GW1--03300_Well Construction - GW1_20230512

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Feb 15 19 05:43p Clearwater Wall Drilling • 828-622 7241 P•1
WELL CONCPUCTION RECORQ(GW 1 For Internal 1Jsts Only. -
I MilContractor Inlbr'ntation:
O N\\en 14.WA I.ONES
rwo� pro . naacal '
WellContracterNarae IL ft I •
3Z (Q —A . rt. B. ' I
NC Well ComettorCatireettionNumber $ .00IERCASINGMrmeikatM OR tfa
''CIe( J a x W l Sr II In
Oampaoy Name 16.*NNEit CASING OR , oar.
2.Well Colnlroet on Penult th Z- "(27 � .. o, iO g, �5I�• tt wit ln.
14it ail tgryrlloaslr nail cram waton panatir(Le.WC Comity, Ymlaae8.ci ) '
tL ft. is
3.Wdt Ilse Watch sad use): 17.SCRII
WaterSnpp(y Well: PROM To eauMIORR ' ew OM rice anon _tt+� tA1.
Agrictt4ttrel DMunialpnUPubiic 0 R u- in' `
Gautltennal(8eatingfCooltag Supply) gibaidcntis!Water Supply(single) a. p- in.
imUtsiria/Monuacraial RiZ defttial Water Supply(shared) i8.GROUT .
G 'to ittipatton aJawsamit .1uie�tcdtiie.tr morn err
aM�
Non-- nterSupplywell: 1 ft. 71) rt. CC a t C MOLL
Monitoring R ft. fa
-
njectlatWdl: ft. it.
Idler ClQroundweterRamcdrsltaa 19 SANDftkAYBLPAC!((H )
quiferSterugc and Recovery °Salinity Barrier Pauat TOntel�t.� ..._17.4k0011rlbrt'noa
Aquifer Test • fStattrtwatcrDraiinage ,
rt. a
Experimental Technology QSubsidericc Control ft. R.
Geothermal(posed Loop) MTeacct 20.DIll LOC(t#hr• .!..:1.' a= ,-?agnaad_ „_ tar.
..,,K rTo s;ti11L ,
Ocolimilnal(Ht ing/Cooling Retum) nether(-•,..,in under#21 !Lemmas) ft. ! al�a'`n,►�1�11a' i .r • .
&Date Wetl(a)Camp Well UM r p _ : 4 ► al�lA ri2u v4-6
'5r.Well Lowman: i n al S 4� 't t..•C� smul T. t; a' 10 i ► i .
\off rk1nPS r.nni er f rme r- ` MgripIOW, '_
Faelitylanneritante . FxilitytNit(ifapplicable) O. ft. • 0
rt. ft. x\ �s L.ti°s x—:.J
Physical Address.City,and?lr I'xt.rlgalu►tttts � fivtAY 1 2 Ztt3
Cooley Parcel ideatiticalion N.(PIN)
Py 1 t
IAS���v'.?.j^�l Pr^�:F..�ar. (.fit"w
Mr.Latitude mad lang eindegreesiminnterlsecasdam'decimal degrees: �tatj�;U,�,a
(ifwelt Odd,one tatfiaagfe entlic ant) 2 CA dot:
$5 4'9-3.to� N 9,4 tS". 5a . • w 4 - - , 3- r -73
6.Is(ato)dmlvdt(s Q'em �7'
Porno tat or Ita of(mini WdlCniraotor Dale
..��,,(( l n n8 tntn,l+,rw f hmwhv.nornjy that the,writef)nos(wan)ooefl►eeted to aoewdorce
7.It lids*rcpairto enctittlig wills DYes or I tito with I SA.r1C.tc 02C.0100 or Ili 21CdC 82C.0200Wd1 Cmulmaianattadatds atuf float a
rrhtrrsa main Jill wabtown well swam:tampLtfbniattona'r';ui splata the nature(Phu 4014witlrle Ward harbeeh Pinged fnthe wall Ans e
r rvjr cantor 121 rvteadoc awaen areatfic dart ojtblajata,. la.Site diagram or additional wrfl defeat
8.For Geoprok!DpT m'DotWdarbpGeodwootd Welts having the tannc Toe may use the back of this page to provide additional wall site details or wail
oantructian,only i GW-1 le needed. fodicelo TOTAL NUMBER of wells construction details. You may also attach additional miss ifucce saty.
drilled:. — pitemierrAtINATRUCTIKINS
9.Tad depth below bud stem `OS . (It) Th.for Ad Weiler: Submit this form NvIOJin 30 days of completion of well
rear+avalyn,warn and:w ar ir (nunnlig--10Zairarmizeiev, construction la Ma tdttOWlai:-
10.Static water level below top of esalog: •• (R•) Division of Water Resources. Processing Unit,
If water turd Is awe coming.the+',,"' )6I7 Ma$Service Center,Raleigh.NC27409-1617
it-Dot+ebotediameter: l5r (7. (la) - 24b.Forlrrlertiosi Wells: to addition to sending the foam to the addicts in 24a
1� • above,also submit one copy of this form within 30 days of completion of welt
it Well construction method: 1 V t cuustnmtian to the fatlnwin
(t e.ow.rotary.Mk,direct push.etc)
• Division or Water Resources.Underground infection Control Program.
FOR WATER SUPPLY WELLS ONLY: o 1636 Moll Service Center,Rnk)gh,NC 270'94636
13a.Yield(gang IS Method of test: .4 e( Mc.Gar Water Sone/&ialeejion Weft In addition to sanding the them to
Mc nddrt;sn(es) above, also submit one copy of Ms thou within 30 days or
13b.Disinfection type. 1►nmun{: completion of,well construction in the comity health depaitaent of the county
. where ern enacted.
Pone OW-I North l]rolinaDeperfmcntofiinvlroiiitaitalQuality-LtitisiteofWaterrfesmueas Revisi/2-22.2016