GW1-2023-02314_Well Construction - GW1_20230331

Feb 161906;43p Clearwater Well Drilling •
8284122;7241 ' . P.1
uz ' s"'"a'ION RF.CAR1y rr+vr:.
For internal Use dory:
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in . 2.. Ls!.1_.,.. tail. i. immifirmui
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ill AgriculturalMlalialpa11Pn61ic met• *D out a •• s1,01112e
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III lfti:I 'net li�idduiat water Supply(shared) r
Nota'W P1Mitt11: Irr T •aimu►t. Cram.acemeor mamma oprocuer
lit MonitoringIr Recovery t^ ' !ii t t q 'k
ig
Aquifer Recharge groundwater Remcdiation n' i>:
'AquiferStgragGiatdRcatwpy °SAlinityBturirs S. M/GRAAVELPACKOrT.1--.r. ,
i Aquifer Test Drain 5 �1' ttmE2wr;• use • ,,.,
I Experimental Tetimelody ubsidenee Gummi a
111 a.
Geothermal(Closed Loop) DTtocc i r;
li Geothermal .., . .:H r Realm) OG(admit..._,:._- •.
.- Id Older •+a. 'In under d21 Ranigh} r� ,�,; •. : -- •,
'? tr. � tt. �6•f�� 1�. 4 ���ael i
«e Dare Willa)C+mapteted:p9 �? 2•r
sq.Well Location:
all MP V•R �I O• �� TI�.lL_
alnimmeilliiiiiiiiiiiiiiiw
Ile `• Fae/lilJrlDit(ifapialtaable} ' ft. I �J. r,
' lanai Add ��
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Comity 'MU
" t 1sr+�itnrittisit Parcel ado nitieation No.OM)
5b.6geitodC and 1
( w.one merb eg oimzterlsemeds or decirwl degrees: ANIMINIIIIINEWEIMIIII
6.re(arc)the wd'( l� ' __ ]
t:erR or �17'run@orary Signe.41r1,, (Ward%hammier / ,`3
Is this a ttpq(rd►as lair: .)+of• der(arm./ ereby ante,thin the tardral atru i
/ actorakeree
T T.
I s irin A r l sh-1 o a rn w . w nits or 0 with. nIt 02C.0/00 or rsAH ax_.aH/o fruit t at„a�potrmktA2lrcaalt teremiteborlo ainAanrrtnregrthe fh/srrtnrrl/t4sba:p ltrarn4nr�exrlardermd+hor4 jttDllfBed to l/lo widi„y�
R.Far CeoproectpPT or Closed-earn 2�Site th ern or additional wed donna:
R.Far
I GW-1 is p Geothermal Welts bovine the same You may use the back of lhbt page to
drilled'
needed.antihero TOTAL NUMBER ofncoLs constnction details. You mayalso O�ttogel wail ee& ty. or wall
/'�I _ attach additional pages�,
91.row ttCi1 depth below land argue: Q(lLL S
For,.td„p/c,veurtrunuacn/�tr�►ea!(ataaop�•3(�10o•�d�/dp) �+) ZAq r Wi ; Srrhmit°H.0 torn winan 3t/days of canpdjfion of well
lit metre�•'4nrllvCl below tap.of easing: cnnsllupileealt to the t■iitltotttog:
Division of Wirer Resupaem,Itaiitrnegtton Processing tltdf,
rimier tyre!IN Ouse mow.me". c.).
t r.Aonebotediarater: ( 1617 hid Servile Center.Raleigh,NC27699-1617
IZ Well conrtrue -{— v?Ab.star r■t;so_wetr,s; in addition to sending the Norm to the
addrom it e.ntse:rotary.cabin, etc l .. T�•
�also submit one copy*?this form within 30 da in Zen
canstmetion to the following_ ad pl�lme of well
PM WATER tsiCt'AL SWELLS ONLY:
Division of Water> teourc s.Underground tNeedon Control Pr
Lin.Yield( } Q� innsasad Service �ma
Method of tee Center,Weigh. 27b99-TQ6
zthe:tc, water nets& eieetlon yjer In addition to sanding the ram M
tan.Disinfection
type; also
— --�� .Amumb completion of well construction tatthe co one mrPF a� within this farm 30 days of
laama CW.I whore cotatttuetedd health+RFattrnent of tflon4'
NOS'Carolina Department oft:awtruiaiwm
tnl Quality-Pi vision&WaterRemo em
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