GW1-2022-01027_Well Construction - GW1_20220107

- 828.o22-7241 P.1
Feb 1619 05;43p Clearwater Woll Drilling ••••• ;;,„„
WlRX'L CQNSTEtUCTION RECORD(G U1 For lntemal Use n y: -
I.W C.ontrartor information:
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raoN r R Rltl'itON
Well Cori nlI a''oor2r Name fr. ff,
4' cli Cnnmavf Certif,calinn Nunkher^Y ,t S. 1TER C r+ING forme welt ORL1�11 n
P;� e 1/� [�Q
PROM ro ofATt�t1ALIFi� ft, M
enmPany Name i -&WNER C S NG QR 7ItBING eothorma s1�eA
I ir. Tp DtA T11ICI:NPSS MA'tER1AL
2.Well Conntrnctinn P 1,)( Zermit A: s
Lint nil eppliewhk wall rnn.rrn+dton parmltr(I.e.Ul(:County.State,Varlance,NO .
ft.,
3.NY01 Vie(check tvdl Ilse):
WaterSapplyweil: N^ rtttc sas MAuL
n AM ,_f+f/�T•
Agricultural Imicipallpublic () ft.
(leothcrntal(I.-Ieatias Cooling Supply) esidentiai Water supply(single) @- it. in.
fndusiriallC,ornivercial csidential Water Supply(shared) "1& ROi1T
F 7 MA L WMAZ �aA a MOUtts
(rri^orlon tt• �
Non-Wnter Supply VI ell:
Monitoring Olkccovafy to. ft.
giection e4: ft• —ft. — —
DAquife•Recharge E3crotndwotcr Remcdiarinn 19,SaNO/CkAV�L pACI itewdks
AquifcrStOrflgc Anti Recovery �
RecnvcrSnlitlity f3atriet -PRAM tQ A 1 L f ACEMBMTMCT1iQ�3
Aqui ter Test [3StarmwatcrDrainago
St ksiderim Control �• R' _
L•'riperimentai Tec)nlology Q �.
Geothermal(Glowed Loop) OTtar:et Rti.t LOG ailac6 r -co 4t tite.ale.
FRotrt ro la.. .�, r�l"-_.—.1--;
Cicnthennal(Hearin oolinR Rea,n►) (hher(ex lain under fi21 Rcmwks} �- it_
it,dateuleq(s)COralifeted:Q _ 0 .a(Well IDI/, ✓ fr. 4-79
f+u.WcF1 i,nrndan:
I:tttiliht+(lamerltalne Facility i ffifvP140ble.) 0'
R. JAN 4
Pirirall Aedress,City,and?.ip fq ft.
.-Ul•[ PrY n- w
n,,.,,,,- 'n' •�1.RFMARICR t� �lUl"'J�'�r� ^i,�°.!;sli
C:vnt(y Pnreol fdewiticntinn No.(PiN1 I --
Sh.Ibatitude nod longitude in dgVm-;/mintrtcs/seconds or deeimnl degrees: -—
(i MVH field,one Inmong ir,naiTiNcntj t IC M cation:
3S'030�...y T� �i ,Y
b.k(am)tfie wetl(s) crmnncnt or ©Trmporary Sipnn c ofCenifial WellContrnetor pate .
1 y.t4minh rots.Joan,I IrRtwhV t10rr1Jy that Air twdlfi): tom Aver:)c(MoNfred tit ar9Ylyda ice
7.1.this a rcPair to an existing welh Yes Or No v-igt 15A.V(',tr..02C A100 or MO NCAr t121.V000 Waft L:nnsrntrnnn Slnnrlarrlr m1r!Aral IT
1f761ri.v0repnir.,i11mrknnnmieellcon.Aracomnitifonnalinn and ciploint6eananegPhe tap)rnfih/tfrcaNlltncdh•+7pMt7�vlfar1trSWCIimHirr.
Mpoor under+,21 raa+nrk.r cFcllnn err nn i1w hnck of rhi.%farm. 2.3.%iie foilgram or Addltionnl µvM decant:
R.for Gmprobe/DPTor Closed-l.nnp Geothermal W011%having the same 1'4Ht may use the back of this pogo to provide additional well site demils or well
txmstrtt:tinn,only i CrW-I is needed. Indicate TOTAL NUMBER of writs ctmstniction drtails. You may also attach additional pages ifrteccssary.
h.Total well depth beltrty land surlacc: `'►`v Ll ___(R'-i 24a. nr Aa M.' Submit title form%vithin 30 days of completion of well
l Ar n+ulllplr H•rl1.c fl4r all n y+du•i/di(f'erant(ctnn+nla_3(n�7(!0 and i21nn'J construction to the following;
10.Static water itwt;l below top of rasing: - __- (ft.) Division of Water Restmrces,information Processing Voil#,
!f w•aler heal lr nlvair cminp,+ter"•"l )617 IH>til Service Center,Raleigh,NC'274"4617
#i_tiorcholediemeter: .(in.) ?,ih.Four laiection Wells: In addition to=ding the form to the address in 24a
12.Well constnlelinn method:__,_• alcove,also submit one copy of[Iris form within 30(lays of compilcuoit of well
1 c.Well,rot.•st rank,direst hod: ....-,.�.�, etinstructiolt to the following:
Division of Water Reamirces Underground hdattion Control Program,
rOR WATER SUPM li WELLS ONLY, M36 Mail Servit*('enter,Rak*fi,14C 2109-1636
13a.Yield(gpm) 4 nRethod of test: ^111e. far W tit,yr CpnR(Y&TaiecHOn Wtils: In addition to Sanding the Ibrm to
the addre.m(cs) above. also submit one copy of this form within 30 days of
fib.Olsinfection type: Amonot: cnmptction of well construction to the county health department of the county
where constructed.
FarmCW-I North CarolinaMparimentoftin-trounicgentQlrniily-nivistnnofwaterRagnur s Revrsed2-222016