GW1--03433_Well Construction - GW1_20230518

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Feb 151905:43p Clearwater Well Drilling 828.822.4241 ti PA
WELL C(�1�T ,Z'R1,TCTI ,> (GW 11 f For intern r ►al Use ly: ' .
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2.Well Colf1trnetian Permit fit
TO _ muMecr>>i terAtgUiGps MAMA
Mrta8 applicable tail sauvnrmlonparmur(f,ta WC County,&ai Marla et4) '• $. tt. tn. 1
3.Well Ilse(cam well use):
ft. ft. lc.
r Water Supply Wells rr.s
t�ricaknral �MtatkipaVPubihr �v�aot.• ► B.
women tteareas raveaa xAri:*fA►.• ,
Geothermal(Beating/Cooling supply) Residentlet Wool.Supply(single) ,"' It, At. + !
lndtattialICmT�ial Residential WatlerSupply(sitared) tis.dour , I --
trtigatlon Tt) AThatt*. �y1�R.ACC101#100r AAA mutton.
Nna-Water n e' 11�.IVC
Monitoring DiReaavery a
njectlan Well: at. h. I
Rt'>terhalgc DOroundwatcrRemcdiatinn �t3 VBLPACK if 1
pig:el ort o end Rummy y f Seliuity Barrier _ tint -,1 ,'` 1 •-•," f uo
AgtdtbrTest E3stennwaterDrainagc ft. a'
ExperimeoRlTeclmology (SuhsidettceComrai re. n.
Geothermal(Closed Loop) rliTimacr ••PRILLi LOC(a�1i:_ 1 _ ''
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cimal atinVCoottin6 Rant„•. ■kher(etplaiuunder#21 itemerks) • x tf. ft. ci t 4 i� : .• �`+ Ate _
d.Date Wens)Completed: Well IDO -° h, • '1 pLautilw
Se.Well Lase t t WL 16 I
S .. Ann' - * it. SiretatilE
F. • .(lwttetRoue . �{{„LAD DotlyIDO(if appllcaldc) .. h. tt. • ( [a n r"-`�g s..
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Phyla I Addnota1 City Zip n• ft. I �. IV I Q L U Ll
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Y , 1 Pined kleatiilmtian No.(P[N) .,, CV."'�;�C1 'i
Sip.trtntude rued longitude In dcgleeslmhuueslaceondsor decline. l degrees: t 1
uwo11 Aatd.sae tatlteaaiaetdtlataM) '
[0.41 N 83' tk-5 'Srl avw 1,.., 4t
(1.-- 2 0 - 23
6.store)the wtit(a Ptermenent or ©Pramporsry Shin a of Mot •. ,, pate
By sigmas MN farm,I hm3;v ootO tkat Mr eell(4 KW 4ovvJ canon red m aa'rderce
?.IN Qis a rcpairto no aldsthtg wells Dice or *o with MA Ante 02C..0100 or MA NCAC 07C..0111AWd11 Cn;Wnaelairylmataidc and dye a
irthiar0 olookfif1a lbum%urn cowmctlnah +miatlaamalcpdatnnceaatxneau Yeflhis ream,AogbeepProw tlaMa well myna.f
Moir under A21 rasa*sit flan ordittRd hack offhis,famh, 23 Site diagram or additional well delft: `
8.Air Gagsrobe/1lPT or(9ereed•Long Geothermal Welie Wink the sane Vou may use the back of this page to provide additional WW1 hits details or well
tsn uantalian,only I GW.l Isrroeded. Want TOTAL NUMBER afwolts erMstruetion details. You may also easel]addltloriat pages If necessary.
drilled:•
DM. AT,iN tiC nONS
g.roar well de Newland mane {tt-t sem. 6or,a weigh: submit Otis firm within 30 days of completion of well
r+err.vuuipre two tortradatelsr yeilarrntpoawP/¢- 'and.4)/oa? construction tothcfollolring:. 1
10.Stade'rater Ind below top of'carhtg: -• (rt.) DivisionotWater Resources.I ibreonNonPocegai gUnit,
Ifmafrh•laralLt Awe citing toe . 1i617MillSlerviceCenter,
Wleiitb.1t1C27699 ibl?
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re.%Malediamteter; L) ,(In.) trb.nor t.lertiop%yeilp To addition to sensing the Alms to dm eddrom in?yin
•13.Well riot : ] ( ohm,also submit one copy of*Ls within 30 days of completion of well
tt c.a»SC1+ocul.cable Owl push,etc.)• ' •w construction to the fehlawing i
1�OfY WATER FF Cit,'pAI.V{yam ONLY: Division of Water Rt�Irees.Underground Injection Contra)PRIMP?,
n o(� inn Map Service Center,Rrttetab.NC2769946i6
I s.Yield(rtpm) Method of test: •,t","I 24e.Oar Water.Snc .&;Mention Wells; la melon to sundtog the AAm l0
the addrcss(ce) above,also submit.one,copy of'j ink bow n Within 30 days of
tab.Dtsinfectton type: . . .Aetauot: completion of well constan ylon to the comity htsalth department of the county
- a wines eanentteted. .
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l+orm GW.l i
North ofttavltilclttcthW Qn;hllty->aiWshatnot'Weter Wanes
RevFte12 22-tad