GW1-2022-00998_Well Construction - GW1_20220107

Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 PA
WELL CONSTRUCTION RECORD(GW-11 Fnr Internal Use Only:
1•Well contractor information:
JDSh 1 ►S t4,WA7•ERtONES
1Vejl Conpradtlr blame rM." TO DE5CIHrrtov
y,\\ 3-1 -A ft. _ A.
ft. It.
.NC.Well enntndor
Catification Number _ tt G
OO1FT4 ffoLr mattisLeA LVER if a iMftw rYr Ve CKNES8 AT".,
CompnnyNamc
a 1 t t 3y 3 16.MIER CASING OR TUBING dw al elosetldoo
2.Well Construction Permit 9: lnaoM I TO DIAMETER THICKNESS MATERIAL
i•lty all opplitobte wc)I rnncrntctfa+parrnitr(l c.IiRJ,C.nnruy,Sarle,Varkmev.ct ) ft. ft- in.
3.Well ifse(check well use): n. k. in.
Wa hr Su pply 1Vc11: ^17.SCRREN
FROM I TO I nIAMCrM I SLOT 91ZE THICKNtiSS MATERIAL
Agricultural 0MtmicipDUPuhlic U n. in
Geothermal aicatingicoonng Supply) midentiai Water supply(singic) IL
GtdusiriallCommercial Residential Water Supply(shared) I.S.GROUT
1ri^a110n FROM To MATERIAL EMPLACEMENITM91'HOn&AMOUNT
?Yon'Water Supply West: f+. D ttaAory- /
Monitoring 1311ccovery U. rr_
injection Wcll: ft.
Aquifer•Recharge E3Groundwoter Rcmediation 19.SAM RAVEL PACK iie liable
:Aquifer storage and Recovery Salinity Barrier FROM To I rntreACENEWMET1600
AquiferTcst 13StarmwaterDrainagc t'- t'•
Experimental Tcclumlogy IjSubsidcnce Control tt rr•
'Geothermal(Closed Loop) Tracer 20.DRILLING LOG attachadditionalsbeett If necessary)
Cienthennal(Hcatin ootinR R.eu,m) Other(explain under021 (Zemarks) Fmox To oEacRwnoN eotor.tutrdaeo roWroctcr rAn+imoc.)
/ tr tr
A•DaleWell(s)Completed: Well Intl
Sa.Well Location-
1 ,I scilih:'(lener?t(a�m+e�. Facility i114(rfappiicahle) (fit. R l"
�Physiral AArld�resv,eCit�y,andZ,ip^
Camay Parcel identification No.(PNI
;ih-LOW&and longitude in degrees/minates(seconds or decimal dr:grees:
(ii t„c11 field,one laNiong is suflicicnt) 9 i :r2.Certifrca n:
6.)s(are)the well(s)i�BP"Anent or OTemporary trig of(knirrrd Well Contractor Dale
'� lav �ung#1 Ar.,)rm,f hwrhv crrrlj)�that the tw ir�was(war4 crimeinffe I hi acwrdmce
7.Is this A repair to an existing well., Oves or No ndNr ISA.4l.''AC.'02C.0I0(1 or 114 HC.AC 02C.0200 Well Constowmair Slandardq mrtl tha+a
6 111h is a repair.fili m+fkrmwn xv4f--moron ntformadaaaru crplairt the ruaure grihc tarry of/hie h rorJAocArtn ProeiAdto►&wenl ntwur.
rrpair under G 2/rcmmrin stxtl4rl rrr nn Iln:h rk of fhb'jrrrn
2 3-Site diagram or additional well details:
9-Por Genprobe(DPT or Closed-Loop Geothermnl Wells having the same Vou may use the back of this page to provide additional well site details or well
tx)m1ruction,only I GW-1 is needed. Indicate TOTAL NUMBER of-,clls CM9tntetion derails. You may also attach additional pages ifnocessary.
drilled!-,----- �/
p GL^� R.T �StQ.�(F'�I,iN4TRUCT(ONS
9.brutal well depth below land surface. I _( 2r111a. Car All Wells: Submit this form within 30 days of completion of well
P^r rxuhiple>.•rlAc liu alidvptler�d�crenr&...I.)r-3(p?100'ond�n1/00� enn9mmion to the following:
l0,Static Water level below top of easing:_ _ (ft.) Division of Water Resources,information Processing Unit,
1J'tralrrtar Isehrvecadng•rrte/' ^t c 1617Matt Service Center,Raleigh,NC274"-1617
1 i-Borehole diameter: lJL b An.) �� 241b.Tvir Injection Wells: in addition to sending the form to the address in 24a
12.Well construction method- 1 (/7 Wi% above,also submit one copy of this form within 30 days of completion of well
(i c,An9c,ro, construction to the following:
ray.arble,tliraXpttsh.efc,)
Division of Water Resources.Underground injection Contra)Program,
POR WATER S ONLY:WELU9 VLY: 1636 Mail Service Center,Ralctgh,NC 274994636
13a.Yield ifipm) itiethod of test: i 24c.Far Willer Suadv&lfaiectlon'*tlft In addition to sanding the form to
the addresses) above, also submit one copy of this form within 30 days of
13A,Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
FomtCW-1 North Ct 4inarAparimentofPu%ironmerwilQuality-DivisionorWaterRemarcec Revisal2-22-2DI6