WI0100629_Geothermal Well Construction Record_20210918

Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 p.1
WELL CONSTRUCTION RECORD{GW-1) For)ntemni Use Only:
1 ,ontrattorinlormation:
K WATER ZONES
Well C'ontrat2tx Name rttoss Tn DESCRIFrION
Well CnOndor Certification Ntonlwr
no
iS OUTER CA.i1Nti for mat6gte0 we OR LiVER a e
I / PROMM DIA rli[l9Ct( S MATERIAL
1 `L ft, f4 I in.
Cnmpnny Namc
r n^ 1}16.INNER CASING OR TU81NG thprma!ctaacddoo
2.1Yell Construction Permit#: v y D[V 1.1c d- 1 MOM TO 014MEF I TarckNEW NAtEtWL
i.lrr I'll applic-Ne well crntrrrucrien permit,(l.e.UIC.C.nmxy,3mlg Va ta»ec,Cr--) h• k• In.
3.Wrll 115c(check»ell use):
Ir. ft. trti
tYa to Supply Well: iz SCRSBN
Mom TO DIAMETER SLOTSME TRICKiYFSS MATERUL
Agricultural E)Mtmicip2Puhlic o ft-ft. K
Creothermal(Heating/Cooling Supply) Residential Water Supply(single) g•fL in.
ustrial/Commercial Residential Water Supply(shared) 1&GRa11T
Irri^ration FROM 70 MATERIAL 6MrLACF.ME.VrMP57idD&AMOnNT
iVnn-li'nterSupply'1'rll: ft. fr.
Monitoring Recovery ft. fr.
Injection Well:
Aquifu Recharge GroundwtuerRcmediatinn
ft. R
19.SAND/GRAVBLPACK ifa licable
Aquifer Storage and Recover' USntinity I3saier FROM J To b9ATMIAL trtACrrxBNTMLTIt00
Aquifer Test SWMW0ter Drainage n' fr•
Iixperimentai Technology fjSubsidence Control tL fr.
Geothermal(Closed Loop) 137'racct 20 DRILLING LOG faftth additional Wheels
ea
neaesa
PROM DE5CRTPTiON Crbr, rdaee,taR/rotk t , rate siu,ete,
1Cientherm.1(Hrin Cooti`trR Re1a,rn) ^ 01ber(explain under#21 Rem
TO
arks) ft. IL
4.Datell'dl(s)Cnmpleted.(I `C7 Wc1IDt/ a fe. 3 tt.
tSu.Well Location ft- R.
tot t
facilit,'Miner?lame Facility IC61(Ifapplicahle)
A. o D ft
53 t.C16 1 Cre e-L Tr, krd 0c, !
G_
ft. ft. ati a,srtn
fsiml Aeldre s,ary,Ind rip ft. tL J A N 7 202?
21.REMARKS
CmuuY Parcel Cdcntificatinn No.fPily rl t(,;EI;III ia
5b. OCEWNU UN'l 1
Latitude and longitude in degrees/minlittsfsecandsordccimol degrees:iC'?Fi
iiwo11 field,one latnang is suiricicnt) p r
r3S`a-) 5-
A.1s(are)the well(s)t4p-manent or ©1Temporary tiiitnawrc o Cenifia{WeIlCtmuactor tie
7
1ey tigni»g thin;,r'm,I herrhp erno:that die+w-11(4 wa;(were)crmsu wed in"mrdnace
7.lythlsArepairtoanexistiDgwcll: Dyes or No adrhlSA?iC',1Co2C.0100»r1SANC.ACO2C.•.0200W¢ItC rrs/nrrtinrrVamloo-dxerdrha+a
011hicarepair.fillmake»nmxrll+ax,arnuirvrigjnrmalio»araicrplaint e.»mvrtnjnc, i»!!Vnfdttthxlrn)haehra prots3ndlnlJre well ntvr7rr.
rrgoir tinder i 2!rcmnrkr.rtxr/rdt or nu 1/rr.hark of11N,r form.
23.Site diagram or additional well deMils:
R.For Geoprobe/i3PT or Closed-Loap Geothermal Wells having the same Vou may use(tic back of this page',to provide additionui well site details or well
mnslntction,only I G%%'-1 is needed. 1'2 i o TOTAL NUMBER orwclis constrvciirm details. You may also attach additional pages if necessary.
drilled
a area
n5*,Qft TA1,1NSrRti C."il<ONS
9.2'otat well depth below land surface: DJ 14st, F0 All Wells: Submit this fort within 30 days of completion of wellFirinarllipleWedslilta1)dp11taifdr$crrnr(rtmnple-3C»1100'and 100)
constnoilmto the following:
ltl,Static Water level helot,top of taiirrg: ft.j Division of Water Resources,Information Processing Unit,1)'av hrr fur e!ls'+vhrva c7rr/rag.+rae^•"1617!flan Service Center,Raleigb,NC 27699-1617
11.Bonehotcdiameter. in.j ZiK For IRjection Weill: In addition to sending the form to the address in 24a
I Z Well construction method-
alcove,also submit one copy of this form within 30 days of completion of well
6 C.au a.,re, cin stntetion to the following:
g tap.a7bk,direct pttsb,etc')
Division ofWater Resources,Underground injection Control Program,FOR WATER SUPPLY WELL,4 OiVLY:1036 Mail Service Center,Raleigh,NC 276994636
13a.Yield(gpm) illethad of test: 2-tc•Far Wate elrSany&IRieetion Welts: In addition to sanding the form to
the address(es) above; also submit!one copy of ibis fort within 30 days of
13b.Disinfection type: Amount:eompletion of well construction to the county health department of the county
where constructed.
Form Gl4'-I North CnmlinaDepnrrment,if Iin.imnmrnL i Quality-I ivismn of Water Pcmurees Revisotl221-201 b