GW1-2022-03373_Well Construction - GW1_20220314

Feb 151905:43p Clearwater Well DrillIng 828-6227241 P•1
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r+u0frr M D7A MATERIAL
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2-Mlt Construction Permit a. �/11C _ 10 Rn rctcel `s MA•tss U^U
00 nit n/yrlim9ly sell cvrnxrntdlan permits(1.+-111r,Conaly,SMrc,i artmrrc,et: Tn-
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Geothermal(t•Teating/Conling 3uppty) g01idential Water Supply(cit>Ste) ft. tl. 1tti
Industrial/Commeroial R`esidentialWalerSttpply(shared) Cut,
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19 SAM=ftg!E PA 1 hte
rAqui ler Storage Md Kcr overt' Salinity Sorrier Tq} MATISM _t:ACEMEnT MLS1i4R —
AquherTcn [3.SmllmvatcrDrainagr FL IL _
Experimental Tcchoolop Mlibcidence COMMI n. it.
Geothermal(Closed Ump) D'V= Oftit.LOG 10C&AtathaddilleaddIeft Ifinzq] _
Geothermal ttf aolittRRcaom) ther(ex lain under#21 RtcMMl:sl FROYt TO eeler. 4fyae,anlrmrlu,eMd
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(:aun(y Parcal fdrntitiaaion to.(PIN)
'h.Latitude and tonAltude in dcgxWlminuteslsecondsordecimnl drgreec
(ii well fide one IaNktnll is snflicicnt) p 31 t(` I lion:
ti.)s(arc)the Well(c)fYBPcrmnncnt or ©ITrmpnrary ;i ntma fCenific+tv✓d! anitoetor t)me
7T�� FU sharing+utv;nrm,f hrtwhv crash:alma lhr oral(.)was firer:)miumvrnsl In arahrdance
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J'Uri,ir;>rcpDtr,.lJl onrkrvrntn urlJ a,>nxlhat/nn iltrprmolJPn rdcril"rb:Wit're r!(rhe e0A1,1{fjhft rre'led h4a Arm prorl"!trim tve"I muter.
r,79/r tatder 01 J rrmorkc xcrttrn noon 1/ra ho:L nfrHh fnm�.
23.Site diaRnum or Rddltitmnt Welt de altst
s.ror C'coVrQtPe 11PTor(9naed-lAnp GEMheemnl WeRa having the Sant* V011 Wray use the bed of this page to provide additional well slits delni)s or weil
cxlnstn+ction,on)v I CM-1 is needed. I'ndicme TOTAL NUMBER of-rtis crmstruction(fctait— You may also attach additional paM ifnecessnrv,
drillui:_i
.....w.._... __�__..,.. �;�l���r•fij1i.41'RUGTtONS
).'Total well ne/depth&/; mr land sumitrrx (R.) 2,fn. for All Wert Submit thin f0rM witIlin 30 days of eomplrlion of well
1%rp nnr!!lplc xrA rlirr(+lid%r/hr ifd;,(/errn!(Doan+ele•.t(n�1?p'and 2(r�lnlJ�
ctmshtiction to the follmVing:
10,Static WOW level below top of casing: M _�__(fr-) Division of Water Resources,hdhrmatign Proeessiai,Unit,
//•Mml,•r•/ur,•J Jx.>h,1Y.'>Cm'Jn�,ux`•' M17 Mail Scrvlrc Center,Ratagh.NC276"-1lil7
ti.Borchotedinmecer• _�h(ia,y 2t1V.For rAIM11nn Wills; in addition to rending the form to the addresst in 24a
t2.Well ramtrnetlon method- above,also submit one copy Of this form within 30 days of complrrrllarr of well
(i c,sage rnt1s}.r dale,dirtxt pus)t,uc.l �----- c140n[ction to the follorAng:
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SUPP1 lr i,LS ONLY: Division of Water Resawt.%Undergtnnnd linjet:tion CoRtMI Program,
I636 Man Servietfeunw,Rolelo,NC 27609.T636
) Methad of(eal: 2•tc For U'ater Snook&fa➢eelion Ad►r In addition to sanding the ibrm!n
tn►type_ the mldress(cs) abovo; a1So Submit Ioae copy of this form within 30 dot's of
.-- ....— Amount: eamptetion of well mnsimc don to the Monty
httalth department of the county
Scher*constructed. t
Vann ow-I C
WorGram"naDepnnrnentofl:nirdnmcrralpuamy.nivi5tonof wow RoMin!" '
Revised 2 22-2n1 R