GW1--03427_Well Construction - GW1_20230518

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Feb 1519 05:43p Clearwater Well Drilling 828-622-7241 ; P.1
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WELL coi11TS1RucrION RECORD(GW,-11 Far Internal Use Only:
cliCnntraeterI oamatlon: _ _
.x i ak)S
—u,WATER sexes i
SIMI T- asseurrson
Well(:antroutif rrs
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clialliocuctrNC Well GmttadorCatilieatian limber ,(� s p t 1 1 TO
IL t,)UTBR CASING(Get vrdb>�>�a ) 1
Y V tUL �� l 4 n1 M it.�AL in,_ (e (
CompapName _6.1NN�RC y OR 1p thos a1�0.4kopl
x.Wen Coa>sarllcliatl knelt ii: p ) 0 e12 CY2L PRoa+ 'to au setae ., nt[cta EMS MnllgillAL
Moan oardlaeDlewallaxvurrorlotrparmUr(LeWCCaaaty.StemMilliner:.cm) fl ib in.
3 Well fits(cheek sell use): it. in. - .
WatarSa - �i7 -
PPl!Well: ra ntANLIMart . Ar en= Ywrdenaa rants.
b.
Agricultural MartiaipaVPubllc U a.Cieaatemnal(tier ing/C«atagSupply) Residendat Water Supply(single) ft. tr. - J
fnduslrW!Commeralal riResidsoulal Water Supply(shared) r aGikour -
' irrigation . - Vado 4A r$A'r'751ttA1. ttiirtaelemoirstallOna Aietitnrr
Non-Water Suppirwdl: t n' 20 if" (.iCMI V t► , ` u Cid 1
Manilori% Ic Recovery .. a. It.
njtaani al:
D
We-Recharge - ©GronndwaterRcmediatinn
19 SAN/IA/AWL PACKiit'tnittlL4lirlt)
qu+fasWrago ant Bosomy E3Salinity Barrier "nos[ 1.0 MA 1ilr. i tat fMellvltfritt:ruoo
Aquifer Test J3tmnwat -Drohlagc 0
Experimental Technology OSukaidenee Comrol ft. rt. r I • .
Geothermal(Closed Loop) f Taco 2a DRILLiitiG LOG taltt a.:,,.r. _ It:_.. _trswiurli.
coal rmel(Hcetit:g)Cootirtg Rcwm) 3Odter(exploitrundor1P21 Rama+is) FR k "TO •. h : f.. ..-hotel Oaittia,.tal I
t.DamWdl(s)Completed:T (4 2 Weil MDS - It. `) !' ant 7L
5a Welt L : �l 1 rt. tJG 1 Z� r ���, I •
S�,o' �- Goms ' I 1 IDS i:, It /.l ., i p 1% t .1 r
Y� :,
Its Name . lieiltlylDil(ifspplical,le) n. ft. •
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R Lr. MAY a a 90?31
_maim)Address,City(,and Zip rev(Jam t #J C R R
trr yL / q U 31.AEMARKTi J lr.^ur' ,' e�t1 ";;r :v'.v Ur::
Cauaiy Parcel ldaoiificarimtNo.(PiN) t
5b.Latitude and longitude la degrees/min iteasteeands or decimal degree= L
WWI field,OnZ tsNloagiarrdnOterdj 2 •
L'j '7 Syr �—i y' S , WI 40 # 4-- o Z3
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6•t arc
a( )the wNl(rkierninnern or Clircollyoral7 Sian c of Catifial Well Contractor ' I Date
By atptmg rhte form,I hereto aatttfy that tla wcL law M®et)alnetir htilIn itrakete rce
7.IN this a repair toan= baagwd1: ElVes or o with l.i1. .ACa2C_QlpperISA.YCACWC.OXJDWattCasstrnoaanStandamb mot dtat4
FAOia a repalr.Jlll ourbsom n sflaoaa+uurm►infoneatt a,r?Laplaire rho up,n yf,hc omelet's ward Imebxa protdded In rust aw n-. f
n;roir tan ter 112I neon*secant orettUlc lock PJr,ft(erns.
23..Site diagram or addltioaat well dell a:
&ForGenproberdlrl or Ors Lanp Geothermal Wells having the saute You may use the bock of[his Inge to provide additiooai well site debits er well
colettnttslan,only I GW I is needed. lndimze TOTAL NUMBER ofwclls cvatniction Mails. You may also attach additional pages ifacces ary.
drilled•--
+ - .....i SPIM1•AT.INST6>i��'II� !
9.Total will depth below land aurlircc: 1 VS lTkits) An. !far Aft WSW Submit this form within 3n days of completion or Melt
Perntah ofeWt eliaeadrnthrV'A8••aceasoatio-36aem o• d taut construction to the follo►sing:. -
1n.Static writer 1evc1 below tap of easing: (it) Division of Water Resources,!affirmation Proeessi;g Unit,
lixwtr.r(acal rs ohm casing WE ^L(2 1617 Mail Service Ceuta;Rdeigh,NCIN10-1617
II.Borehotediat on.)
?sal►Nor taicrltop Was: In addition to sending the form to die address in Z4n
12.Well rimslrpcHgp m4Uled: f J about;also submit one copy of sits tam within 3t1 dope of completion of well
(i e.aim r,sny;tut*,dim!putt,eta.) ctmstrraction m the falhait+rog: 1
FOR WATER SUPPLY WELLS ONLY: Division of Water Resources.Underground lq)eetka Centre)Program,
1636 MaillStrvine Cone r,leakelah.NC 276994636
1Ja Yield lup>rtl Method of teas g zaa Fur%trauer SpraW&ilakrilea Wei In addition to sending tits form To
tab.tllslnfcetlon the addresses) above; also submit one copy of This form within 30 days of
types Amount completion of well constnx6on to the county health department of the enunty
whore constricted.'
Foos GW-I Noah CaredintiDepanmontofi:moist;hihiatr.ilQtality-Division of Ware Ro omeeu Itsu 2 20t6