GW1-2021-06863_Well Construction - GW1_20210429

Feb 1619 05:43p Clearwater Well Drilling 82"22-7241 p.1
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Aquifer Rediaq c E30roundwater Remediation 19 SANMCRAVBL PACK o file
quifer Stang;and Root a:ty E)SaEinity Bantu PER mA &tirlwCci•»B MCTtwo
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Experimental Tedtnology JJSubsidence Control ft, D,
Geothermal(Closed Loop) 13Tr99et 20.0111I.1LINGLOGattach assess
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A.Date Wdl(s)Completed: Well IDY
oat.Well Location: in D
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I aality C mcr Nmnc . Facr7ity 104(rfanplicable)
Pbysicnl Address City and 2'rp rt P
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County 1. 111wel ldemitkatian No.(PIN)
5b.Latitude road loaKiltade in dcgreed mimttes/seconds or decimal degrees:
(i,Wl fld ' b „t2.Cerititication:
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d.1a(art)the aelt(s)tPtrmantal or 1ITemporory sinyowtofCailfraiwdlCoaunamr Date
7iv tivilag tkis;nrnr,I hwehv etttJA.-that flip.nxU(so"s ofwr)emonloW to eeamrdam
7.Is this a repair to an cidstiag well: oves or l*o with 114.tiC.4C ox:.broa or 1SA N c4c 01C.i 209 Well Cnnsfenctim,9aft ardt am1 AM it
�rtldrivarepairfillmekmwnw.11.resitroctiani,} n"W1onnmlrrplainhiemmovt!JJa CapyrhftjtfrrccardM,4'btMPmt-Akdtothemelowner,
mpoir un*r 921 mmunkc swoon to on its; afibisfamh. 23.Site diagram or additional well dulls:
&For GeoprohelDPT or aosed-Limp Geotherraal Wells having the same You may use the lack of this page to provide additional well site deW h or well
a nnatntctian,onl4 1 GW-1 is seeded. indicate TOTAL.NUMBER or-wells comstruction details. You may Am attach additional pages if access my.
drilled:___ _ S1)RiNM_ AI.1Pt'i"I'mg
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9.Total well depth below land surface; "✓O� (M) 2,$& IFor All Wells: Submit this form within 30 days of completion of well
I%arnrabip/r+rillsIA401idplluif4V-ent frraa+pk-V)0V'andc@ffia} conmaianto The follostbg:
III.Static water level below top of casing: (ll:) Division ofVYater Resourem lafarmation Processing Unit,
tf alerferalIsohirewons,rise"'. 1617 Allah Service Center,Raleigh6lk(C274W-I07
I i-Bovehoictlinmett:r: O on.)) Q� ,Far 1W'an Welim In additioa to bending the form to the address in 24a
above,also submit one copy of this form within 30 days of completion of well
12 Well ctrnatrnetltm meikod:
cnttstcuctitm to the following
ti c.Rage,rotary cable,dircit pmh.etc,)
Divlslon o
FOR WATER W*PFL.Y WELLS ONLY: i 16M Mail Service Came,,,Rate Underground Injection Control Program,
tgh,TIC 27tA9-1636
13a.Yield(gpm) Method!or test 24c.Feor Water Supply&mice on Wellss: In udililion to sunift it,foam to
the nildres,*s) above, also submit one copy of this romp within 30 days or
13b.Disinfection type: Amami camptetion of evdi construction to the county health deinutment or iht county
whore contracted.
}rant f W-i North Chmtinn Acpanment of Iinvirdamtaatai gtr�ity-Divistoo oP Waite Pesmmces Revised 222 2a16