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WI0100617_Geothermal Well Construction Record (GW1)_20210507
82M22-7241 p'1 Feb 1519 O5;43p Clearwater Well Drilling WELL CONS'rftUCTION RECORD(GW"xl 1 or lntcmni UAe C)nty: 1.WdifAintraetor information: i os h Q.lt i____ E s NE6 1 AOM Dli9 tveil`VoutradorNamr IC vC Well CnntracicrCatifolionNumber d.QD7ERCASIPi6 tiormu e.4 ' p TO atA177ttAL CnalpangNmmv _ Fb.iTrNFsRCAB NGtJRTItBlNG t6orrauil iao N i./`/(/ p J DOM TA nt+b1Crl 7i . TAIQIIYiSS MA'[S111AL 2.Well Construction Permit#-J[ R t i°• US'all amfieahfr veNcrmrrnrmlorllwrm/ls(1.a Ip[:.Crnrrety,Stalk Yarlrmcc,err) 3.1Ytdt Ilse(cheek well use): V,., su i'ersteaL pplyWc11; ns roulturalManicipal/public 1t. ermal(rjeating(Cooi--tug Supply) Residential Water supply(sing*) M to in• rIaIICommercial E)RcsidendalWaterSupply(shared) 1RGRO 81Nionerne fl. R Noff-water Supply wrile f it4onitoring ORecovery tr• Injection el: R, R Aquifer cReehar6rounCdwater Remedialion 19,Sa RAVBLPACK [° uC yg METli6D Aquifer Storago and 12erovcr)' E]Stilinity Barrier ROM TO M n n. AquIfcrTcct Ditto mweterDrainago Experimental Tcdmology Subsidence Control ft. R. Geothermal(Closed Loop) 3T(accr DBII'LiPiG LOG Geott-.'(if-w- ti Return) •Other(a sin under A21 Rcrnae.) eD A.Date Wdl(A)Completed:JWctl 11)it So.Well Lnrndnn: I acilit}d(laner llAmc ii4iy go(ifaaplicAme) l 1i ICi9 Physicni Address,Clt,and Zip r A vy) t1 Sy Camay Pnrcol(damificatitm No.(PIN) 51).Latitude and I'agittide in degreeslininalteslsecoodsordecimal degrees ifwait ridd,one W11oog in suirttelcnt) I2•Certiticatlaft: cVqa4 3D 5 - 7 yga01 efCertiflwtVdGllCantraafor Data k(arc)the welt(s) Permauent or ©17 emporara+yyJmtag rNlr iornr.!hrrrhvrsnrljy drat the nvJ!(xf rrtrr fM'e 4 emnd7rYbrAaf aeanrpo!rcr i.ih this A rtp8irtn An CidYdtig WrJI: Elves or IOIYO r+1f/ISA tif_'AC'a2C.410Urrr 1SA NC.AC 01C.'.111t10 WeNG r+rlrncrian SYandardrmnl then n q'thLr i.a rgm1r.,i11 m¢known rvr11 aataruenan irl(prma ion an crplahr the aanmm nrrhu pY njlfilr reeard hat'barn pmOdwi to the well Amer. r.,rair render A.1 remark rcatitm ar an the heat of 8/ts.famt. I&Site dhtgrtan or additional well dads:1'ou may use the back of Iles page to prDvidc additional well site demlh or well R.for GeoprobeAlIPT or Closed-L.nnp C,eolbermal Welh hAving the same axi4truaion details. You may also attach additimret pages If nocessarY muminlction,onivIOW-lisneede indicate TOTAL NUMBER of%vclls ti S f- m'.ri'l a [>. ve-rrM 9•Totat well depth below land surbec:IM4 2211a. 9'or Atl Wells: Submit brie form t+rithin 30 days of comptodon of Weil 1-er milhiptc wells lisl andeprrrs iftrefferent(exmupk-3(o17pP'mtd sLa17A0'1 const aion to the following: 10.Statie water level below top of easing: Ft) Division of Water Restntreea lafnrmat)on PrOcMirtg tltrit, I(water fine!1s alvtvs easing line"•" 1617 Mats Service Center,litatefgi6 NC2709-1617 I borehole diameter. in.) 2Ah.Fur 2kS up Vetis: in Addition to sanding the form 6t die add>ew in 244above,also submit one copy of this form with)a 30 days of compledan of well t 2 Weil construction method: ra>•nstruetion to the folirtwing: i e.rorge•,rotary.cable,diroA push.de,) 1?Ivision nfVl'a[er Rcemtrees.tindc><ground igjection Co Program. FOR WATER S1;PP1 if WELLSS ONLY: T— 1636 Mail:3ervice C Ratelo,NC 291v9-1636Came; lac Rot WAI r Cu.,.a re[Mtion Wells to addition to simding the form to 13%.Yieid(gpm) Method of test* the addrsss(cs) above, also submu anc copy of this form within 30 days of Antovat completion of wail consuuction in the county health department of tht:county I3b.Disinfecttan type: - w}rGYe eonattnctod. 1'mm CiaA%-1 AMrth(jmlirtnDepnrlmontaf linvlrrinaUmtal Qtmlity-tXvisimt Of wow ItaBCllree5 tavi"&2222atb