GW1-2022-09828_Well Construction - GW1_20221028

Fob 161906:43p Clearwater Well Drilling 828-622,7242 P•1
WELL CON>zSMjT, T ON_12EC0. GW 11 -For Imemni Use nty:
1.�clt C.nntrnetnr lnfbrrnation: ��_
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2.Well Conxlruction Permit M r ft in.
i.la7 Pell opIthcnhru well cnxrmrcrinn pamtllr(Let.VIC.CPnary,Sale.Varhtnce,cr,) .i _
3.Well iltc(chests even list)_
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NRO N 1Y►
Agricultural uitia}po1/Puhkic (?
GeoncCrmal(14e81ing(Cortting Supply) Iteskdentfal Water SuppLv(cinglo)
Industriallenmmereial DRtsidcntkat WalerUpply(shares() 18 Vf
Irrigation ro MA t L tru► !rt a+4 A ores
iVnn►1'nlcr5upplyNetl:
A4onitaring Recovery fu fk
Injretion Wcll:
IAquiferRccbar�c afitoundwatcrReniediatinn t4 SpN11/GR�IVRLPACC I!
aquifer storapt:and Rer:overr D"inity antrier PROM TV! 7 tie, itanru►c 14a;NrM�rnop
AquifetTest nSwrmwaterArainage
ih-perlmental TmllllolnV 1:tSutwidence Contras
Geothe mal(Closed Loop) 1371aaer 20.nRlta.ttvc t oc aeh ids If naetittarsl
PRO 1rr TO � Tf0 mine lc tk kr�e gra�niUrs,einl�
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t.tlatclt'eli(s)Compllewll-a-1— Well!D9 c'� R. ft. rn"
Su.well I neatlnn:•T f tkJY�l L-5 �—� O n' t% ^..
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Physical Address,City,end zip LL 1!
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CaltrttY► Parcel idcntificntion No.(PINT
5b.l.rttitude noel MnAltude in degrBiWinimstexisecands or decimnt degrees, - lair
(e-11 ficid,onw ltagnngiinsuffielcnt) t II 2�,{; Orion; , Pr`c''''+'%
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±.In this arepairm Fin existingwell: Elves or No trrrAltr:VrACD2C.#1&VPr1SA.VCAC42C.021iOWtflCarurrnertmr57rmdarde(md ohm or
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r:;�atrnnder t121 ramnnkraxcnan neon tier.nncx nflhlxfnmt. 2;.St1F tliagratn or arttflttonal Weli delRiis:
8,For Geoprohe/APTer('Jawed-i.onp Geothermal Wells having the some ),Ou may use ale hock"of this page In provide additional well sirs dmits or ruell
eOnalmetlnn,Only i CrIV-1 is needed. fnd[t atu TaTAt.NUMBiiR of+.rtis construction driails. You may also m;tach additional pages if ntxessaty
drilled 1 AT,114S]RLt _OtYS
l Karat weft depth Ir41aw land sue sites: ___(tt.) 2,1,y,jar AN Wells: Submit this A mt within 30 days of completion of ucli
I%rr nrnlUp/c mrO,clit,aliAitpllu•fili�er err(rxrrnple•3 n.1Qp'nnd 2@lna� conslntrOm 10 the klsllOIT1119:
1n.SlAtie WAUP levRf helow tap of caging: ___._,._.__(fI:) Division ofWater Resources,InibtrmRtion Processing Unit,
1J tenter lucr,Jls trhara tpslsd,uae" "1 7617 Will Service Center,Raleigh.XC276"-1617
ta_Boreholedinmetcr: La
'9 0.') 211h.Bar Infection Wens: In addition to Priding*P,form t4 diir address in 24a
a Well conatnicNm►method: �j i�C�Y�_ cuesql?rlyc,also submit One copy of this form within 31i days of eompit�lnre of well
cnttstnrctian m the following:
(i C.m,gc-,mtnry,cable,4ioect ptuU,via,) •-�T'
Division of Water Rrsaurrt%Underground lidectfon Coarml Psogram.
fY31R WATER St;PPT v Lti`i ONLY: 1636 Mail SerVICe CCntCr,PAICl�u,r(C 2709-�63e
13a.Yield(1;PQr) � i ethod of(egos,,T� tile,For Aftler'quelY"&_FAkc oil Wrdir In addihts In sanding the Foote to
the oddrass(cs) Onion, also submit One COPY of 111I5 form WHIlin 30 days or
13A.DIsinfecnon type: ,Amount- completion of%Tell construction to the county hr;alth dcpaltmcnl of the county
whare constructed.
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