GW1-2022-01034_Well Construction - GW1_20220107

1.r-.h 1519 05;43p Clealwater Well Drilling 828-822-7241 P 1
WE)Gir-C4— NEE TS 1ON RECOR7U fGW-Ai JFnr]ntcmn1 Use Only;
' l• C:nntrartnr lnfot'mation; �___._______.._ ..-_ _----
w ONES
Well C:ottloaclix MAIRe le, A.
NC Well Cnntrnclor Cetttficatinn Ntrmha• S )TFR C SANts rer ItroI tll�lk t0R UNM If e t -
1
•(L�xY_La _ T7 .1 Jl1l�`-•���LJ L � � f/. f1, , in. AN
CmtpnnyTtamn 16.INNER C NG OR "No(wotMrtwll ARM—
!.Well Cnaltlrnt4ion PctTn TO DIA TJ1it d: - FI• tk ln.
O-Valli/7rRrnhfeweJJr.Arttlnler/na(tUriniLr(l.++.1l1(:,C.mrruy,Strrlr,Yarinncr em) -
i" n•. R• in.
3.�Vr.1l l 1-le(check Wei)list):
�YtItN'SgpptyWCll: — ^1i.8 N
T 1►A R69 A IA.
Agriculh+ral tmioipallPubliG O R_ ^- to. in,
C.V11" ntel(11catiug(Conling4upply) evidentint Water Supply(single) "'�ft• �fti �—in.
[ndustrial/Commercial Residential Water Supply(shared) l& OUT -
trtf orlon ti VIM
7MATEAUL ttMPu A PTN t► uNr
Nnn 11'nterSopplp�l'cll: _.__ fr. R. ---
AQonftorin ©Recovery
njZion Wdf; - - _ -- ------_---- --
ft. tt.
Aquil'a'Reehprge E30roundwntctRemedintinn .J9 ANiJ VT;LI'AC iia b __
!Aquifer Storage And Recovery Snlinitytlnaier paper r�_r� �` tAC¢MBNTMIesuon
AgtdterTc.q nstnnnwatcrDrotnagc
Experimental TeclmnlIM [3Subsidrncc Controt �ft.
Geoihcrrnal(Ctoecdl,nnp) �7'rnrcr LT, .LDC Itc4 r rr�iybwr�ct<trtx,awtns�r,
FROM TO
CietHruxtnal(Hcatinpa(Coalint�Rcym/)� ��ONu r ex lap in u)tder(l21 [tcmnrks} I f�- tc Sana ±:Ck -
•t,hate Wcll(1)Completed: `1CZ!Wc1111)Ji l K 1L�_ —
�• r R
su.Well Lnr.Adnn:
r•.,eilit�:�tt,:,,er lion, 1 Pnetlity IDii Gf•%Tp{tcnhlr.}� n• --- ft.
AkAL
n, Jt IAnI
P Ill., Addrec.,r:j and7-rp
,X1.,R�tNAAK.S
5b.i,ttittidc pod tnnRlhlde in degrecslmhmtmtsecands or deeimnl drgrees:
(i ,r)Ifreld,�nalntgnnl;issulnMrnr) firntion:
.�:►r 1-7 3 N.ova la 5DJ-
6.J.-Ore.)the well(8) rermnnent nr �n empnrmry ;.;. +:nrC.nrttfitvl weuc,mtrneror Dmc
/b w, Ming rrriF pair,1 herrAlp cwmfj>thni Iltr twil(r)Hwr(Werv)r.T,h uNL►91 hi MUMAMI-r
•1.4 this a repair to nn exieNng well: rAy" or No x.+tl,J.SA.4�'Ar.a2('11JnJ1 or 1.5A NCAC Il1C.•AJ20[Yell(.'r nr/nrrruur SrnmlarA.a mil thnt r:
�Ihir i,,•orclmir,,pll tmr knm,m,urJl.!ra,atrn<•b'n+e igfn,mnl7nnmtrJZord'l/I"-tuNrnY n(rhu t,,prnf1MV rrrord/OR wo pwidrtfro the writ nwttrr,
r:;rorr tied"'t 21 w mnrrn a'ct/trNt fir nil dir hark aP101,,T[rill.
2;1•.Stle rliaRnm or attditlotTaf well dalalls:
R-ror C.mpmbefOrT or Closed-I.Artp Geuthermat Wenx having me same- 1'nu fully a r.nu:Nick of tha page to provide addiliondl well site details or well
MnSIT1111inn,AM,I GW1 is needed, loilicato TOTAL NUMBER of writs cnnvtrvUinn drlails. You may RISO atdtch additional pages if rues.vary,
drilk
rl.7r4tat Well*Ptb Mow Mind surfacc. 40S (J[,) 2,M for&U Wells: Submit mils thrm tvitilin 30 days of colnpit:lion of terll
f•�rmallrpJc,erticliNnlir/!pulcelJdr((cr,rot(<vnmph�d(�l)I/f1'nndi�atnn') cinm ictiontorhefollowing:
!0.9totir wwm level Imlow top of M'41pg; _ - (ft) Division a(Watar Reaettrces,Information Processing Unit,
11 T+n r tc+el Jx rrlvron veering,r'tu•// "1 16171Man Service Center,Raleigh.NC274"-I617
1 i.TMrchote diameter:_-La I� ()n,) 2,41).For Jnjection Wclle: In addition to sending the farm to the addrm in 24a
t?.Well cnnetntetlnn method: � abnve,Also suhmh one copy of this form within 30 days of completlon of well
rotnev.mi te,Oreetpttsh,e(e.)
vwztruetinn rn the foilotvinir
T'()IZ WATT R St;Pri y WR1,i Division of Water Resources,Underground injection Control Program,
n, 1636 Halt!q"ce.Center,Itale4h.NC 27b99.•tGi6
l,ln.Yield(gpol) Method of lest: I�t 2.11% UPE Aaffr RODDJ�gjgsn n Weltl: in additloo t0 sttnding the rnrm to
^� the, address(es) above, also submir. onc1copy of this forin wilMn,30 days sit:t_ih�ltlOnfechon type: i Amount: completion of well cemmrruetron to the comity health depanmeln of the tarunty
'— whore COM91 feted,
t:nnnt:VJ't NorthC,nmtJnn nnmen+nft!n..•r'�-T I nnfirntaJ C,>,ii111u-Ditimum of WaverRmmuraas KevF.ged;24_201 F