GW1-2022-01098_Well Construction - GW1_20220107

Feb 1519 05;43P Clearwater Well Drilling
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J.Its chi!:A repairm An existing mall: Oves or0 rilh 1.SA.vI::At.:02C.000 or lSpNG,1r 02.•.h1B0 Well e'-'-slrnrnr Srnnrlardg nnrl/1tm.T
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re;.wir under C?tremarksseem,"oronriot had-nfthA./ornt' 23.Site diagram or additional hailda tilst
R.Ivor GeoproheMPTor Cfowd-1 onp Geothermal W01A having the came V tat may use the batik of Ibis page to provide additional well site details nr well
mmirtetinn,only i Gib'-1 is needed. fndimte TOTAI.NUMBER of wrlis constnirAinn details. You may aise attach additional ptiges ifneeessnty.
driHul•_—.._. _______..... �'" �;��'g)��,�R1.fCTIONS
<i.1 otat west deptA below land surface: ✓ ._- OR-) yla• f4J,A11 W&-' Submit this form within 30 days of completion of well
1%rr atilliple weiie ms oll d rths l/rldrercnt consMiction to the following:
Ill.Static water levttl below top of casing: ... __.- - (ft.) Division of Water Restnirces,Information Prormieg Un(l,
IJ'WahyIan!Itabovaewing•fix, •(" 1617 Mail Service tenter,Raleigh.NC274"4617
1 i_Borehole diameter: u (in.) 24h.For Infeetian Welts: In addition to sending the form to the addren in 24a
12 LYcif roastrnctine method: nlrnvc,also submit one copy of this form within 30 days of completion of well
J c.Well onst idle m tposit,v9c.l — Construction to the following
Division ofWater Resources,Underground Injection Comm)Program,
M- R WATER:+r,'PPt.V W I.L.R ONt.Y: i636 Mail Service('enter,Raleigh,NC 276".1636
t3a.Yield(gpm) Method of sect: Lit. 1 Qr Watt r SppDiv&iiniecNon Wells: In addition to sanding the Ibrm to
t the nddress(c. above. also submit one copy of thi!: form within 3n days of
tth.Disinfection type:,.r Amount. completion of wdt consutuction to the ctnmty bealth depattment of the county
where constmcted-
Frio riw.I Noah Cnwlinn ncrnnmcat of tin irrinmrcrnl!)panty-nmimrr,of Water Rosnurcec Revised^s-22 Iol 6