GW1-2021-03712_Well Construction - GW1_20210823

Fels 1519 05:43p Clearwater Well Drilling
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5h.l,ntttude and lonRRtude in degrecirniaureslsecands Or decimal degree,:
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i,i,y tLis a repair to an exisMag vaelt: c), or OP ,.spy of dtrr r and Oakum PM► r In the wr.7 ntsmrr.
frdils iso rapair.fig m rkaown wd.:oaarnclion A ormalran and'er l in lb"near a(tha
::,'slur rmder R?f rcMnr ,VMrMn or nn the bark offiitr jam,. ;13.Me dwiiran,r additional wail dISM110t
8.For GeoprohefllPT or Circled-Lonp Geoftrival Wells having the some l'ou ms1 ug°dtc track of this aimpop to Dravida cnEdAdd Cage IfIlwell site derails or uKU
: .nvin:ction,only,i Gran 1 is needed. fndietuv TOTAL.NUMBER of—Ile u0t19triteirtNl tlrinlls. you map also attach t►ddhhtmal pages if tlnl:G49BlV.
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9s A'atal welt*P11%below land sudaca �✓ _i ) t4a. Efor A@ Arils: 3ulunit this forth willmn 30 drAts of WMpletion of well
porntnlliptcwellslisraridep0aeijdfcram ;@1091 rani111iGitmtothe�lto►R11�:
10.StAtir,tvatP.P IeMSI below top of casing: (R-) Division of Water Re ourceit.Information Processieg unit.
9"Mi"Th"r„risahirecmYng,me"."1 1617Mail Snrvk*Center,Ralsdglr.NC274"-1617
I1_itoreholeAiatnetcu; `� (In•) ?.db mien Wn111C In addition to mending the fora to the addrtsts in 24a
td>ove,B1so WbMit one copy of this form wilhin 30 days of eompietion of weal
12.WrIl construction method: .__—� cA)nS nc(ton to the foilowinr
0 C.nugm,mtary.r,*14,direct lash,cte.)
Division of Water Restltim1h Underground injection Control Ptngt M.
ROR WATGRSI;PPI V WELLS ONLY: 1636 MullServia Ceouw,'RtRteigi ?4C7:769)61616
t3a.Yield(gpm) -- Method of teals _ �` Y.:ie.Rai Water Cu > &lAIt:C1i9n�YNt,4 In addition to sending the ibtm to
` rile oddrms(es) above, also suMnct not copy Of tbiS f6tflt vAMIn 30 days of
t3h.DIMPfactiolk type: - -_ — ,Amount•. completion of Ivaaw4trnetiDA t>,the cQailly tiN911b dyiMMM of 14C tantnq'
wttare cxmstmcted.
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