HomeMy WebLinkAboutGW1-2021-03707_Well Construction - GW1_20210823 828.622-7241 p•1
f eb 1519 05:43p Clearwater Well Drilling
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Well Cnnte•aeMr Information:
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z.Well Construction Permit#: ft.
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S.WIN iiir(cheese wdl ust): —7 tAL
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Aquifer Rtahatge 13(irotmdumtcr Rcmcdistinn V6L P n
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Aquifer Storage and RZccovMr DSniinity Barrier IL
Aquifer Twd nStarmwatw Drainage
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Enerimental TealmoloV [3SubaidcnC0 Contrnk L
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i Gcothamal(Closed Loop) C-.��4'Tracer , (,��•
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.l•bate Wolw Completed:v , well toy___�_` I ?.
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Physical Addmm,City,and Zip
c ouuty - Paraol ldmtdfimtinn No.(PIN)
5h.Latitude ana lonAitade indcgiecabnis>attesfscmndsm dccimat degree= -
(iiwellfrcid,Ong tatgopgiasoitnictd} �2.CarNRatipn: -��) /
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�,,/ Stains arCktttfieJWd{Cantraatot °
b.ta[nrc)the wett(s)� Illanent or �empnr�afrY � 5 rnxr 1:N.- 14
prwRv_5721 nwr n r wd►1"1,aer 010'4 1W",01"d A►oronnrinocc
7.iathfca repair tn'aTnc`xittipgwdt: Dyes or .n+r ISAtit_•AC`0?.l=.p►0'om'lSS,Y(.AC07C.'.(IXfOW+dlCruetrntattnnr+lRaaA,hm.r
a- _ a'pYnflhlFrrcnnrhDslrtdlprerrfdrdMtluWcllnwtut.
/ftl,le;x a r+cpalr,,Rl!a1u knnW»twll.:onn,verron ir<jDrmarlon rrl e,plDfn d,e rxrnn,�n/'r6u .
rrmlr made,G2!minn,frs su:►f6a arms rtn Marl r JWia,(arnr. �� Sate dpgrntn or addlem al WWI de"111%t
R.ffar Geopralte/1/PT or Clwed-t np GeW6crnml Welts having me came 1'on may rA uea the back of 11iis Pry to provide dladditional wEfi al its ea well
a snatmatimt,nnly 1 GW 1 is needed, rndicato TOTAL NUMBER rtf welts
rafn.9trurainn drtails. Yen may also attach addlCottat ptlges
9,Tatat welt depth below land surface: �� (R) Ala Rrot�U Walls: 9uhmit 9ti9 ibrt»taritinn 30 days at completion of weal
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10.Static waterlevtl blow tap of ra>atag ( ) Diw1617 Nbj SarvK e1�8b•AIC�116111 ,
1 /Titer Uroai is(Whave rasing true "
11.Borehole diameter. lu 'l� (la.) zst,Q'�t�MctiOa�dt� to+dchition to sending the fMW f��edcPof�R
/� al>ovq oleo submit one copy of this fonts within 30 dar.
1 z Well constMeBan TMIkad:��`R qmst a tion to the fofkmnz
(i c.cage,mhlry.atbla,diraat pnsb,cta.)
-- 1)Ivisfan ofwatet'Reamlreet.Unde;glrottad tefaeNon Cnatml ProBran►.
rim WATER�+tPPt V WELL�i ONLY: 1G36 mait3ervia Camas,RAtelo NC 270OL-106
V� McNtaW of test: 24c 1' "`•cr 4n v&Talectlon'We1R: In tedditlan to sanding the sham m
13a.Yh:idlapm) r--r the addta+sc(cs) above,also submit one copy of Ih[s thtm w[thht 30 days of
11b.1115infactfon type: _ Amount.: rtemre� I tonstmemm to the county health dcbatlsntnt of the county
Farm GW-l Narrh(�mlmaDaparlment nrtin�kcinmrttual Qmttily-tMvisratt ot'waaT ita9anreaR
tteviFeA 2-22.1016