GW1-2021-01687_Well Construction - GW1_20210429

Feb 161906;43p ClearwaterWellDrilling 828-622-7241 p'1
WE L ION t ne Use a1y:
1.Wellll<`atntraeterinformaiion: V
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InfarrO WR Season9
±IC Well Crmtr*ciorC ftlinnM_00 HALOMRCA51ING11armtdieatei OR
it: ft. Ae. DVC
Campmty Name 1 R CASING 9R I11DNKC ebotrtmai
2-%Vc1l Ce=rraefta pamit�: �tCt -- o a a� ,ro B1�t Mr >I,�L
i.(i9 all agdiaetilr well erntefaamlon l VIC,C h M) �• � '�'
pQfetrr (� (1iRAf);.SielG Y41WaM•c
3.Well Ric(eke&Well use): -
iVster Sappiy Wcq: �t7.
Tt? 6 tC ®B fAL
Agricubura) �NFonicipal/Publle () 1t. tt 'm
Geathcrmat(Iieetiag/Cooling Supply) Residential Water Supply(single) 1t tr in
Industriawotnmetoia) DResMentiat Water Supply(shared)
lrri aliOn ttnoM T YA rS L >w Ddc
mon-W nter su"IF Neil: �- IL
MonitoringEIReMovery
1n)tcoon Well:
Aquifa Reeh 130ronndwater Rentcdiation ft.
Aquifer StCtrage tmd Recovery EJ,Satinity Bruner atstF�SMNAK.RAVBL PA a L >rMr MCnMo
ACprirerTea DSm newwaDrainage
C xnerimentat Ted inolim [jSulbidence Control IL n•
Geothermal(nosed Loop) DTracer 21i.021L LOC .0
(lmthcrmni Heatin ticnftr►) in under#2l ltcmarks} RBOIR 70
A.DateWdl(a)Completed: Well IDY V R• S-1 (t 1 l 11Ln
Wit.well LnrntMn: 231
Cotlstyu( on iroc R. o s& i -
r•,ci►"Ow"axamc . Facility DO(ifapplicave)�
I�3 S��ic'Vd, W ecwe u L le iNv
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Camay pareel IdemiAtsttion No.(PiN)
Fb.Latitude a00 lonl(ltnde in dalreedmimites/secandsor dccimnl degrees:
(ii►mn field,at iatgaau is auffidmt�", p / !2.Ce tilicafifm:
k ls(ure)the Wtill(a Pamantnt or DTewponwy 94VAGre ofCknirerl well Cownewr Date
!!v.11jM t$rlals.{nr m,7 hrrtAr—to,'hat tlrr.ttvdlfaj"wt(WOV)CONW V%d 6f oeanrd"M
7-Is this A repairto an a slog weW E3XC% or boNo twNr lSA.tir,AC a2t .410Aor1JA.V(tfC OIC.'.O1at)WrllGau/rsteraaytat rhrrdr mrd rhaf a
�Rler too as�vli;f111 anrrknatvn well.�avnnrarof i>�irmatloa and ulsltrNa the nnwnt n{ihc SPY afdalt rr:aarrl hoe lMr'JJ prmNBerlln the twit!mvtru.
r Mrundu 9:1 reroarbaxilm arm*harkafthlt,Ibim.
Ll Site diagram or atl0iuotrol well detrtiis:
8.For GeoproheAlPT or Closed-tamp Ge(dherml Wells having the same Tou may use btu:lack of this page to provide additional well sits details or well
unnaltttctien,oniv 1 GW 1 is needed. Indicts TOTAL NUMBER of wclls coannirAion drtnils. You may also a1mch eddifionai penes if lime nary.
drilled:
_ __ NAY1OX&LIMMI�
9.T101411 well ticptlt belolr land surAtt:c 3 � .1R.) 24A. tier ad )}yells: Submit this form.vithin 30 dabs of completion or well
rnrtenJNplewcl)rlittolidarlJeftf�arrnr{errlmpla-3�TlJO'aut;@1W) eon0l follolvft
10.Sietic water level bunny tap of tailing: _ (ft:} Division of Wane'Rewarem laibrmadorl Prociemft UaU,
q'rmrr.r hrml is rdvrre tmtatg,rae(••', Q 16171Hai1 Service Center,Reldilb,MC27690-1617
,I-%1teholedinmeter: `a u (10
.) 24b,179C Isicetiem Wells: fit addit onto sanding the to=to the addroas in 24a
U. above,also submit one copy of this fmm within 30 days of completion of well
Welt constrnetioe method: r"` '`�� amisbntction to the fallowing:
(i 1.auger,"oats'•eabk.dtrm ptisll,Ctc,)
Division ofWater Remun x%Undcrgtround injet:tioa Control Program,
FOR WATER St,'PKV WELLS ONLY: iM Mail Service Ceata r RAtelglt,NC 27b99-1636
132.Yield(gpal) 4 I►icthtul of test: 2itc For W r3onoty&laicctloe Wells: In addition in sanding the ftnt to
rile addrem(cs) above, also submit one copy of this fomi w)0nin 30 days or
13b.Dlsintection typo Amount: comptation of well construction to the comity health department of the county
where constracted.
Vann C.W-t Norr11 CLmlifln Daphmnent of lin-kintnental QrctrttF-Divisionat'Warer P"01Uees Redm ill 22-2a16
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