GW1-2022-00924_Well Construction - GW1_20220107

Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 P•1
WELL CONSTRUCTION RECORD(GW-11 Fnr Tntemni Use Only:
t.Well f',nntractor Information:
tk.� A� 14.WATER ZONES
Well Ctarraaot Name K TO DESIQIUMON
3aIFU f� -
It. �.
VC Well Cnntm for Cettificchttiionn Number s.0IlTF.R CASING for mat6eastd wells OR LIVER Ua I* bit
PJJ a IJ ACI� (l l PROM TODuntsrts n«xrtess MATERIAL
CnmPanyNamo tt. ft. Ut'ti-in, V
16.INNER CASING OR rtl81NG fewtftrmat closed-too
2.Well Construction Permit#: )Ttoat To orAMETER THICKNI S MATERIAL
i.i.tt a!i nppiicaSJe trpllcnnnnralnn permits(l.p.U/C.C01rlrty,Stale,I'aYMne'c,d:J ft. fa in.
3.Well I lse(check well use): n' k. '"•
W to supply well: 17.SCRBEN
FROM rA b1AME7F.it � S[gTStr6 TAtCKNESS MA ERtAL
Agricultural 0Municip2l/Public O ft, ft.
GeothrnnaI(1-icating(Cooling Supply) Residential waterSuppl_y(single) R. ft. in.
Industrial/Commercial Residential Water Supply(shared) lg GRQIff
Irrigation NROM 7o MATERIAL SMrLACEMV`ITMT1 NoDdc EiotJ
Non-Water supply Well: tf. fa t
Monitoring Recovery ft. fr-
tgjeetian Well:
fl. R.
Aquifu Recharge [30roundwaterRcmediaiiao 19 SANnJGRAVELPACK a Uablt
Aquifer Storage And Rceovery OS:flinity Barrier FROM TA MA IAL 171tltACEMEnTMU1toD
Aquifer Test QStnnnwater Drainage;
0iperimental Technology Subsidence Control fr ft.
Geothermal(Closed Loop) �Traccr X.0RIIA. C OC fathech ad al sbwb if rseeeso
Geothumal(Hcatin ootinRR.eaum) Uther(explainunder#21 Remarks) FROM To DESCRWMN cotor.furdmam;;Wroekr alnrsee,rtc,)
tt. re- 64 f T
.�l� — tr.
"I.riateVlrell(s)Completed. t� �Well IDf/ tr. _ il
,( �
Ft. /1 ( h
SAu Wclll.nrntion; �J. ck
�F.1ciliha'ChMey tNnam'e FaLilify lOif(tf�pl}icablej n ft.
Ph sirnt Addres,Cit and ZiP ft. &
II.REMARKS
��1LLL t
Caum I;
Y Parcel idcmification No.iP(Nt +_ •
Sb.Latitude and fongitudt in degrwslmintites/secondsordccimal degrees
61 well field,one lattlang it:suR'icicnt) 22. er ficntinn:
F.ls(are)the welts) crmarsent or ©Temporary Sig lure o Ce"ifi well Catrnt; fuse
q. 1,uplaipi
Irvs4rptag dN.t•.;%,rm,J herrhv tr/tify that flip twdl(.v�wai!'Were)c(numfoed inacwrrrpMce
7.ly this a repair to an existing well: oyes oroa ibe anatre pr1hu top),"fluff rrefedhoc hten prmd&,f In Nu:wrif Ammer.
r;pair under A21 rcmarkv.nVion or Ott rim barn offh0 jams.
13,Site diagram or additional oetl details:
R.Par Genprobe/t/PT or 0osed-1.nnp Geothermal Wells having the sane Vou may use the back of this page to provide additional well silo details er well
amsinictinn,only I GW I is needed. litdicate TOTAL NUMBER nr-k%rlls construetim details. You may also attach additional pages if necessary.
drillui:
alum TiAI•tt1STRUCTiONS
9.Total well depth below land surface: J _(IEJ 24a. ror All-WON., Submit this form within 30 days of completion of well
I"nrnurlliple erRchitafJdrpria ifd crenr 6xomple--WART J00'1 constiWion to the following:
IA.StRtie water level below top of easing: _ (ft.) Division of Water Resources,Information Processiog Unit,
11'N•ah r turf,Fs r7Jvtre prolog,u1e •"I 1617 Mail Service Center,Raleigh,NC27699-1617
11.Borehole diameter: V' � ►�c(i�n1) 24h.For infection Wells: In addition to sending the form ID the addraa in 24a
12,Well construction method! above,also submit one copy of this form within 30 days of completion of well
(i c.rot•e,m, constretion to the following:
b. rary.c:h1c,direst lash,etc.)
EWATPRPPr l'WF.t.L S ANLY: Division ofWater Resource;,Underground injection Contra]Program,
5 1636 Mail Service Center,Raleigh,NC 27b99.1636
Method of test.- 24c,lFor Water Sigpfv&ijeclion'Wells: in addition to sunding the form to
the addresses) above; also submit one copy of this form within 30 days of
type:--- AmotmC rzmpletion of well construction to the county health department of the county
where constnicted.
Faun CVr'-I Noah Cnmlinn DcFnnment of f in%irdnmcr.tnl Qnafity-Division of water Roeonrcaa Revisetl2-22-2a1 R