GW1--03301_Well Construction - GW1_20230512

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Feb 1619 06:43p Clearwater Well Drilling 828-G22i241 . Pi
WE)C.L Cp1Yg'I'RVCI'ION RECOR)U(GW--11 For Internal Ilse Only:
1.welIContrattor filbiettllon:
hail A\k fl - — 14.WA*a•ZONES
rum •ro n +
WenContraclatlentt
VC Well Comma CodifWionNumber ' 15.OUTER CASWGlhrtnolli oed ." 1� its.:...•
°e(IrWel hex W e t l -bit l�MCI ft. «.'L_: USUAL .
l32 tQ`( � �Ui!:
Company Name r16.OMER CAIlINGOB '1.• ' ipetlrteewdsbaa
2.Well Coaelrielton welt tit JW.2_7! (p l tS Z. �° "! '� nt"l lM `�A.rd ,y►1114got.
Mt aii cnnfioamtcetallanutecilenpcmar(La VVIC Caaetl+.Srala Kean".04)
n ft. so.
3.Well Ilse(d iedr wall use):
WaterSopp(y • all: ~ Lanni►snro nunnenut 1 awe son Femme 1 ztwTOeai.
I Agricultural gResidentiat
0uttmiaipoliPublic 0 it. ft.ill Goathoamnl WestingfCaatinBSupply) Water Supply(single) et. ' ft. in.
II Indut11ia11Co11tl6rolat Restdunial Water Supply(shared) is.dank .
43111 LTO illisaut. isteLaL tm
rsttnpammeter
.i
Non�Whlcu SupplyWdI: 1 ft. Zr) ,COW- C�J el
II Monitoring ORcco Y r` re.
*Won Well: re. tr
■'• 'viler R Gronnwatc Rctncdiation
ncltatg+e © d r 74 SAtVIIfCRAYBLPACKtIie) ;�ae�rwe�ritbrt;ttoo
pl Aquifer Test'AquiferStorage and Recovery ]Saltmty Berries IRnou TO MA
© wat r Drainage n.
n.I Experimental Tcelmology ['Subsidence Control . n.
II Geoticn tal(Closed Loop) 3i'secoc '20.DRILLING LOCfaU t 1"co >ar ds) ,
)li Geothermal(Heating/cooling Retum) �omerf n under d21 Ram"_ ( n, 13-L ti' la' r ......
4.Datttweuta)Completed: vlretu WY (_�/- 1�I2rt. l
l/(i�.�l6 Q(.( t l�
r ;rEr.Well Loration: • —fit' MSit. a ran t+C.
13ci1itye(lwnetltrotte oak.lDih(ifappticaWe)
Physical Addiew,My, ��"�L JLt 1 -6 ..'`�..9 L,.I iv �� -
tC-t C. - 1 '" MAY 1 .2 2023
Camay Portal ldamiticodant4a(PIN)
b.Latitude and losutftatle in degreeslmimUedsemrds or decimal degrees: - f ,--.. "; "1-- ;^''fir j
Woad,Auld,arts tarpon*ioeufllcfcnt) ? Ce don: 1 � � �a�d`iQ.'30.
3515i N �S`�. 03 43,c13 w C ......- 3—t-1-21
6.Wart)(fiewdt(s wont or ['temporary Sisrtnture Mad WdlContractor Date
By*ring Fit farm I hereby ant*dim die n+ef(s)wet Oran)eontucefcd in accordance
7.Is lidsa repairtn anc>ci111agwell: ['Yes or 14No vie:ill Ar*C 02C.0i80,orJIANCAC07C.0111014lCanlmrnrenStree eoedAm a
eddy:vorcpatr fill=do wnwutl.maassetoakronoadonautuprcanlbcuoiurrofthe copy afdds record halve;provided in dead/men
repair tau 1121 nmearti swum etch the lark offhrxfarin• 13•Site diagram or additional wades/lb:
8.For Geopnik(DPT or flatoddanpGeothermal Wells having the smile You may use the bock of this page to provide additional well silo details en•well
caiatnicttan,00ly I GW-1 is needed. fadioata TOTAL NUMBER of•was COtruction details. You may alto albeit additional paps tf Atxeeaty.
drittedt 1DMP1'1'/PIIVSTRUCTmo4S
9.Ttlat well depot below ked adieu;etx (tL) 24a.for AJ Welln Submit this fool within 30 days of completion nP well
Far waluPre.wll list elf ease&ifdeannerecamphc_3(ffaalrwelatarair construction intimfollowing:•
Ili.Static wafer level below top of sawing: -• (it.) Division atWater Reemlreea,Information Prom tlolt,
Omer arks/lenJenra caring rue(". I 1617 Mill ServiceCenter'.Wrdgh.NC27699.1617
1I.Borehole diameter: "0 (� (tn.) 2 b Fet•lol shoji Weil= in addition to sanding the loam to the addicts in Zia
rb�a�u above,Mao submit one copy of this form within 30 drys of eompletion of well
12 Well comtrucq to mterbt)d:_ f . coostmetion to the fallowing: ,
it a copes,rotary.tab/4 4*W nick etc,) - Division of Water Resources.'Underground igjectlaa Control Plrogram,
FOR WATER SEPPLY WELLS ONLY: 1636 Mall Service Center,itateigr>niC 271114.1636
Method of tent: 'G 2 Far Water Soapy&Infection Beth In addlion to sanding the farm to
13a.Yield(goat) i ilia oddiass(cs) nbavoa also submit ono copy Of this farm within 30 days or
Jltaouat: completion of well construction to the moldy health apartment of the county
136.UfsialCdtlatt type: where constructed
Font GW-I North CarolhntOsynamant of l:nvlriinuteetn0 Quality-Miasma otWatar Rostrums Ravise82-22-2e16
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