GW1-2022-01099_Well Construction - GW1_20220107

Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 PA
WELL CON-M_VCT10N RECORD fGW-1) Forintcinni Use Only.
i.ITI C,nntrartor Information:
14,WATER ZONES
kvell Con"clix Name !M.W xo fr. VESCklrtTON
V(:WatlContranort atificate[on-N,rtn6er histom
f.01TERCASING fortnald.aasedwells OR LINER ifs livable
M DIAMETER I 711tCKNEBS MAl't'.RUL
in' nVC
Co:npnny Nava V 0
rI&INNER CASING OR Tlnr1NG thermal eloud400
2.Well Construction Permit#: FROM I TO I oUMI"L TAICKNr- NA'tER1AL
i-10 rri!a!ry iicn5lc well rnnrrnrerlon parmirr p.a,I/X'Counly,Stalc,Vartrmm ctc.1 f4, w in.
3.Well 11se(ehtY&wdl use):
!l. h. in.
Wit ter Supply well: �17.SCREEN
ERO TA I b1AMETM I SLOTSM I THICKNESS J MA4RR(AL
Agricultural MtmicipallPubkic U rt, rt. in.
Geothernal a icatinsicootiog supply) 13IResidentiall Water Supply(single) rt tL in,
[nduslnallCommercial Residential Water Stipp] (shah") t&GROUT
Irri^atiOn 1+t0�M TO MATERIAL EMPLACEM6VTmKiliOD&AA OUNT
Nan-iyntcr Suprfer
ly Y1 rli: ft• r° [�!1 i I I r
Recovery tt. farge �Groundwatcr RcmcdistinnRAVEL PACK re livable$c and Recover} Salinity(3atrier PROM T Mt. AL 1x1R C)SmrmwaterDrainage ALrt-
Laperimentat Technology (Jsuttcidence Control It rt.
Geothermal(Closed Loop) DTfacef 20.DRTT.lJ1 LOG olls hadditionalghftifneenu
r+RON TO MCRWrI0N kabr.ha trm. kr Ineter,stal
Geothemal(Hcatin coring Rclum) Other(explain under ti21 Remarks)
4.Date Well(s)Completed: Well IDf1 it. it.
RV) fr. ,/ ft. 1
Q.X� SSA �S�Y'I � n. � rt. :.-•. ,, �...1 acT{ity'tlK�, llama Fac [DO(if applicable)
1 c- Cls%\
rnyair, rity,and
N�aci 21.REMARKS
777
County Novel Hentificatinn No.(PIN) 1U
Six Latitude and longitude in degrees/minutes(secondsordecimAI degrees:
(i'welt field,one latgong is sufficient) o T I b.,
� -
6.is{arc)the well(s)�(BPermanent or DTTr npnrary d Well Contractor DateT 0.1.gt7i"Ibewiureorthu
,!herrhv crrrlf}:thal,the 1wdl(..)was?ttwz,)trmaraHer1 in am"rdmice
7.ty this a repair to an existing well: E3 Vcs or No *4111 iJA.k?'IC 02C.4/Ot/or ISA M AC n1C.A200 Well Cwatenmon.Vaud d..a and)hat n
fr'thh i.:>rcitair.-ill outknnKn nett rursunrellvn infnrma;iaa copyofi/He ra»rd harbrenr pros-i&'lIn r&well nwurr.
r•:mir under A21 rarnarkr sct:ntm(Aran me harR nfthh.(orm. 23.Site diagram or additional well details:
R.Pir Geoprobe/1111"T or Closed-Loop Geothermal Wells having the same V011 may use the tack,of this page to provide additional well site details or well
conslntction,only I GVJ•1 is needed. ladicatc TOTAL NUMBER of.,vrils construction derails. You may also attach additional pages if necessary'.
drilled:—
, ._-.. jIRMMAI,INSTRUCa• M
9.lfotal well dcptl►below land surfncc: �j1JJ ,(R•i 24% i'or Wells: Submit Otis form within 30 days of completion of well
!%nr n+trlriple>tr/lc rite all d.pAr ifdijfcrenr conAtTACUUn to the following:
I0.Static water level below top of casing: (rt.) Division of V4attir Resources,Information Processing Unit,
?1""Wer irtd Is aMtvu rns/ng,use 1617 h1all Service Center,Raleigh,PVC 274"-1617
11.Porchole diameter. (in.j 1A6.For Injection Wells: In addition to sending the form to dic addraa in 24a
12 Well ConstnlCt[nn method' above,also submit one copy of this forth within 30 days of completion of weal
1 c.au ell rotary. P. - construction to the following:
b c-*k,oireet 1Lh,etc,)
Division of Water Resource&Underground injection Control Program,
[13a.
)R WATER SI:PPL FlJ-'Q ONLY: 1636 Mail Service Center,RAte'igh,NC 27699.1636
Yield(gptn) tVtethod of test:JAI 21c, l�nr Water SnpDIY&iaieeHon:V1'e [n addition to seroding the form fithe address(cs) above, also submit Inc copy of this form within 30 das of
A.Disinfection types m Amount: of well construction to the county health department of the county
where constructed.
Finn GW.I North Carolina fkPartment of tin0roroncrtnl gnality-DiviUrn►of Water Rasonrces Revised<^22-2016