GW1--03264_Well Construction - GW1_20230511

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Feb 1619 05;43p Clearwater Well Drilling 828-622-7249 P.i
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UL T CQ t1;rCTIQI,'j RECORJ¢(GW 1) For{ iicwoJ Use nay: ur .w
1.Welt Contractor informa(d=
{ inicti4 WA ' 1
IvddCmtgncttxNamf: � Tt?ZONES .
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ynC Well t onhaebu Certification Number
id.OUTER CASING Dar Ql� )
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2.Weil Contraction Permit gl IC: I OD I al c� v . n � �r ;�t+t11�A[. "-
ldrt all aepticabiewetteetwawatlan paean(L,.INC Come Sale Vds w c.ere) N. a. - in.
&Writ Use(check well use): n. _ �. •
Water Sappy Welt: t�sc•Rl1EN n Bt�t�ftr+t > mammas' >a�►xmtur:
A9tricultural Municipal/Public ( It* ft. in.
Geothermal(Lieatittg(Coolittg Supply) cstdentiai Water Supply(single) t. fi.' ;a,
lndmhriacernam dal 0 esidattiat Water Supply(shamed) -
UD� I AT AtA1. `.mttrt,acttitre ra DRAl11nor'Irrigation aDM 7f1 /gin(� } / �,
ivoa 11ulerSupplyKlll: —
I fv. a� &1 '�`J 1Q 1 frAS --! e
unto. EJRe covert' a, re. •
Rjext3am 11: .
Aquifer Recline �GroundwmtmRcmediation ff.
It S wit.PAC/it: n�1 11git A
Aquifer Stomp end Mammy °Salinity Banta PROM TO iYIA r. mtt'twCttntaln•Smhwo
Aquifer Test jSmtlnwaterDrai� '- a.
Experimental Technology OSubsidencc Control o. it.
Geothermal(Closed Loop) ETraca 20.DRILL'VG LOG( +�iirllt i�
Gamin:,mai(Nrating/Cooiing Retainer) lodttx(aplohlum1cr 21 Remarks) Feat n° 5 ' ' "
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a.Date Weil(s)Completed: were Ind , agit, ID \ ft. kraf\' .-Ne., _._.
lot Well Location: au.\n atoa4. L XF Ai. e fL, _ .
I acey.m....r Hama . Facility iDii(if applica1 a) a. ft. • ,,
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1 qa13 P>14 H-L,c iryp f 12-ci ,
L R. ,hysir tAddnenap,Cy*edgily MAY g 2112
/i yOf 21.AFdtIARKfi
Canto Parcel Weatiiieatim No.(PRd) s^ r^ r� )IY
DY10.i5^kaSt).Latitude and tonde la dcgtenfmiuitalsee ds ordeciaal degrees:acid anc wens ismatetmt r 4,..,
6.le(are)the well(a)3.7lPpmmmnt or lTempurar, signature Cenifiel Well Contractor pem
7T t� Jry vpntng des.f.fir.I eamy weify that ScJ a¢if(aj was(wee)eaiw>ase4 b aveaelance
7.6 this a repairto an e]tilfiag wen: pies or 12kio with ISA it C,tC 02C.e100 or MA NCAAC 82C.0201,A+rMCraten atart&r der&and data
MM.isa Neale fill Minimawelh a tnwaanittfararmtanandexplainllmuanuxofihe tMf'njthic word Whelp proleadWiz WUMar.
meek tauter Alt rrlttaetCsmA!an eremite back of Mix farm.
13.Site diagram or additional Reel diddle:
8.For Ge oproberlIWT or Clo ed#,unp Geothermal Wells having the same You may use the back of this page to provide Addirtottal well site details ear welt
commotion,only I GW l Is needed. Radom TOTAL NUMBER dwells lls totitiraclion a tans. You may also attach additional pages Ifllecersnty.
drilled* _.
9.
3) $UMIJTAL lN47R)Jfl jo
ToW well depth below land Mama lJ J
/%erarrlHolevs>tew.rt.ry,a..fa .�.,r Rzo c- mcr oau�erew7 •
10t) .Par 4,H wAtti Submit this firm within 30 days of led=or well
construction 10 tint Mowing:.
h.scathe water level below top of truing: •. • (ft) Dtris on of Water Reaaur
If miter fowl is ohn�et casing.me", Iles Information ProcedioR Unit,
1 1617 Mil Ser$ee Canter, NC276d)9-1617
II.Derehmedaamehr; LO t p (la.) •
24b.Fa-Jbleille itSYesrba: In addition to sending the farm to the address in?Aa
IZ Well construction MOW: re -/h - above,afro submit one copy of this form isit� e,o
30 days of mpietiore of well
(I a +plus &es etc.) •
""pA'`'I� cpristmctipn to the following
i'oR WATER t+"1,'PPLY WE ONLY: Divisionof Water Resources.Undlrzgmund Nation Coaxal Program
c 1638 Map Service Center'leatetse,eic2769,4 sons
I3a.Yield(sperm) Method of arse: �
24c.liar Water Suet&fmfectlooa Weep In addition to seeding the Rum IIItab.lltninfectioa typal_ Antotmb the addrletion of
above; also submit ant copy of this than within 30 days of
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comp well construction to the calmly health depptpaent of the county
where consunated.
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a o<m e.th+-t North CarmianDe pmenentoflinvirattihrnml Quality-Dittman of Wear Resemcet
Raeute12-22.2016