GW1-2022-01120_Well Construction - GW1_20220107

Feb 1519 05:43p Clearwater Well Drilling 828-622-72A 1 P 1
WELL CONSMU-,CTION R—BCORR{GW-1) �For internal Use Only:
1,WclI CAintrairlor Inf,rm -
\ll/�f� 14,W T ZONES
r1i0a7 Tn DESCRIPTION
Well fbntracll�ot�hrRme IL ft,
...E ..(S.L .._
ell Cnntmelpt Catificn• n Nitmticir M?,tn1TER CASING for melded wells OR LI?iER Ua e
C(( ( �HROM M D1AMCfLR_ Tllt Q"s MATERIAL
akiK
(:nmpnny Name ~)6.LNPIER CASING OR TltAlNG dtpra.alclauld-lao
2.Well Construction Permit#: "iamx To ouaILTEA in• THILINcss MArFRUL
iAst all 1111grlicw5fe well mnrintelinn parmitr(tc.1/IC;.C.olrrxy,Smle�1441•ranc4!,ere.) fr• R•
n. k• in.
3.Well Ific(cheek well ilse):
�lasC N
WaterSupplylvell. FROM TO DIAMBTFat s[AT. Tn1r.Iuvrtss T1tRu1L,
Agricultural E)Municipot(puhtic Q R, ft. in..
Geothermal(ETeating(Cooling Supply) esidentiai Water supply(single) rt. fl. in.
indusiriallCommercial Residential Water Supply(shared) -IS. ROl)r
p MATERIAL EMPLAC BIVEM TN M AMOUNT
tar{^ation .�• ft. Ft..
Nnn-�1'nter suppiv W'ril: -
rAquifer
Recovery tt, fr
injection
fl. It.
gc QGroundwater Remcdiatinn
e and RcrovcrS Salinity Currier FROKNT1/Gkt1 ALfe cCMBNTMrns
f3SmnnwatcrDrainage n. n• _
Experimental Technology Subsidence Control tl n
Geothermal(Closed Loop) 13Traccr 20.DRIi.LINC LOC irNaeh sdd onalslltats I Reetniva
FROM TO DE3 dolor.hardwis,ollffieck IM,itralm In.eted
Ccothennal(HcatinVCooIiLjt Return) flOther(explain under B21 Remarks) / tt ft. a_
d.dateWell(s)Cnmpleted' ! I�1— WelllD# �Srt. (t. /
.ria Well i,ncatlnn: O It.
F:Icilifi:'Owner#lame Facility IDil(ifoliplicAlr.) ft' ft.
Pli i d Address,City,Ind Zip
• fc• ai.
B r'C 2l.REMARKS _ '
...___...___ILL_
CaontY parcel idcmitlenlion No.(PINE)
-qb.I,atitude nod longitude in degrees/minuteslsecondsordecimnl drgrecs,- 022
(i�well field,one tntnnng in suRleicnt) , 19
3 ll �2,Ce (' lion}
Q3 / -I
/ b `( �a `// stc7loi
6.Is(arc)the wells)&—Permnnent or ©ITempnrory ::ignntur.of C.rrtificd WAl Contrm or Date
ltv.rrFminl;rlrtr Chrm,1 herrhvicerrl)y that the iwdll(y)was(wwr)ermanter`u1 ht actrirdonce
?.1n this arepairman existing well: Oves or CNo r�.r1rMASCA..'02C.0100ar13ANCAC07C'.02001Te11Crnr/ntenanStandardsemdthata
ft'lhia is:>repair.fill OW11101va ovIr emsfrnction i*imalinn oat'sprain the tuinn'e nriha znpp gflkc record Doc hear pmvidad In 111e well MWA•r.
rr,•rotr under✓N remark'scrr/on arum Me hard of fijbf ami.
73.5itc diagram or additional pcll'deWJis:
R.Par GeopmheMPT or Closed-Lonp Geothermal Wells having the same 1'ou may use the back.of this page to provide additional well situ details or well
amstnictinn,only I CAV4 is needed. hidicatc TOTAL NUMBER of,,ells construction'details. You may also attach additional pages if neeessery.
driliuL______... UIRMEaAl.1 STR
7.IrOtat well depth below land surface: (R.) 114% L011AVA,We)i9; Submit thi< form-within 30 days of completion of well
For nrnhipre wen.,liq all r6.prla ifdffewnt(esaniple-9(g110w acid z@ l00l canslntetian to the following: '
I0.Stotic Witter level Mew top of easing. LQ (It.) Division of Water Resources,Information Processing!loll,
1j'iralrrirrr.!I.eihnpeCrtrinp,lilt " i 1617EIail Service Center,Rategh.NCIT4"-1617
Rarcholedietnetcr: / (in.)L 2tb.For Iwicction}'Zeus In addition to sending the form to the address in 24a
i Z Weli construction method: T above,also submit one copy of this jfmm within 30 days of eompletJon of well
construction to the following:
0c,mtge^,'arty.ail+le,OireCt[RISK,�•te,) T—�
!'OR W,#TF R S1:PPt_1'WF.I.LS ONt Y: Division of Water Resources.Underground Injection Contra]Program,
1636 Mail Service Gunter,RA fth,NC 27699-1636
134.Yield(gpm) /D Llethod of test: 2+1c. Igor Witter Sppely&i kehot Well;: In,addition to sanding the form to
the Mdress(es) above, also submit one copy of this form within 30 days nr
t3h.Olsinfection type: ,Amount: completion of%vcll construction to the coitnty health department of the county
where constneted.
Id.mu(1M'-I North Cnrnrinn Dcponment of viwirdnmcntnl ouality..Division of Water Rorotircmc Rrvifted 2 22 gal b