GW1-2022-09829_Well Construction - GW1_20221028

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Feb 151005.43p Clearwater Well Drilling 828-622=1249 „ .
WET,L CONS'li'RUCTION RECORD iGW-Xl ) nr 1nlclmnl iJsc niy:
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?.Well Construction Permit#:,.„�,.,r,,,.�_ l LXyy Et• ft. in.
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3.?Yt91 ilic(chock well use): 17.90 ft N
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Geothermal(Reating/Conling Supply) Residential WaterSuppi-v(Angle) Et. ;, h+•
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Aquifer Storage and Rcerlvcl), �".
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r..anirnailer01ramarkcs tanarnnllrrhackaflbtc.jom,• 1;,%todyagr:tmor additional waildowils,
R.For GeoprohelopT or Glttaed-l.nnp GetlthermAl Wells having the sane YOU may use the tuck of this page to provide additional well she details or well
1101stinction,only I CiWl is deeded. rndtcarrt TMAL NUMBER of kvrtls cnnstntctian actails. You may also tdtnch additional pages if necessary.
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'l 7 oeat•well!depth below land surface: -^ AO S7 F* ;l4a. 1For AH Wttls: Submit this form VAtllin 30 days or complrtion of xtell
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M.Stntiu water levgl hclaw top of rasing: (ft) Division of Water Retr wees,Information Processing Unit,
!jxatarbnrlIsI'dwritCab•1ng.lae 1617114ail Service Centan,IZateigihNC2.7400-1817
t l-flnreholedflameter: W ' �._(i1n.) 24h.For Islectign W" In addition to sending the Soap t4 the Addnas in 24a
1 (J 1 l U zlmve,9lsn submit one copy of this fmm+vithin 31)days of compledt m of well
12 Welt ettnztrttellnta method.-
tic,mt cnnstntction to the foilotving:
mtnrp,rabic,direct pusil,cic.)
Division ofWnter ReatHl ra.Underground injectlnn Cnntrnl hiigram,
FOR WATER SUPPi li WFLJ S ONLY: Iy � 1636 Moil ServUx Center,RAlaigh,14C 2.7699-1636
13a.Yield(Rpm) v IVEcthnU of ta41: r +� 2 tc,leer Water,upof &TAFteflon Wclis: In udtiition In sanding fhc(brm to
i(te oddrrss(es) above, also submit one copy of this form willlln 30 days of
IA.111sinfeetian type_ — Amnimt� cnmpiction of%Yd l constJrucdon t:a tho cotml)health depamnen(of the county
where oonslmCUA
Dorn)M.I taattti CamllnnDeportmcnt.iftinvininmmril quallty-Divis,nnofwMar RosenraeF Revrse42224ftf6

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I hereby cm*that the above re emced weu mms grouted m appeamnoe in ac=41001 with
all County WeRMes.
well l ler; eocAu-� 5 ed, 7- —
Certificatef<q 1 l Daw Grouted- =-Z =- 2- �--------
Construction: Gwd.
Total Depth• 'E�Js = ---^-- r
Casing Type:" C T17ie1mess: Intl
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Diametm:.
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