GW1--03330_Well Construction - GW1_20230512

•
Clearwater Drifting 828.822 7241 ' P,1
Feb 1619 06: 3p ••..•••~""
•
WELL CONSTRUCTION RECORD(GW 1) For Internal Use Only:
•
I.Wellconirattor'cremation: - - _,
Vlar(1-. M-i.SQ1 —44.wA TNJ
To
Well Connecter Now Rios' rt. a. 1 ! •
VC Wdiemoteetos Cogitation Number 15.OUran 10 G gar ` aMa ) va,
Company WWII C Id.INNER cAspc Qa � 1 0
sue
2.Wdl Constriction Penn1tti:c . ;
O. tL In. Til
'Joan a�gtheati a:aliemunnrationpamtUs(Le WC Camay:Sate.Ymt ere)
rt. in.
3.Well line(ditchwdl tie): - ..a,scan"O
.ry ma Nevado. _
WalerSapp�Well: viola• TO n4NMr_It R�
Agri«daantmialpoliPu p R• U.
Oe altcrtal(lieatiag/Ceniiag Suppiy) tesidentiat Wator Supply(singe) " ' t+. ii. i
IadutftlalfCommewaial gesidendal Water Salk;(shared)
sairoACOMWertince mount
N ales Supply W ell: a^^ ft- `/�♦A A-`l��k��t.1-•1 .1 ti
Monitoring fRecovery tr. U.
Djtcdon Wft: re. ft. . .
Aquifer Rttd►n(ge ClGraandwotcr Rcmcdisliun ,1AN1I/rRAYSL PACK '[
golfer&Wage and Recovery DSahtnty Billies �tlt L to I.vr we.
Aquifer Test fSmrinwaterDrainage
lbglerimental Technology 13Subsidene0 Control n- U.
Gcodtrsnml(Closed Loop) r3JYaec+ 20.OAF l.00( : �.ut • • i _ ppr,uartrta,iwi
Gea►keatna COillgiCeoUn Rmr S fladierf ill Mar#21 Rcmatl-s)_ ` °N u. '� f V. ' L t .
a.Date Wdl(a)Cnrupietedd: Well _ _ it. (,•Q 14U a r I 1
mil, I IL i 4-iL A '
IL_Well ell Lneae e: Q.-e-
•
(LOne . NM t�C,�;~_. � 7 ..�. .I a
Fah, .,lawoer a F lay QM1(ifapplie ble)
n. It. I
ale !n(viciCreeiL U. gt. MAY 1 2. ZUZ3
lesdAdd My,an ip ftAlos Iniurrr,:,.-::.,:'?.:;..f.tins Lifih
1 . 421.J +n lite41.V 3�k.:
County Fatal IdomiReationNo.(PIN)
5b.Lutitude aid langfhde in degleealmhaueslstco ndss or decloul degrees ,
oroonfield.one i°°gin lX �' ,��! 1 l� igp _ f:L tificati :
la qi tV l ( 3t' w al.L.:.:82
6.1a{ace)ttlewdl(a) Men or ©flempanlry SiJcntub!°PCati elnC Dale
yam(! Bp*ring rhss_rarun,I hereby rarer then Mier=U N was(wane.}caod metre.Si owardetce
I.la Shia a repairtn an etdatlagwell: mires or ph, with ISA. AC D2C.0100 or15A.NCAC 02C.0210 Well CrdntnreinnSar marls and dun a
lfthirisna�clrllflaurbmn mil.m arneuenntbaatmlap�yll:rpIarrkg mum nfahe v1+1'ofth*tcurrlAQFbriePtO►'IBodlntiB mil mstus.
rYolr under 121 italU lrxcsMat or&iThe bark ofrntsfama.
13.Site diagram ar additional wall deistic
&!Tar Geoproa I$p r or anted-leap Geothermal Wdh1Ihaving the saute You may use Ma tuck of ihit page to perwide adrritioosl well file dela&err well
coreamrticn,only 1 OW-I is needed. Indiaalo TOTAL NUMBER of wells construe/ion details. Yob niay alto idtSeh adtlltlottel pages If neemeety.
drilled:_ _ — ,ems S(Jf1MITTwi.11b.CTRUC l flNS
9,Tail well depth below bad when S la) ztat.For Ail Welk: Submit this form within 20 bye of completion of wall
r•araaahaph was too vs1Artaydpareatrampre.3estr•aadvivo construction tothefehlo►rftig
10.Static seater level below top of easing: •. - (U.) Division of Water Romoreee.Iofnrmmtion rracessbq Welt,
Tonle bug 1s Awe t 'ae"(10 1617 Mil Service Center,Releigb,NC27699-1617
IL Borebotrdiaateter: t i) (la) Mb.Forlaieclto,)Yette in addklou to sending the tam t4 this address in 24n
above.also submit one copy of dita form within 30 days of completion of well
12.Wall construed=needled! rD ` t X�l`. - -. - cDnstrnction to the following: ,
(I c.+o m wary cable,front push,etc.)
Dlefelon of Water Resource.Undergromid filmdom Control Program.
FOR WATER SLPPLY 1.L8 ONLY: 1 G36 Mail Service Cmma,R1beigM►NC 276994636
13a.Yield(sr,Patl llfethod of unto teOl 24c.I nr Water Smote&lfakedon Weft is McMinn to sanding the form to
the sddlt s(es) above,also submit one copy of fhb fain tillslli 30 days of
13b.Disinfection type: Amouat: completion of well construction to the comity health depaiment of the county
where ctmsttacted.
Form OW-I Muth Carolina Department ofNmlaumStatn1 Quality-Weannof Wear ttesanteen 1 Redaef2-22.2016