , 27.Cet tt[ieatioa:
I_'S.-130 W -- j I
!+•tx(am)the wdt($O "lnaDem or DIremarary S4 of a 75"'Motwellcmetrsatar Data
g.osmiag i41t f;,rm.]hr-AV-Wit.-0-the w l(4 erwr 0=4 cof MA%Zd A aewencr
7-Ix this it repair to an a dsoug wielt: DYes or Q�r4. x+%rb 15A hL:itC 02C.PlOO or 15A MUC i 2C.OX V Well Cown diarr ShMw,?r&mrd rhos it
rtldr Len sgsolr I M aeirkmion iurll.earwruclnw inArnwllnn and explain the amum 4?r1hc wpy oflldi revord illar Ma pMtMlk 10lM:tt KIOW ar.
r,aairoadrl all MAIDArsrcn`lat or on the harkofNltsfomh.
2,L Site dwpysm or additlanat wdt dee Mr
S.For Geoptrobe/ppt'onr Cltw&li.cmp GenthorMl Wells having the same You may use the back of Etas ptt)pa to provide adatiotlal weft alas dasalis or well
aanslntctifat aois 1 GW 1 is needed 1'ndioatc TOTAL NUMBER of~yells ci)a trudiondetailc. You May also attach additimt page&If namosalp,
9.llotat well*PM blow land sat9ler. � 110 t
lnrhUNPrcW111Vlis C11Uetilta Y41WdrrnlfaxamplF3tDiU00'ond2@ltm) � wed' 3ultmit$l1.4�ltl'h 1Yitrin 3O days of completion of wCll
cnnsttutatian to the roltotring:
10.8tRtie water level beinw top oftatting: �(R) DMd000f Water Rewwtxa,In%rmatkntPrvomingValk
tlaolxrfosxllrrrJrrvacatlrrg rice'•1' JQ7 Mal Strrvice Center,Retelgh.MC17690-111S17
It.hotichatediameter��
lib.t7nr twicetiofi Wells: In aMdon'to wading the fans to dw addlew in 24a
11Z Well oanatnretion metkad; `t alcove,aim submit one copy of this to'nn within 30 days of aomplathm of well
(i a m,ge•,retry--bk.irtrars ptuh.etc.? eotlatntetiaD to the fallowing
Division of W ater Rtao nx%Underground Injection Canuid Program,
[173s.
WATER AU'PLY VVEI.L.S MLY: 1636 Man Service Ceatcr,RA1010.ADC 2709-11616
Yield(Rout) Method of test: .24c.,fir Wpforaeady&FAkeHon Wear In ndilion tm sanding the fmm to
the addw,"Ces) above,also submil Ong copy o£thinfontwithin 3Q days of
b.Disinfection typo: Amount: aampwtion of well cwww dion to the eatmty health depatlment of the coumy
Wharf coftamteted.
Form Gw-I North Ckmlimt iaapnrnnnnt of INvIrdinventnl CNghity-Division aCWater Romweas ReuLaed2-22 2at fi