GW1--03293_Well Construction - GW1_20230512

828.622-7241 ' . p.1
Feb 15 19 06:43p Clearwater Watt Drilling •
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WELL COATST WCTION EECORII Gt W n For Internal tlao Onlj
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1.Well Co 1 Fm'irlafto
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C.ompanyli limn id.MISR C.=I OD , • I [a 10 ,,�,•
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2-Well ConsIructon Permit#: D To In-
list ail applicable wall eananieilonpmtet0.r(La WC COMA SOK Varfanco.atn:i '
it. it. ih.
3.We4!Use(Mack well welt • — I7.SCltl1 N
WaterSapp4j Well: PROM• des t�> BRl Sias TIIMIAIISI lauaMIAL•
A dcu l aniaipttVPublic () D-1. t''
Geatttern l WaMillfliCanliog 3141111y) Idea ilal Water WRY(Single) ft. U. to.
IndustrlallCommero al PfiResideatiat Water Supply(shared) �1 amour . MOM. rG trlllrt
Nbal�rr T+� ,• �
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iIrrigationt it. 70 R„- �1 MO tfLl- (1^'`
Ndra.N stanter StrpplvTl Well: i 1�r�y,d<u
Monitoring aRccuvery n- in.
gleudwt Weal: n. P.
Aquifer Recline ClGroundwatcrRcmcdiatinn A S 1`fNGRAVBLPACK t •': I,:.! i
Pifer&Osage anti Reetwroy Elgalinity Battier . .., V111M 1 ,i t. • ;Uitt.:rt r..
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Aquifer Tat Ejs+ioefltvuaur
Drainage D'
ExperimenttlToe mololy •sahaideacOControl ft ft'
Geothermal(Closed Loop) Neste' 20 pot. LOB fill ' •:_+_ Ill _. _ ��w
CIeoUermal(EtcabngCooling Roam) Q011terf inunites#21 Remarks)` _ U. DO a. 0A r 1 •
a.Date Wed(e)Completed: Well IDtl _ - •) rt. (1D ``rat '
R zr 6ivwr �� �` ,
Sa.Well Letdttlnn: l-l l ,
LoXesur e Vall 1 1 f . ft t, i
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laeilitygloacrRd . Sheila, 0'
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11 A Mor1►ri..Acrrs T)r -1 kt-stilt l NC. ft. tr.
Physical Address,City,tndZip m L `�'t.(• �n
Ulr� ilsDri oil o��-1�1 ( �g 2''` a MAl 1 2 ZUZ3
Canny Parcel identification Na.(PIN)
•Sb.Latitude sad longitude is degrace!minuets/seeneds or decimal degree= is rt�,"Fr,=;`•�1 pr��c ��U
(irwo71ffe2d.anelatAangiaauttiaiad) 12.Cer1it7tatioeet ram`
35' 15° i.4 . 'I N $? 613' ct?, � 3-0 -,2.3
6•ts(atc)the wttl(a)&f i!'tnonent or �t-!►nary sign of��Canned Welleanhaaror t]aa
Z attotiag OW jars,.!hatch"on►tfir t'hal the uail(51 was(Seed eaawaeRsi h,accordance
7-hi this a repair in an adrtlag well: Mires or 6No with ISA:4C.K:PIC.Od00 or 1.1A.YCAC 02C.O2O1)WdiCnwhn cdanS waimide anti Aso a
!!juthJaamaktfiiinabmwnvettepavrouunEtrannadomaniasplafn the aNu+rnfihe rafi/tfa Ward 1?7p la!bawdl!Johan
male tinder 12/aenarktscram ravage back aflhttjatm.
2.3-Bite diagram or seditloaal wed Ikons:
&Far Geopror e/DPT or pored-Loup Geothermal Wells baying the same You toe,Y usa the back of lain page to provides additio ial well Alta details or well
amatniction.only IGW.tle needed. bdltmtaTOTALNUMBERufwells construtitnlltetails. YOUmayalsoattachadditionalpagesiins: sty.
drilled'1'a �1 LL �llli�j)�r*i1.INtTRVCITQNS
a. g1 well depth surgtcrr_ « 1 (tT) Mo.For Ail Went &!omit this form vilthin 30 dnri of eom}letioe of well
Foraudapre weasasiaiidcpaa jatfrwear It cowl&383ao'mrAitittarr7 coastlbCtiaul to the fW101Tlag:-
10.Sadie wally level below top of calm (lt:) Division otWatl r Resources,,laibrunatbont Processing Unit,
if wafer lard la r tine crisis ins-n, p 1617 Ma l Solite Center,Roteigh.NC 27699-1617
it.itotcttolediameter: U4 ' 0 (to.) • ?Aix Fitr_laiestioe Wets In addition to sending the taro to dui addrms in 240
I/ai- i above.also submit one copy of this form within 30 days of completion of well
i a Welt oragVa l4o flaetiodt t I e l construciian in Umfoliowint ,
tl a aux;may.cable,tgreet push.etc.)
• Division of Water Beemuroel.Underground tuf tedoa Control Program.
t WATER SI PPI.�i WELLS ONLY!
1 1636 Mell Service Center,Ra43gi.NC 276444636
13a.Yield(gpm)- `•e Method of test: 1ei 24c For Water Sonots Fc tnteetlon'e In addriIon to sending the Rem to
tor, sddress(cs) abover, also submit one copy of this form within 30 days of
t3a.Disinfection typo:_ Amount: . .. completion of well eonsteflaion to the county health depanmoot of the county
where contracted.
Perm GW-1 Wall Can,linn°apnnmentofitmirriiiriattal(itedity-?aiv;rnnoPWa[MTI:Waa*enl Resistta222.2Or6
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