HomeMy WebLinkAboutWI0100503_Well Construction Record (GW1)_20180927Clearwater Well Drilling
82M22-7241 P•1
1. WAI Crairartor lnformattom
Josh Plemmons
.413._...7-A ...._.,.,,_._ JAN 14
`C Wc(i Cnnnnctar Cedificalion lounlo ,
Clearwater Well Drilling Inc. Ho Sp1gsr E,2 , 43
Comnnny
2. Well Construction Permit H: CJO_LT
Mr, rflepplknAle well parims fro. Coney, Store; Irinirrnce.lnJecflon, ere)
3. {Yell Use (rheckwell ose):
unic)pal/publle
(Healing(Conling Supply) I tosidrnLd WomrSuppy (single)
ormircid ORoulmajol Water Supply(Anmd)
C1Aquifer Rmhorge
OnrNmd"WRemndietimm
17Aquilar Storage and Recovery
CSelinity Bnrriar
❑Aquifer l'rxl
OStammwmaT pmiwago
OErperimernal Technology
OSubsidenee Control
OGenthetmnl(Ciosed Loop)
OTmca
�r I�-ins Q- -7 g
d. Date Well(s) Camplrlod: 0 , 1, 1 W??eq�,�f,M1 ' nn
Sn, WM l.ncntion: C`e\jooh n 3(9c -LC \
Fngiliryf0nanwlJa'nq P¢aay RM (irefulionble)
CM S W cu C- Ir -[�r , �rsbt i I� , PC
Zeal AdMM. . and 7AP _
�e o cave D� q s- CO j- 3 3a_)
6wnd PemN IdgnddoednnKo. (PIN)
Sh. IsHmdo and Innginrde In degreer/minutealareonds or derlmel degteast
(ifemil field, Me IA6lnng is sufficient) / m
Qom° l¢ 3,Ig ��. �l aS, W I W
6.13(ore) the well(s):*—Amrnt or OTomporary
7.1s this a repair In an rattling web: CrVa or ONa
if IAA' Innlrpan.flll ma known m.11ro ;Meaen mfoenallonerleepMln rise w1u,, nflhe.
repnlr n+MerAT/ nrnnrke.AnlMnnr nn the Lmk$IhlrJwm.
a. Nrrm6er of well, t,mtnteted:
!br mvheple rryecnon nr non.wnsrr.vvpply xvlk ONLP v4rh Ihervaxn mmburrinn, x.. ran
.aMmn nngfnn,.
9. 1OtAl well depth belowland anrface: ^,(g)
r*,mwuplewefl.Ntnall dq&,ifdffi4 rfennmple- 01'U1'U"I2[alon•)
1fl.S,Rtk wider level below top of casing: - —(ft)
ffwaerlmal k.bcr. cueing, ure -+"
Iljhra INomnl llxcONLV: i
N, f4 In.
v c ORT
R
In.
ft, ft. 1
N
70
fn ft. In.
n. R In,
01
rn MAWRIAL
n. -h
fL tr
% fr
NDMRAVBL PACK Ida male
PO MATaRtnl.
n. is
fa R
M •LOG qha d
10 DCY,RRTIRN-
n, 0.
n. n,
n. _ lL
D. R
P.I fr
& I —L ` oM91
r.
RAR
23, Cer/1Rution; \(iLj(tU�Q`11 1
-- q -a 7
Nrc ofCeniOad well Conkumr One
I//b',,•NgRMQ PAIA firm, I Fcrebp coolly JIM III. Im11(s) oa, (xere) wwme.kd aI amardnwr
wrl6 ldANCAP 02C.0100 or IfA NCAC o2C.62" IPa1lCnnrnmlomm Slgdardr amdMorn
cpynjlhfsraenrA/wx hampmerdMsm rin xWI omnan
$3. Site diugram or additional well depth:
You may use the back of this page to provide additionai well site details or well
rnlRtrygiM derails. You may airs almch nddflianal pagm if nr ely.
S(1BMITTALINSTUCTIONS
Ma, For AB Wells: Submit this fbm within 30 days of completion of well
"Preinlelifal ro the following;
Division of Water Roomette, Information Processing limit,
1617 Mall Nervice Center, Raleigh, NC 27MM617
1.1• Borehole dlAmeter: _- , (In,) 2Ab. Po�doo WeIh OPIIN: in addition ro sending lho thrm m tbeaddrM in
?f1A above, also submit a copy of this learn within 30 days of eumpfeiian of we0
e Well mn.Hnrc llon method: rnnieAion to the Poltowing:
(i,a. -ugly. mmry, 'Al.. dircctnmh etc,)
MvFlon of Water Rewurees, Underground Jertioft Cam"I PrAgram,
IPOR'AAlrfilt n
SiiIPPt.k' W P,LL3 ONLY: 1636 Mail Smite Center, Raleigh, NC 276".106
13m. Vidd(Rpm)__. _ Method of leatt 2*-e'er Water BaaNL@iejeetlm Well.:
" Also submit me copy of this tbrin within 30 dnysofoomplelimof
13K Dhiefrttion O'Pei—Amount vW11 canslnlrfan m the Malay health depmmrea of the county Where
I-mafi1v-I Nod'Cami(ne De runt anfF;mirnn P i most ani h'anrAl Retonmr-.Ilhdafnn nfWrer Rgimnmes Revimd Ausmm, 7013