GW1--03417_Well Construction - GW1_20230518

• 828.622 7241 ' . P.1
Feb 1519 06;43p Clearwater Well Drilling .............
'WE�.t c011�1SZ1� J TION RECORD(GW 11 For Internet Use Only:
1..WsllContr'aetre lnformation: rn on C _
_ I J 4R W i TONES .
a.(,1�d� •y4,W za p
urea OmbadorNmnr a= :t. , •
--A . • f. .....
a. I
MC Well enannonseatiSeatinn Number t IS QUTMR CASING Ger woutiOtd QR1 1
t Imq
CempaeyNn�ne /t -WANNER C CAdi„ �taossu 01
2.Well Construction t'ermit A: ( b b 1 L t -sum ft. fTn OL01L'rtER � w L
Milton applicable mall onnuwealaa patstb:p u:11IC Canary.Serra YaNterra CM- !t. k in.
3.% lice(check well use): `
17
Water Sap*Well:
.
to eMnrsts eraraaa •rttrciatoa wtdtt .
111 Agricultural lmieipaUPubiic 0 R 0.. I1e.
)r Geetimmal(EleatingiCeoiiagSuppiy) midcntlel Water Supply(single) R ff. in. f
)r indusltialVCotrmendel Residential Water Supply(shared) tf a ava>. egyM.►cR -•rr
NI,Irrigation - t{
Non-Weser Suppi-TWdi: - 1 rt. &I }+ I,.rvL ►A-- (Au 6LC
A blanked ateeove y f. D•
n)eetiaa VIrd: rt. R- r
M 1 Aquifer Rectangle gle ©Groundwatcr Rcmcdiation DI.SAI�10)lAV6L SACK(K ) I
a,Aquifer Stooge artd Recovery f Sn inity Battier most *no PA 1 ttaRtr►c'entserrPianos'
n O.
II AquiferTest riStCrdnwaterDrainage
.11 Experimental Tcctittology Dsubaidence Control fa D• 1
111 Geothermal(Closed Loop) )T[acer 20 nwLiib1GLOG(Wash�� ifs.esw.p)
.Geothmral(Hmtingrooling Ream) _DOtber f lne%xp ar 021 Remwics) r•t le t6 R ca XIm l 1rlx•l+MriQ.sca
d.Mae Weil(a)Completed: Well IDS - IL 5J j !t lIA v- J .
Vopl!e4il.natHno: 1 n 7 a i [� i .
lt ►• Q . i AA_( 6-7aR_IPI- r ,,-.�.
fredity?tkm 1 E roil(if limbic) I,, h. ft. . I `_, .,r F...a t 1.�,•
acts
Myriad Mal City,and Zip ft. h.` 1 _ r - _ ..
011)Cail ' :-1.2181MVIS 1 Icy10;i-tt.,...v.. i2:01.80c,
Court PANG'Idamiilentian Na(NM)
5b.1.gtitude nod longitude in degteesfinimt ufsecceds or decimal degrees: I—
(poell itr]d,one sluing is olable:03 , 2.a 0' co' t9 :-I.i N lg. 5a- (91 w 2.1Ce 'r,.hoot
4-02p -0)33
6.! t
stt1�)theRNt(ejPttlltmeeat ar �(iemltorary alrtcofCarrfirdweUeartreasor Doe
it&pang Ma form.I herehy camp that the elk)was(went)erZWnt rod In aevarde der
7.In this n repair toanesbtiogwelb F31tcs or No rah nil:w:ACO2l:.OIt10nrASANCACAWC.e1MWetlCmMm e cticaReader and Ama
10*;so r ak..JUlcurb:nenwet/ermarecuewifriimunten plain the mnlneelbc eBPyiithixrriordMfihraipn,1't III thewrl/ntvrrrr.I
repair under A21irnawtarurgnarta the hackaftbti.fann. 2LS1tc lOairam or ad boat wall tkt*lle: 1
&For Geopreae/DPT or Clamed-Limp Geothermal Welit having the seeta You may use the back of lhL page to provide additional well site detai)e tr well
consmee'dlan cnry I GW-t In needed. indicate TOTAL NUMB R ofwells construcltondelails. You omay also attach additional pages ifeeeessery,
dnlleele
-- - gURMI1TAL It4a nC I OHS 1
D.final well depth below land Surface: ( 1 24n.For All Wells: Submit thLs fluor within 301
0 days of compictioo of wall
Far mh/pre wells lk ifOe.alldapthrm t(example- ane411o07 caneljw*ilniolhalidlowing .
lit Static water level below top of mina: _ (it) Division of Water Reimers,Information Processing USN
{lanletrfurulIrhtMntcuing aleri I.
1617 Mall Smite Cutter,Raleigh;NC27619-1617
II.&stholediameter: ( 1 C2 (ia.) 24b.For lobelias Wells: In addition to sending'the Than to the address in 24n
aiAove,,also submit ono copy of this form within 30 days of completion of well
AZ Well notiel►netG10 Mandl rr.)H1 4a.14.4.-
0 a ange'.rotuy.cable,direa pub,etc.) - combustion r n the fallowing
lA0!>I WATER t+t.'PPl.V t.L3 Division of Water Mauro%Underarawnd nil cedes Coma)Program.
Q-i1'cç
1636 Mail&niceCennRatWE�NC276114ffii6
th13a.Yield Son) U Meod ortst I 24c.Per syaler_Sonolly lib Ietcetlan Weld; in�t1loa to sanding Me(ten in
the nddress(es) above, also submit one.copy iflrbis Iixm within 30 days of
rib.Dislofolton types Amount: completion of well construction to the county heath deptalieria of the county
where eenluueted.
Form(W-I North Caroline Department.ufEnvhatin intel< ,rhy-DivisionorWaterRareureea
Revrie02 22.2af d
— I