WI0100510_Well Construction Record (GW1)_20190104

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828-622-7241
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i. Well Crmlra~ Infortoodol
Josh Plemmons 11lat�r.
4137-A
N1: Well Cenrracem Cenificenan Nam6er
Clearwater Well Drilling, Inc. Hot Springs, NG 28743
Cnmpnm Name _ �f•'(,
2. Well fbnstrn AOR Parrott R: —�-�
IAee Mlr{gdmnhk Aril pmMlt h•a. Cwmpt hvoR Vrm4,nrr.lrp+clbn, ele)
3. well flee (eheckwem ase)c
Supply)
❑AquJcrRceharge
OAgnifu Storage and Reenvery
OAquiler Test
13VNpedmcntnl Technology
OGanthermai (Closed LOOP)
a. tote Well(!) MI
SO, Woe IA ndn"..
I_ lManicipolAPublic
❑Residemiot Watersupply (air&)
flReddamial Watrr ,Upply (shared)
❑ (`ermMwnter Remcdietion
CSaliniry Barriar
OSmrmwam' Oreinaga
OSubsidenm Central
ormces
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t�i�11s 1?�ver 1�ic
Crwnp• perch 61amldmmanNo. (PM)
So. I.atRMu and LonglMde is, dagrcea/mimnnAseaoWs ear deeprml elWnR
(irwetl fpd, nos btAang it suffidcm)
035 �� . ��+. rL Nova° r W-1— W
6, fs(are)KC Wr11(!)�el'mnaanl M ❑Tmnporary
7. L, this a repair to eta existing well' CSYas nr AD
Mao ern rtpwnPUoWAM. mil marmWentm olybrmadonnm/st kh, the mmre,fW
rvpwrrnMerpl/remnrLrxrcrMnnr ov the ewe#ef C' /S
A. Numhcr nfwNle mminlcl¢d: ��`'
par rnWoprc• rgfeeAon nr rroa-warm rupp(v WrIh ONLY xdb fAe tmen ram'harAan. Jsne mn
xohmn mmfn,n�.
7. Total well depth hetaw land anrfam: (ft.)
),nrrmAnpre veItrI&,aItdaplk,if ffrew(trample-djfod';Rd 2©IOb)
10.SiMfe Water level below top ofearing:
(I `ralarA:rrl4above meing, urc"+"
11, Borehole diameter: _ (in.)
12. Well mnatntetion method;
(ta. Pane. merry, rsEle, e6eetpwh etc.)
IROR WATf:RSUIFTLY WRId.30NLY:
13a. Y)dd(Rpm) Method nftah_______._
13L Didalls do r ryinu Ansounn_
yu•�
t rm;ff_�cPcfton
tb. CerNReatiom
4i n,rc efcmlfAd Wallcamaetor C °
h n/pone Nde fare, I Aercoy comfy that the wM/N Wnr ri r j enaraacw N oce"dwe
`vub lfA NCAf' 02('.0lno ru lfA NGCa2C.d2dd IPeNCemfrvrnan SPoMmrh andtAw n
rryyaf,hlxremnd ore htefilt"Oedm d*WIt 0w ,
U. f,)te dMgnra or addlttO=l Well details:
You may Ilse the hack of this page W provide additional well site ddeits or well
anutntction drxals. You may elan aaedt additimnal(toilea ifnerxssary.
SURMr7'TA__L!N87'U_CTf(MVS.
No. For -All Wells; Suhtrdt this form Within 30 dhyx of, mmptdton of writ
maslmntion taiho 11ARMIdng;
Division of Water Raanorecx, Informadan Preteadag UAN,
16f 7 19ervite (',enter. Rsldgh, Ne 276"9 1617
7Ab. Far tdlt figD Walls ONLY: In addition M smdfng Iho fhrm to tbmsddrese in
24a above, also oubmil a eopy of this fmo, within 30 days of mmpletian of well
construcuen to the following
U(vfainn of Wader Regoveses, Undeayreaad Injection COMMI Praream,
1636 NO 8uvkc Canter, Rdelgh, NC 27674A SM
P,, O Use Waept,S W & Issieptiet, WdM-
Also submit Ono copy of this fbrm within 30 dnysofanrtydttinn of
mail mnsrrumlon to foe mumy hralen department of lire wimry where
owtsbaeted.
Perm GW-1 NarA Carolina [lCpMnmaafP.mirnnaMAM Nimol Ralpnrerr^Divilon orWHOrRaeomorc ReeAred A,µsm2m?