GW1-2021-04044_Well Construction - GW1_20210823

i-cdb 1519 05;43p ClearwaterWell Drilling 828-822-7241 P`1
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tVater Srtlyply g1ep: -17.SCREEN
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Cdoantrmtat(I`icati"Wrooling Supil residential Water Supply(single) ¢ fi (fir,
Industrial/Comtneroial Rmideo lal WaterSuppl,(shared) 18
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AquiferStorgcl:M4t�eGovery E)SNinit Bo ier 3 L A �, -A nteruaD
Aqutfcr'i'cct 0Smmtwatt:r Drainage 0- 1
ft.
13aperimentai Ted,11010W DSUI%jdcncc control 0. 1 ft. _
Geothermal(Clued Loop) 137(aorA y LwAft
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Sb.t.aNtud-find lonl(Ittute in degrees/mfmrteslsecartdsordccdmnt rdrgrees: _.
(ir%voll Geld,On,¢tdaMang in sufldolcntl M,Corti lion:
6.15(arc)the ".
welt(a)r�Permaacm or �rrcmporary Si
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7.is fill.-ill repair to an cdtlstipg tYd1 Oves or 15NO a 1.Lt W2',V 02C.0100 of ISA iY"C 0X'.OJ00 il'd/Grmteursion S9atr*nfsmrArhor.r
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rrrorr finder 1121 mmalix srxrlmt(A rw 11r hart of lbfl
zf.9itc.Hagram or additloaol we11 dtleolls:
8-For Geoprobe/ITpIr or Cittaed-I.mrp GeotAornm)Wells having nc�sam- l0nu may usa the tack Oil page to ptrsvido additional VAI diln deigns or well
wminwilaril 1(3W.1 istteedecL 1-ntrcatoWfAI.NUMBER or rlis t:tmoMWinntraniis. Volt MAyakoafthadd1lionalpegestfnmwety.
driliad:
9.ii`otal wolf depthavlin 1d41nw land Su1711ce:
1 t I 2-1st, IFor Ail We111: Sulanit thin form within 30 days ttf cranpltaion of well
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construction to the follolsing:
All.StAtie[voter Paw ringns,,me I r top of rasing
xmffrrlr.swJ le raMve ta (ft.) Division of Water Rettourees,Iaihrtatrtton Prvress6tg Vail
!( 1617 01111 SW*C COWA Reldilb.KC.2709-1619
1l.Ibrehotrdtltmt ter: (in) firth,&r��[No_ _n ^s: To 4*11tion to ond3og the tbrm to rite nddloa;,in 24n
12.%Vet1 emtatractlnc met@od; ro above,also Submit one Copy of this form within 30 days of a mplatdrm of weil
(i t m'ac,mnuy.cable,41rw;ct push,Cie.) constIntatinn to the fallotl
r:1731k.
WATFR SCII Pf V Vill ONLY: Division oft+Fater Rtttwlrs*%.Undergtonud lnjm ton Cooml prMr'am,
rr// 10S� 1fi36MAII3ervlocCcarar,Rate}gi,.MC2M9.db96
Yield(gpml 1� MetittW of tesh (�(C 2te tear Water ca�iF&fafullaI Wilt. in Wdaim to lording The tbrtn M
h,plsinfcetfan type; � the addwss(cs) nbove, also submit one copy of this form widdn 30 days nr
Ammar. u�rapletion of%vdl const'taction to the mnnty beahh department of the county
where swrmttacted,
PI Gw-I North C5sml(nn0apnrtmont0111t •Iroammw nnnty•Q I](vdsinnafttrmerAasameaa Revitad2 Yd 20tb