GW1-2022-00941_Well Construction - GW1_20220107

Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 p,1
WELL CONSTRUCTION RECORD(GW-1) For In(emai Use Only:
1, cltl`,ontraetnrin ormation:
' �K W TER ZONES
tt)cli Contractor Name FRO." TO DES RlrrtoN
ell Cnntradnr Certification Numl+q Al -11,QIITRR CA ING ter mntli arced wells OR LIVER Ua Tieeb[e
,'nv� FROM TO DIAMETLR flfICfCN 3 MATERIAL
Vlm)Cn;npnnv Name _ ft, fa t in.
°l (� �' 1 16.INNER CASING OR 7Y►RING thormal etmN4ac
Z.Well Construction Permit#: ` ( �J L-i `• o>t To nrAMLTt7t rnICKNtss MAT>rtuAL
i,i.ct all npplic»,91c well ctuaanrctimr permits(l.e.l/1I:.CnrrMy,Sla1c,turiane e,ct.} Et. iL In.
3.IV Jl I(Se(check well use): 1t. B.
Water Supply Well: i7.SCRBEN
Mom TO DIAtrtliTF9i SLOTS= THICKNns MA7'MAL
Agricultural �Memicipal/Puhkic 0R. ft-
Geothermal(ticating(Cooling Supply) Residential Water Supply(single) ft.
Industrial/Commercial LJ Residential Water Supply(shared) M GROAT
Irrlantion Ttil-10—K
TO MA tAL EMPLANonWnter Supply Well:
monitoring Recovery it. ft.
injection Wc11: - -
ft. R.
Aquifer Recberge E30roundwater Remediatinn Ig_SAND/GRAVEL PACK Ifa liable
!Aquifer Storage and Rccovcr)' E)3alinity Barrier PROM I To I MATERIAL I otPLACEMENTMLTIrOn
AquifcrTcst [3StnnnwatcrDrainage R_ n-
Lxperimental Tectmology 13Suhsidence Control a. R.
Geothermal(Closed Loop) [3Tracet 20.DRILLING LOG attach additionalrtltoels feacesaa
+FROM TO DESCRIPTION lciibr.hrrdam,wits—k1 rAFiskp ded
RGeothermal(Mcatin onBrip Realm) Other(explain under#21 Rermt,") / hi
ft- (L
A,DateWdl(s)Completed: WcI11Ds/ ft. M (t. lie
WellLoriltion Q
lacilitl?fAtincrlLartn Facility Elm fapplicahlr.) ILi';•= )_ 5
A&C" ( R. fir
sir d AdAres<�Cyty,aitd 7. 1 ft
,If,-T`TZ1` Zl.fii;MARKB -
Cou111Y Parcel Mernification No.(PfNi — --
51).Latitude and longitude in degreeslminttleslsecendsordccimal degrees:
0'I well(dd,one latgnng is iti firicntj
6.Is(are)the well(s)l;�Permnnent or DTemporary Sig rut atcortiri d we contnivier Dme
riv.utming rhts.;%,rm,I herrhv vellify that!he nv:U(s)rear(won)emstmaed tit aeaud'"Ce
7.is Miss repair to an existing well: Oyes or o via;l.fA.tit.''AC.'02C AIM nr 15A NCAC 02C.0100 Well<".nrlraninir 3tatdlmd mitt Am tr
1,t'Utn is o repo ic•r'Il oatlnm unm wn 1L ll.!oacurny Ofarmaliwrarn sprain the Beane rr(tha eapD nfthlt rereird har hftwproilded In dal well mwier.
r.-!.wir under 621 rcma»un scrtlen or in,I(r0 dark afthta frirni.
2.3.Site diagram Or AddldDrinl tTY:II details:
R.Pnr GeoprobetOPT or C.Insed-lAnp Geothermal Wells having the same Vou may use the back of this page to provide additional well site details or well
w.risttrrction,only I CTW-1 is needed. fridicate TOTAL NUMBER orwclls oxistructiondetails. You may also attach additional pages ifneeessaly,
drilled,
___.._. �VJ _ ) 1� iTTAI,1NgYRLICTTONS
9,lrotal well depth below land Surface. ( ma. rer,An_Wtus: SuhMh this form within 30 days of completion of well
!%nr mnhiplc wr/Lc Utt a1i d rpllcs ifdiiffin r(rsamplc-_@100'mtd 2 a 100) construction to the following:
in,Static water level below top of easing: (ft.) Division of Water Re_wtttrecs.Information Processing Unit,
!(wah r luTe.ls.rhiry caring,rru 'I 1617 M24 Service Center,Raleigh.NC276"-1617
1I-%reholcdiameter: / (in.) 241b.For Iniectign Wdis: In addition to sending the form to the oddym in 24a
12 Well construction metb0d: (,(i! a1mve,also submit one copy of this form within 30 days of completion of well
construction to the following:
0 e.edge,rotary.cahk,direst pits[,,etc,)
FOR WATER St:PPLIt�LLS()NLY: Division of Water Resources,Underground Injection Control Program,
igh,i 1636 Mail Service Center,Ratc NC 2704-1636
13a.Yield(gpm) Method or test: 24c, &r Water SunWv&[ejection Well In addition to sanding the farm to
the address(es) above. also submit one copy of this fort within 30 days of
13b.Disinfection type: Amount: completion of well crtrsstsuction to the county health department of the county
whore constnrcted.
Ilona M.I North Carolina rpnrtment of lin0ranmxtnt Onality-Diukinn of Water RoeourceA Rrvisat 2-22-2616