GW1-2022-01068_Well Construction - GW1_20220107

Feb 15 19 05:43p Clearwater Well Drilling 828-622-7241 P.1
WELL CONSTRUCTION RECORA,fGW-1) For ln(cmnl iJse Only:
1. c11C,ontractorinformation: I
�X M ea J uWS 14.WATER ZONES
SVell Colanclut NxInt >ROK Tn ors altmoN
S ft. fL
vC:Well Cnnhaetor Cettiftcation Number��(/lnt`� S,tn1TF.R CA.SINt± tormatfi-used wells OR LIVER ifn lkeble
FROM
�JC.1 l TO D1A R 'nitcxN S MATERIAL
- ft. J ft. 1 in. V ClCn npnny Name ff ( ( !1 16."FR CASING OR TUBING th"Wal eimedaoo
2.Well Construction Permit ma L -'_.i. � 4 OM To ountctsu THtCI:NESS MAfEaIAL
i,iit all nppiiea5lc well cnnnrucrlen Permits(l.e,WC.Canmry,SMIe,L'nrtanrc,cr:)
ft. (C. in.
3.Well IISe(check well use): It` ft. in.
Wi ter Supply well: �17.SCRBEN
-mom Fbi bIAMET SLOTSUR THICMMS MATERIAL
Agricultural unicipaVPuhlic ()
Geothermal(lieatiugicoming Supply} gResiticritiai Water Supply(single) R. it in.
Industrial/commercial esidential Water Supply(shared) I . ---- I - --+
1a GR L
ltTication FROM TO MATERIAL EMPLAC TOUNT
Non-Wntcr Suppiv Well: rt. tc
Monitoring Recovery U. ft.
injection Wcll: -
ff. It.
Aquifer Recharge E3croundwatcrRcmcdiatian 19.SAND/GPAVEL PACK fo liable
Aquifer Storage and RecAvery [)Salinity Barrier _FROM TO MATMIA nNPtACsntBCVT METut?tl
AquirerTctt nstnnnweterDrainagc n f'
Lxperimental Technology JJSubsidcnce Control tl ft•
Geothennal(Closed Loop) DTracer 20.DRILLING LOC failsch additional sheeft ifnewsa
FROM TO DESVIVI'VION eator.hardm=!gLrmkt rain size.we.
CieotGennal(Hcatin C�liniti R.en,m I 1301her(explain andcr fl21 Rcmarks) ft. (,-
t.datelWeq(s)Completedq a tit Well1DN ft. H1 (t.
n ran
SQiEhNckl�'CTHRMC
.Well LarAtion; ft.
. Facility iDil(ifiVplicahle) I'll
P sicd Addreas,(;fly,and 7.ip h ^'
21.REMARKS
County Parcel fdcntif cation No.(PiN) I A AI n
2022
Sh.Latitude and longitude in degrees/min»teslsecands or decimal degrees:
(if%veil field,one tzatgon�gii(s'ssutiicicnt) c t-ft0eniffixt
; P;`NR SECTION
03 L.CV� V �� W NFORMA11c ipo"O"'11P
�� 1
6.Nam)the well(s) Permanent or ©)Temporary Well Cantrnetor Dole
By atimrng Nils.t,rn,1 hsrrliv errr/fj:that the null(..)wai(Were)txpw rmfful in aecmrdaaee
i.1.4 ibis A repair to an cydsfing well: E)Yes or No n44,/SA NC'dC.'02C.0100 or IJA NCAC 01C.0100 Well Cwtstrnrtton Slandardc and ihm n
/f'fhir is n rcpair..f-fill n7ukmKT:ua/1 AWav,talcimn inforMOf'on r plain the annire gfnc� tape afdtfc r ronl has hPCCa prot7de,fra the wt11 ravrter.
rrpair under A21 remnrtt<.trxnan fit rar 111l!hnrk nfrhf.v frrrn7.
23.Site diagram or additional well details:
R.For GeoprohetUPT or Closed-1,nap Geothermal Wells having fhc same Yew may use the buck of this page';to provide additional well site details or well
w.nslniction,only I GW I is needed. indicate TOTAL.NUMBER or-mils conistnletichi details. You may also Attach additional pages ifnecessary.
drill+d!
HIRMf IA1,lNHB—Tu,GTfONS
9.Tntat well depth below land surface: ( � _R) 11a. ('or All-►' s: Suhrnit this form within 30 days of completion of well
harmnllipre wells huirlidrptltaifdifffemar(etampl d(511r10'ond2@1001 construction to the fbilowing:
In.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit,
11'Wadrr 1cve.Is•ahfrd taring,uu/n•',' 1617 Mail Service Center,Raleigh,NC 274"-16 f 7
11.i3omholedfametcr: U 0 (in.)�!° on 24b.For Infection Wells: In addition to sending the form to die addrats in 24a
I Well construction method: �{�y�f above,also submit one copy of this form within 30 days of completion of well
0 C.au - anzIruction to the fullowing:
anger,rnhry,a>hk,direct pttak,cte,)
Division of Water Resource%Underground injection Contra)Program,
FY3tt WATER St;PPf,Y WELLS(NVLY: 1636 Mail Service Center,Raleigh,NC 27b99-1636
13a.Yield(gpm) �Is Method of test: 14c. Ifor Witter Sunoly B faiection Wells: in addition to sending the form in
the address(es) above, also submii�one copy of this forth within 30 days of
13h.Disinfection type: Amvtmt: completion of well construction to the county health department of the county
where constructed.
Fnnu GW I
North lJnmlinn i�cpnnmeat of lin.ircinmcrral Onatito-!>iviamn of Water Rosoureec Revised 2-22-2016