GW1-2023-02455_Well Construction - GW1_20230404

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Feb 15 19 06:43p Clearwater Well Wrl ing 828-622-7241 ' p.1
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WELL CQNSTR'iICTION RECORD ww-11 For Interim/use Only: - ' 1
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M R,ADS 14WAT ZONES
rttaN! ro mumililrtott
Well Cosmos Noma D. O. I I ,
V eilCmissoareettiSetgenti 15.TITER CASINO Dor� Oily /it�l
0,��,�,NI t'V� r �1.\ I f \�OO ",cow , ro ni lrQltltlt� TI; W
tt• m a- �� - —
oram
16'WI"
2.well C011sh nelson Permit II: '� """�"
Q. it_
Mutts(opAraide Pall aamtmrotian petmltr(La 11C Camtly.Stale:Variance.cat) in
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3.We'11 Use(check well else):
Water Simply Well: —��17.SCel/ "TO --010011111 swarm 'D#lFtnVpa R4►'tRatAL
ji A3ricukural El onioipol/Publlc U 0:. R. b.
ill Gootltcnnal(L3ealing(CoeingSupply) Residential Water Supply(single) e. {t, la: i
E InduslrialfCommeratal Residential Water Supply(shared) tpmcgour -
II Irrigation a sssetrts�iritta'erst AAUstn4011
IVat-Water SupplywiD: I O"l t
I Miniton •: #Recovery o. fr. .
n cotton'-'et: - is. R
II'Aquifer Recharge OGranndwater Rcmediation 13.-9,01I!/GkAVBL PACK R
1i•golfer Storage tad Rumm ©SalinityBaules "'ARer1 TO +► nwfi.+ciatarrzun t�vm"'—�
ill Aquifer Tett r3StnortwaterDrainagc a' °'
II Experimental Teeimology •D.SabsidcnccControl n- ft.
MI Geothermal(Closed Loop) Erma :20.PERI IOG( ,.- rs1-
JIM TO 1z` , neRhee4 [raMriraete3
•I Geothermal -:,. .. e�oli ;Ream) 111 a mink Remarks) tr. ‘��a 1 �Y _...;
4.Date Wdl(s)Completed:2' �t ll mgag _\3R^ OD art: let'
5 WNl LocaN Nn re- RJ 1 D.
r� VnUIc 2 -n`C. Zo\ift: -
irecaitylOrmerflmne r &any 106Ofe),ptieehle) n• n• r---� ith—'3 ,
Pinball
Addresl,City,:n4 tc'�, P.F'R yt !a �Q23
• L21.R1.1frl,tRt(ls
Parcel lebnilication No.(PIN) t _ W '
�XG�:,.s. ng l,T r.1
5h.Liititude nod tongitade isdegteeahnhattcdlecendsordecimal degrees /
(irwptl f(e d.one Mang is nditeIW)
" 15k O N $3 3—C2-23
t 1 lV)0 W ,� Ho>,:
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6.lout)cite weltp) „ Ptrmenenl or Dr mpotary Si cos Certified VlrellCaatreetor mete
T ,y,,,� ap Amos rltla•(urn,l!tetchy earm&elms/he iwL4)ors fl ra)ca arami et occouronre
7.Is this a repatrno an es hell well: nits or(�No with s,A NC,(C:h2C.(t100 or ISA Near MIC.tl111D WWEFCr nslrorion Stmalarda and that a
OWsian mole.111i o ubuneet wQ.waamatot Olwcrtose/at plain ihcaannegrebe �Ynfll UebritMi em pMl'l$2d 0 antI miser
r palr lender 121 is rmttt secant pro atlrc hack Of'Miami. 23,Site diagram or additimwl Win details:
&For Geaprobe/OPT er Closed-lamp Gemtbe nual Wells baying the sane YOU may use lice bock of this page to provide additional well dile debu7s or well
cons nIotiin,only i GW.I is needed. Inds to TOTAL NUMBER of-wells COMIntoliof details. You may al no Sited additional pages If fll1es hay.
drilled:_ .... _ �11tM11'l Al,Ii TRUC1111NS
2'agl Well depth below land 311ftacc: � " (t) 24o. leer AU Wells: Submit this form within 30 des of com}leloo of well
For multiple wens liv atIdartha reCearanr(imsrpla-3(FF}T7OW.=1201an1 .
LYmoti0Ct10r1 to the fullDtring..
111.static wake':vd below top of emdag: -. • (fG) Dirillom of Water Resources,balbrtnatlon Prole ssieg Unit,
UMmerAnvils Ohara casing me 't 1617 Mail Service Center,Raleigh,NC27699-iti17
1 I.RonStotediameter: l.Sr '0 (1a • 21�Sew i atectiog Waite In addition to sending the Loon to e address in Zia
12 Well construction method: rb above.also submit one copy of this fore,within 30 days of completion of wen
it c•nuae-.rose.cable.&est push,etc.) construction to the foflowistg
PEA WA RTE &LPPt.V WE1 14 ONLY: Division of Water Resources.Underground Infection Control Program.
_9
' I` i 1636 Mall Service Caron,ReleTS5,NC 27699-fh'36
131,Yield Il;peel- `t' Method of ese G 24.e bar Water Snub&Infection Wet; In addition to sanding the fine to
Ibis sddwss(cs) abase,also submit one copy of this limp wihhn 30 days of
13b.Disinfection type:, - - Arnmint: - comptetion of well construction to the county health depteunent of the county
where contracted
Menu Gtnl.I North Carolina Depeatmont rtelinebiliinratel Quality-Divrseonof Water Itaemm s Reaed2-22 2a16
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W.0 Driller$ f.$put
Gre
NewVi�ell:
Pew
I h xy certify that the above referenced well WaS grouted in appearance in aaooandanoewith
all County Well rules.
Well Driller,, difOLAD Si erL• _ 3
Cet iftcate#: �� 3 -A _ Date.Grout�ad: Z- �S Z
Construction: Grout
Total Depth; SU - `1'YPe: .,9 -I"
g Type: Thickness: ail OL4O ,
Casing Depth: 1 O Depth: 3D.meter .
ty
V�eightaltdc.• .
Drive Shoe:
GPM: . ..