GW1--03332_Well Construction - GW1_20230512

• 828-622 7241 \ • P.
Feb 16 19 06:43p Clearwater •Well Dt1UIfl •OOO OO'" •
WE)l.LStU1VSTRUCTI^"r ttt>»CARD]!GW it For Internal Use Only:
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x.Wen Ct111ts1trllctko Permit#: ��" �� t(t PROM t TO •
List all opplImble wed Iorstrttelow purer(Le.INC Celatri:stag Variance.etc)'�'r�
re. ails
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3 Well Ilse(egad(wen use): ,' 17.SCRIi@N
WaRrS■ppl Well: Props A. To . aeNat4ott SWetltnia �nrrc ,„u►7CCIttrAe.-
QAgricultund °Nltsticipal/Public 0 . ise —
['Geathettttd(13mtimglEo noise Supply) Residential water supply(single) e. te. ia. _ _ i
D esidettial WaterSupply(shared) 1 la.C 1fr �9 _ MA7isvRlurptaa�t/u�el�M p r u+n5IndustrieVCommendel
Irrigation t_ n• 20 tl 1CT 1 # 1, 1)11deur-VI'nRe SupptyWell: Is.
Monitoring QR ' R.
Median-Well: ft. R.Ag4ifsrRedlarge ©(iroundwatesRemcdi3tiun 10 Sabin/GRAVEL PACK fi� r t�gtltwctSgsiYrMst stamp
aAfpfife rStomp tend Roomy °.�bY Boccie Jam To
AquittrTest DammamDrainno
it
° xperimental Technology QSubsidencc Control • ft. 0• - .
9Gcotbertnal(Closed Loop) CrTeac« i0.(181td.1NGLOC(sil•th[� al tare staMxawa 1
Geothermal(ll iaslCooling Rental) a•faPtain under#21 Remarks) }` ft. •1 a ' — ,l Y-
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4.Date Wdi(a)Completed: Wall IDS �1 1�11` tr. t..l� IL /� r 1� I /1
SR.wd[I.ncnNnn• 'TOR- tot C 'C/VI LJ! .
Toed 6ar\d x (Z.L .c�11 ft ,a5-ft.1 ►r nA �`-- y
reedlylOmrer Name . Faeny iDdi(ifwile/Me) Or rt. � "+. +" $ +' i� •a
c5' O1 Orc -cl ,iru r) \J I IS . It 10 AY 1. 2 2023�
Ph{(y!)y�tent dt�rae�,Cj�hy mdrep
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i � t Ortbv- [ • ,,$i.EtPIARHR 1115 ....'1'; 7r^r$7,4r:Pl7 tJf 4
County An sal tdeorillcetion No.(PIN) m
Sb.Lgtiuu)e Roil longitude in depteer/mimttesfceeoids or decimal dcgracs: •- 1 rnen
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(35 !� '(�_-i ) f � �7 O 12. a do n ,'
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N QI '"l5 o� w 1 \l 3 - 7 -43
6.bore)the well(s) 'inatient or DTemtpnrery Si; taro MeoLtal Vic..‘1441fitraccor Dam
?-lb els a repairsao ao misting wdk 31cs or I
�f Bu.utrrt rldr form.I kWh,MO that thewail)war elm)corn nne►ed ar emord tree
No rttb l3A. dG 02C.@I(ttJ or IJA NC.AC A7C./lTitD WACwtrttacrtaa 59andatda amtdrae«
Ifdrt*is0 re/mina ovilbmw.,well.toosaaxlkm m rwirm,�trcAdoth,mum,Ira, eepynfrhta retard!woken provided tothewelfowlner
141WanderA2/menarktsesdtanrrreeerebactoftblx,fame.
la.Site diagram ar additional well&atla:
&i ,rGeoproIselllPT or Closed-Loop Geode cresol Wens having Moslem )'ou may use floc back of this pee to provide addifiettal well site details or well
comaroctian„anlp I GW.$Is needed. Indicate TOTAL NUMBER ohaslls crm 1roctitod details. You may also attach additional pages ifnmcesaiy.
drilled:
FORI1 ITAL IPSiRucgQN6 '
9 7•oeat well depth below land sutndae 24u.For Ali W_e : Submit this form within 30 days of completion or well
Far ANDOewruetp r•sld& f
issalidesrh -:MS-
211:10). ) construction to the fallowing:-
1)1 Stet&waterlevd below top of maing o D -- (ft) Division ofWamr Resources,Information Proems Unit,
grater lmsr l is rrhaws casing ass 1� 1.1 t I61T Mall&Mee Center,Raleigh.NC27k!!1-1617
11.Botnehste Ammeter: l_5/ (L s(in.) _ - 24b.For falsetto,Wells: In addition to ending the fin to this address in 24a
•
12.Weil construction method: I of CL 1 shove,also submit one copy of this tent within 30 days of completion of well
cntsstnsction to the fcNmPinir ,
0 a nose-,rotary.vabb,duds push.etc l
-• Division orW ater Resources.Uodcrgroliid Injection Control Program.
FOR WATER SCPPVVWEIJSONLY: fin/ 1636 mail Service Ccnnr,Raliglt.NC27t 9.1636
I3a.Yield(pram) Method of teen lit 1 24e.nor Water Snooty at fniectiaj Wells: In reddillas to sanding the Item In
the addresses) above, also submit one copy of Ibis fomn aAhla 31)days of
13b.Ultinfeetiat tyypea Amount: completion of well construction to the county health depe lmenl of the county
' where CCnt@uctad.
Form OW Neigh Conlin Department eftioviraiihmadCuratity.pluLen not Water Resources Revisd2.22.2416