GW1--03229_Well Construction - GW1_20230511

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Feb 1 b 19 06;43p Clearwater Wall Drilling Q`�iG 828.622.7241 P.1
WELL CQiNSIBUCTION RECORD?(GW4) For Internal UaoOnly-
I. 1 Contraetnr'Information:
WeilConbagptNarae it. D.
NC Well Cnuuradw CatltAtutinn Wilber ,ls R Ci491llti g1r •C 1,�o. cikx \M Q to 'Dh U• U l n ieo m _ �,Q i. ' -_L:_ nu • w
Company Name (�(� ( r� �O 1� l�' .
x.1?1'cp CO110sh0etlon Penult It�' ZV zD ' V V l0
MLR C i pt�e An 19 lll.*""�.n :MAIMIT •
idrt at opp n2bleirell anurniaion prima 1RG CtmaJ'Sial4 Wirllo'e.ntc-) f4 (� - ion -
3.Writ Use(check wdl use): n: sn
WsicwSnppif Well: 7.8C. ,
A Dfinithili tiblic 1) Cr- re ft. ntA,i i- marervsa �rttaatarttas MAn.
Qeothamral(Heating/ContiiSupply) Residential Water Supply(single) i. O. la. ,
Industrial/Comtnemial f Residential Water Supply(shared) IN .
irrigation
TO IFrt✓i M& - ,:*' if .&A i'
Non Water Supply i,Vellta �— b A �,� d -�� `\L
Manito' QRacavely O. it.
ejection Well:
AquiferRedirepc Jt)roundwaicr Rcmcdiauion ft. ft.
19:3ANDiGHAY6LPA , If )
quifcrStorngo end Itccc my Salinity Battier soma Td is .IT r, t _ _ •sc — t
Aquitin•Test riStr=water Drainage _ n- 01'
Expo-imam)Tedmology DSubsidenco Control rt.
Geothermal(Closed Loop) ETracw 20.pll11 LOG Wish ..t. rY7
Geotltcnaot(Waling/Cooling Renton) tJd16er(cxpfaln'undor*21 Remarks) t+sd* no11. ` ; ' `' - nERlrnrklypawwto atra
4.Date Wallis)Ounpleted -a "cF 7wcll WU _ p it. i� �. OLI ��
La
Sn.Well McAdoo: but. l i R' 1 # : A l.Jr-
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CrSnn,i'e H Do . •b\f' 54 Sf' (1‘ CALI
i�aolity.'tlwner llama . Fooldy 104 Of applicable) t IL it. - J o f �" , -•--_�..
t to a
R. MAY 1 1 2,0?3
P WI Addrett,City,and Zip
Camay Parcel idemifeation No.(P1N) pglc,Ys•:
r�cs��'�llr;i
fib.Latitude and ton ma;lrtyr ri3L
Made ita dcgtsxstmimrtesfaeeaedt:or decimal degrees:
orweUl flcbi,one tetlicngi i ffinimt) .2.Ce don:
31 '5y-E . N W72 t ` 3-7 1- 'V vv\/ 4-Q-a3
&Nitre)the well(aj Permanent or �1Temiorary slant ofelettIfrci Wed Coahactor pin
D✓� Ilu.onus Om term,I hatwhv rrrlljy Mai the wdl(.)was fleas)oatrn m mi As awordirree
I-to this a rcpairia as misting well: YYes or No with iSA l CX 02C.W UO or ISA NCAC 82C.0200TMI ConsItsa tonSfmalcrdr and den
iJ'�lrivo oniellNattlennwnwelltweetvan information again the mareeihe 41'PYnjlhr'wolf W4ebtxD Ina idtoMe well"Wan
r. alrtrltderAlt rentriesavlett armlike backaftd/rform.
n.Site diagram or additlaml welidaealb:
8.For Geoprobe/D T or Closed—Loop Geothermal Wens having the same 1'ou may use the bade of this page to provide additional well site details or well
ren®►ntclIan,only I GW t Is needed. fntatatta TOTAL NUMBER dwells etx►4truetitOI details. You mayalaA elfaeh addidanal pages ifneceasery.
drilled
Ftltihil TAL.INSTRUQUIlel
9.rear wen depth below land tluM aq`J (It) z For All w roratdupfe well*rivalla.7xlartJdlRaiem/esu+mla s0Jaa au en: Submit this form•within 3D d> of completion of"well
«errsmtctirm to me tato►►tug .
it Stark water level Mow top of easing: (1't4 DivisionofWatteer�R�oaaureea.lafbrmallon 1,ri orturd Ir dhows casing flu+ i 1b17I1+1oR he"arvlee Confer Procession Urdt,
!n i .WtetgL.NC27b99-1617
it.Ronmoledi acted W (in.) 246.Rnr InIgetlni We In addition to sending the form in dm address in 24n
1Z Well conat►nt don methot). ham)'k-CL above,oleo submit me copy of dila font within 30 days of eensid ton of wen
f t c.algal nary.able.durNpi dt,etc) t canstradinn m the fallowing
F OR WATER fit PP1;V WBI IS Own - '' Division orWaterReaauroes.Underground 1nJ Uoo Control Program.
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aa Q ifi36 Maitservice center,iotlt:fp,WC2766Rt-!!tali
• 13a.Yield(gear) v© Method of tell: 1✓�Gi 34e.For Water Smutty&fciectian Wee: In addition to sanding the form in
i9b bisinferttan tbs uddtess(cs) above aiso submit ono copy of this form within 30 days of
type Amount: camptason of well constaaaion fa die,comity health department of Ibe county
where constructed.
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Fenn GW.1 ►inthCa niianDapmtnttntofEnvirdinnestal Quality-Dfvisuurot Water Raramtxs
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