__20220311 (51)

Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 p.1
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'V�IE)GL CO TSTRVCTTON RECORD(GW-1) Fnr intemnl Use OnYy: 1 V
f .
iie
tl?nntraets►r nformarlon: (
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_ � 14,Wan ZONES I
FRaiB To onscaurnos
wcit C air autx nine ft. fb
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:VeuCnnrtnrCeeti}fi rtnt � y OUTERCARING In we aR1iNR ,# Ate)� / �� �� rMft, TO me n &S MA.F i . RAL
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Cnartumy Name ON Co 3DI) I 011 C J 16.INNER CASINO OR TURIN (heats Dane diced-WO-WO2-WWConstruction Pamir a: IMO* TO otsptec&x rFtCwrtj s WAtE%M
i la oN applicable well emtuentainn()errata(Le.VIC.Cana",Sinkt'ariadee.etc.) fl- `
in.
3.Writ ifsc(di ck Well use): 0. in. —
Water Supply WA! - 17.SCR8 N
Agricultural om TO watteren &MS= THICKNESS MATEIr1AL
Sri Mtmicipnt/Public () in. A. iln.
1111 Geothermal(licating/Conling Supply) Residentiai Water Supply(single) "' R ff. 'la
i Industrial/Commercial f Residentiat Water Supply(shared) •- pU.f
Marti Dijon _FROM To ` . "
1n •��tJ. taH C
11 Fi . na.,�MOUNT
Non-Writer Supply WON: ... ter ;� ' (J�� ii
•monitoring gRe every n. ft.
njcetion Well: ' .-
$Aquifer-Recharge QGroundwnter Rcmcdiatinn
19.SAldi1/t;ItAVELPACK(#k1111111 , •)
ill•Aqui fa Storage:and Recovery °Salinity Barrier .i*ROM TO 616111.116iL 122PLAC8M814T!dation
II'Aquit2r Test j tormwetcr Drainage f' a-
II Experimental Technology °Subsidence Commt a. et.
I Geothermal(Closed Loop) fail aces •2a t1R11.1.. LOC.atthmh.odeidattd Unacesaavyt _
PROM TO MirIi rotheeAfytit,atalntrtu,tie.!
I Geothermal(Heaths •olin Return) f other(oxplain under#21 Ramon::;_Y i it. 2, tt �'•
4,Date Well(a)Completedt, a�2 Well IDt! - .� ft. ' 1 ft. � : t i
ctlinenttno• L-110 ft- qi i R• , I f
rr. • S s. 1p 1
aft
Ui I=i
Eicility, aler)(amc . Facility iDil(ifamplicabie) h' R
PO :prod Address,City,and Zip /y a r-C a1� A I� rt R. fl li 11 10Z7
C.t JlK Xv t ' ,21,REMARKS Htl
County Parect identification Na.(PIPi)
Sb.Ilntitudc and tnnpitude in degrees/minntesiseenndsor decimal degrees. -•.
Iir twit fiem,none tatgong is ancient) _ ?.2. nation:
0 l P N OY 3[. b4S ,rY f — Y•— �.
��jj Z Z
6.1s{arc)the well(s)>Y kermnncM or ©1Trmporary sign o al el on r � Date
"�T�� ��(( trh lei,:Baring tbre lam l haft*haft*ee1afy that I$r nrdl(g awe nine')commits!In accnrtlancr
?.is this a repair to existing well: �'�Yes or p(f iVn n• iS.i A ,lC'02C.0100 or iSA.V(:AC d2C_•.RWWIO 0 nermenan Stamina;and ohm a
I/'rhir is;r repair, ,/im,tknn,n trill lwecrrvcupn ittkxrna!icsa It .xpkwi rho nnn,r.•CON e'Pi'afNtis rcranh ire rdrar prtmlad fie the writ m im-.
t 7airanderS21 rcmArier attain nrnothe hark nftbh.fa m.
21 Site diagram or additarmt well details:
R.For CeAprohefOrFor Ciro ed-Loop Ceothermnl Welts having the canto Pant may oat:the back of this page to provide Addiiknal well site details or wen
constructing,only 1 GW-i is needed. Indicate TOTAL NUMBER nrwcIls construction drtaiis. You may also attach additional pages if necessary
drilled:
ir.'foray well depth below land surface: y __(4.) 24a•for All Welts: Submit this'fhmt within 30 days of compietion of wall
r nr nu hale welie liic an deafly rftiljjerenr(example-3(alpl/(1�.4.100)
consiruction lathe 1bIlowing:
An,Static water Level below top of rasing=._ (it.) Division of Water Resmtre cs,Inih rmation Processing Unit,
.uurdre Awe!framed maw,oils •.•'' t cx" 1617 Mali Service Center,Raleigh.NC2711199-1b17
11•Dorehotedinmeter: 0 I U (In,) 24h.For tekelinn Wont:: lit addition to sending the formic the address in 24a
12.Well construction method: fc)f(.11!l_4 above,also Submit one copy of this form within 30 days of completion of well
0c.sago',rotuy..cihk,direct push,etc.) construction to the following
FOR WATER Sf pP1_lr WE ONLY;
1Division of Water Recourses,Vndergrnand filiation Control 1�of;rnm,
1626 Mail Service Center,Raleigh,NC 274094636
13a.Yield(gp>n) 7�� Method of teal: iq. •.— 2.IC. POT WAtcr•_SRpiily Bt iakedon Welk in addition to minding the limn
to
13A.Disinfection tape: Amount:Amount: the address(es) above; also submit one copy of this n within 30 days of
c.,mpiction of well construction to the comity health depenlnent of the county
- where constmcted.
t nm.C.W-I Wont.Cnmhinn Der nnmenL.tf r:mironmcrhl Quality_Divisional'Wan.RoemirceF
_"_ Revised 2 22 Ind R