GW1-2022-07187_Well Construction - GW1_20220729

- ---- -- -- _... 828-622-7241 p,1
Feb 1519 05,43p Clearwater Well Drilling
WELL CONSTRUCTION RECQR G_W_>w.l I=nr lnlcmni Use Only.
i.Welt Antraewr information:
�.------- -_ O PR(N T DESCRIITION
lVCll(�(In1J1U�tIC -•- rL !1.
1 welb OR LIVER cif a e
VG Wr.I Cnntr+ctar Certification N+nn1Kr "S.tWPF.R CASING for motA ea+ed MATcaUL
UROM m D1,hiI, 6R_' 'entCXNBBS
t in.
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Compnny Name. i6.INNER C 1NG OR TIfBING dprmtal cloned NAtFdUAL
'-itt20M TO
DGMC'tr3a TAICKN6ss
2.well Construction Permit M. N. ft.
i.lst all applicable+oe1l cnKaraCllnll permits(I.e.UI(,.Colli Stale,Yarlancc•ct.) ft
n•.
3.Well file(check well list): T17.SCR8RN
Water Supply Well: lmom so 1011AMtLTI� at oT >& TplceuttL9a TaauL
Agricultural TRLiidenlial Water SupPly(sotgiC) O R.i (Ilcatinp/Con3rpply) '
---
ft
industrial/C.ommcrcial Residential Water Supply(shared) g GRQ(Ir MATERIAL 1rMrLAcetNCY U on&AMOUNT
tTRDM TO
ItTi noon _ - f*• E4
Non-Water Supply Well: ft.
U.
Monitoring Recovery -
lnjcction Wdl: ft. R•
Aquiferltncbargc E3GroundwoterRemediation 19.SANDJt;RAV6LPAC to licahfe 1ACcntstltdticrnon
t>ROM T MA tAL ..�.--•------
..Aquifcr Storage and Recover}' f3Salini tY parrier n n.
Aquiter Test 135tartnwater Drainage -�—
I Experimental Technology
Subsidence Control n fY.
Geothermal(Closed Loop) �Traeof TOE RIi.L1N GoLQG adta+ch N tam. ril ar wttrmcar ILA crc,
Geotherniai(Kcatin eating Retam► other ex lain order fi21 Remarks) Itt• fa ��
.l.date Wells)Completei.._.....
So.Wellll, croon: �s� ft. ©sn
l st ilihc'(lnmcr?lamc Facility g(if lopliclilli
h.
f ft. VEf
1 t ,
ft. R-
srrni AdAress,City,nn
2t. MARKS112
Cmuuy �( Parcel idr.wiiiention No.(PiM
inkronalttTtt:n Proc Un'
a"b-LRtl[ude.and longfttade in degrees/minutes/seconds or decia l d(eegrees:
(;r ne+knaina©.�;t>�� 0'j �� 3 "2 Ce fieati41C..
a L—ODate
rat ne arY Sign lur of Ce<i
6.ls(are)the well Permnnent or � p
�...,J 13v a$mi ;arm.I laeMhv crrrtf}+Nral fhr,rvr!!{J war tircrif trMs7rtt+7u1 h?accnrdmrc•r
7-is this a rc air to an existing well' Ales or p,}Nn x•ttG I.SA.Z"AC n7.C.01W1 or IJA YI 02C.'.n100 Well C-nnx+rnrrirm SsanrlorA.+mr�t rhm n
l+'fbia•is n rrparP fill mrtk/callo7 uv11 ronstnrclian i>rjnrmntinn did r cxpinin the rxrnu e nfd+a rnrl nfrhtr rrrvird hoc urn prmNdrd to the w:Q nwtter.
r;voir under z?I rcmnrkr stz►/nn nrnnc/tr.hark nJ'lhh jnrn+. 23.Site diagram or Additional Weil details:
1'ou may use the tack.of this page to provide additional well site details or well
R.for Grn mbeA/PT or C•It+sed-Lon Geothermal Wells havitag the same
txmsinrctinn,only I G%i is needed. ►tdiceite TOT Al-NUMBER cif��'rlls ct�n9��inn details. you may also attach additional pages ifnoctssarY.
driliul'_.._.., IRMITTAI lAi�?
9,TOW well depth below land surfecc: —.(R-) 241a• Ear Ail ells: Submit this form within 30 days of cotttplelion of well
trtn+uhiplcwr0.afixralid.�plhrifditjarrnr(<aamnlu-3fZ14n'ondi tnn� constntctionlntbcf 111138 112:
10.819tie water level below top of casing:__ _ - (ft-) Division of Water Restiurees,Information Processing Unit,
ffealer/I Is al oaring,uPae "1 1617 AI Service Center,Raleigh,NC274"-1617
ti.korcholediametcr: ll� I (InJ 24b.For laiection Wells: in addition to sending the form to dte adiress in 24a
�C above,also submit one copy of this form within 30 days of eompletiem of well
12.Well construction method:-- i-�►�—''(_ co-nstruction to the following:
(i c.anger,mt:uy.ad k,dira<push,cxc,)
Division of Water Retiources,iUndetground Injection Control Program,
M- R WAT'F.R St.PPr_V WFLL$ONLY: 1636 Moil Service Center,Raleigh,NC 7709-1636
I
III Yitid(gpin) IZD _ Methad of test: 24c. her Virater Can v&talec on Wells: In addition to sanding the ream to
the address(cs) above; also submit'.one copy of ibis form within 30 days of
1 ih.Disinfection type: Amo+mt•- eompietion of wdl constmction to the cogent)'health department of the count),
where constructed. 7
Pool Gw-I Noah Cnn linn Dcpnnment of t:n.ironmrntnl Quatitp-Division of Water Rrsource.� Revisal2-22-1,A16