GW1-2012-03830_Well Construction - GW1_20120823

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1=e1) 1 a 19 Q5,43p Clearwater Well Drtllin9 ___--.-----
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1. 11C,ontraettrc Information: .--
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tVdl Cnnmaeta Name --
,_..�. ,,�_,..�,,..•••• -- m j�..G fbrttnt ORL(VB]t a 1►u►rent t.
Wr:11 CantnM t:atification Numbs" 99 s• R C
VC rt Dt '11it B89
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ttoa{i � L
"id, 6RC NG�R ouatCrgt TAt
I:nrntunly Nnmr. T in.
2.Welt Conxtruoinn Permit#: fl iw
i.irt ral npplltnNe well rlmrintellnn purmtG,(Le.lix.ronnfy,slap;Ym lnnet4 ctc.J R. in.
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3.Well ific(check Weil use): t7. N n etctettss u
Wa ter Supply trVOI:
Agricultural, �Mtmicfpat/PuhHc ()
Geothermal(Heating(C0611M Supply) E)Rtzldential Wtncr Supplg(single) n
tt. to.
Industrial/Commercial Residetrtial Water Supply(Share!) ti 117 a Ru mypy/, D4 0
{rri Orion � � r+. � R'
Neu N'1'nter 1tTill_v Well:
t\datritarin R4;covery
injeetlan well:
Aquifer itcchar$c
E3Groun L dwatm Rcmedialinn }9 Apr► L A &A autnton
_
AquifL-rStorageantlRccavery E)S:dinityBMxiet 1RRox 0.
Aquifer Test amrinwatar Drainage tY.
Subsidence ContrM tl
Experimental Tecimology 20,D01.i
(Closed tdN�b a:.
Geothermal(Cld LOOP)
aTrnccr Tot _
(kothennal(HeatinyJC001ir►Q Rewm) OlberCa ain undcr#21 Remarks)
4,pate Well(.-;)Completed;_,,,v_,___.._.1 w,11 IDt/ Z rr
02
So.Welt l.n Anon: M31,
R. "?i
n. .
Faality iDo(i`pfMillic"I"rr))
Physical Addeexa City,andT,1p xi pgletARNS
Camay Ynteel Tdentitteatit+n No.(1'ih1 -- ,,peg''
51).t,ntit»de oral longitude in degrees/minatesiseconds or decimal degrees:
(ii wOl field,Ong tntgong jr,sniTcicntl , ?Z.t'ertiC tion,
E -�. a r W
ipttolarr.of Mlirial We11 Catttmetor
4.11(are)the well(s)w-p-manent or [TITctttpnrary hr raaa'trurnoi r»oetnrAe err
,!?v.dlminll N,ts_ran,1 htarl+,vratrlfj+rho77hr,t1x1t(iJ teat euL)
i.iyttli%ACr pair tDan existing tiYC11: oXe!' or 16N0
J1'tLt,'
SA4C'tC`A71:.41pDnr1SA,YC:AtC.eO wXe.'l.O"�MaDarW.
is a mmir.frl m+rknownmJr�rnmlonvrrl riplmn the antnre ornc cnilrof Ihtx hvvnar7aPda etlCwurmetrnrr3Mralardemrrlrhr++c
r.atirlaldcrt71mMnhtT.y=tmn,nrovati,hark nfrhbefam. 1 yt1elftgnmoraddlel"al well ttetalls:
R.For GrnpraheMPT or Ciosed-1.nnp GeolhermsI We11n having the same 1'axt may use the ttltek of Hits.page to b addi onaladdi RS well site ftry i s cm well
MInslnlctitm,onh 1 GW-i is needed. tlldim q TOTAL NUMBER orwrllc
onawctian rTetails. You may also attach atldiGtmat pages if noetssaty.
drilled:_.....-_ 1
!t.Total welt depth botow land surface; ��� -_iR:l t,�. FartCnr Air!We119'. Submit tills form zvitirin 30 tiara of Completion of well
Mir nulllip/r N•eRe liar nli de/nlct ifd�r.►rnr fartrmplc- ronwimion to the rdlowim:
10.gtatic wari±r level helots top of easing; -- (ft.} Division of Water Resources.lnfntmatittn 1'roecast°R Unit,
l�anrrr/err r lsrrhnce raring,tar 1617 Mai Service Center,6alel9h,PIC 27699-1617
t
J p, gar rtioR w�ta: tit addition to aentting the form 10 the address in 248
t i_ilorehniediametcr; �Pn.} tl► i)s of completlnn of welt
�} �A 6 IdMve,star salamis one c yoPthis,fottn within 3(1 days
I Welt canstn►ctinn method: CLI(----`�1 _ ramstmMion to the followings
(i C.mrg�,mhtp.Mblc,direct push,ctc.l
Division of Water Rramteces,Underground Ildtxtloa Control Program.
170R WATER.M.PPT V WF.Li S ONLY: TOM Mail Service Cetiw,Raleigh,NC 7.7699-1636
13a.Yield(gpm) 2f) MethM of teat: __ _ P.ic.Rnr Wata r Cutrttiv&Feicatldn Walla. in addition tD sanding lht ram to
a the nddrrss(cs) shave, also suborn one copy ta£NO tOM adthin 30 days of
t.th.Disinfection type: Ammmt _ wmplction of rv41 axtsuntxi0a to the CQMIY I MiM dt:jlttltlrltl0(Of i116 Gonnty
vrtterc constmcted.
F.nn Gu''-! Nnnh 4Carniinn7]epnrtment of tinoninmentnt gmdhy-I>Ws+t+n Of WaMr ROO-Mr-n Revisa�2-22 tat tt