GW1-2022-09795_Well Construction - GW1_20221027

Fob 15 19 Drilling43p Clearwater Well Drilling 82$-622-7241 1 PA
WET+L CONSTRUCTION R1P.CGRD fGW-11 rnr]ntemni Use nly:
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t-pair under,121romarkr.,wFianarnathr.had-of1Alxfanu. :1,1,Site cliagrsmorattMonat well d2 tits:
R.For GcorirnhPltlt►T or Closed-1 nnri GeathermAl Wells haying the same you may use llte back of this page to provido additional weli silo details or well
MISIT1119ion,anly I GWl is needed. indicarg TOTAL NUMt3M of�.clts coastrucr{on details. You may also ak¢ah addJfianat pages if ntxessary.
9.7'0121 weft depth i►clow land SurAtec 't —(ll•) 2.1y. barn Weltr Submit this form within 30 tim's of completion of well
1%nr natltipir weacliy nli ddprlu ifdijlhran,re a nola.3tnt24o'and l a 10al consmction in The fallolying:
In.Static watmrlevel below top nreaSing: T00 Division afV4atrrResources,lafnrmation Processing Unit,
OMIT A-el Is three casing,rice•'." 1617 AUR Scsviee Center,INtetgh.T4C?,7rrA-1617
11_Bareholediametcr: Q (An.) '1.4b.Fur .Aiectiow MMr. ro addition to&ending 04 forts 14 Utf addrm in 244
L �F nllove,also submit one copy of this from within 30 days or completion of we11
1Z Well enntirnetlon method: 1 i caummaion to the fallowing.
(i c,suss-,mrttp,cubic,Qira,:t pnsR,�c.l
Division of Water Rtainlrm,Underground injection Control Pragnln,
1�6R WATER.%UPPFy WFLUS ONLY: Uri
1G36 Mail Service Center,VAlalgh,iyC 27699^R636
13R.Yield(grim) a Jl�r 1V O n0 of legs: v'ri 24c,rent Water 3un1EtV&�grSQHan Wrttltn In uddMon to sanding The form to
fire addtrss(cs) above, also submit one copy of thftt form within 30 dW of
rib.Disinfection type! Arnatmh_ completion of Yell consuuction to the county health dcpatunent of the county
v+hare constmctnd.
t+Mm G%*-I Qcmnry-Aivismo ce Wwar Rasalmas Dtrwised2 22 2a1 f.