GW1--03462_Well Construction - GW1_20230518

Feb 1 b 19 06;43p Clearwater Well Drilling 828.822-7241 ' . P.1
_
WELL GQINh pICTION RE9ORRi (GW-11 I For Intemoi Use Only:
Tle.r.rar:e'rr:ni: �
•
I.. Contraetni 1 i • Eon:7
L
at_ •1 iein
, foe WA 7,DNES
Ohl gn ntsacttrnor
WellCmWaareNomr u. ft. I .
3 -Ar " tt
NC Well Contractor CatlSaotttne Weber .. ( �1p Id.OUTRR ASING ear , °' • .411.2 i�iltr yz�1 a,
�1�/1l.-r 0I IrJE E 1 \. n( .E mom TO R' t rr�1.j"" l It4� , ieJUV
CempanyNnme "1 "d, OA7 C�5d 1
2.WM Ctwstrnellon knelt I:/L i Vt11 „�4 E I'n► p � u� �
twat al gpplrmAfawalle tunttc7tan(taterft l.+'.1Aa Cam;&al Varlm+ca ctt) j h• t� iw
n. b.
3 Weil lT (cheek wen rise): - -
WaterSappV Wen: la scRsptu
pgpfiw• To rotor* elttatatae Tstaewt_teaa tMntetGL
/igtkulhttal ) eniaip0UPublic () it O. i
Geothermal(HeatiaglCanitag Supply) 1i. ee(dential Water Supply Dingle) fr.` a't. in.
tndteurieUCemtmereial ld Residauial Water Supply(shared) L litec>n. ,
tailpipe I `TO � rintrate.�A i} ametaacas ra uAmor
Nagar Water Simply Wail; o' �-) O'�XJ11 tJr a►t,Y 1 `��.
Monitoring Recovery o. h.nleutian'Wd(:......" ft. (t.
Aquifer Recharge JaroundwauerRemediatian It 3AltAf/GHAt,►ELPACK
Aquifer Stelrage and Raceway 135alinity Barrier oat 1 , _r to—'"a"'
Aquifer Test O3tnmtweterDminage n- IL I
Experimental Tcdmoktgy OSubsidetec Control I►.
Geothermal(Clos dLoop) OfTtneor 2 flak1VGIAG( ,_;.:l'i::t; . : ,,rmewaonemsh
Geothermal Mmhtrgcooilntt Room) ] Odra'(explaln'under 42/ Rm emksl l it- f ^ 4— , aIA 1(A- • 4;
4.Date Wein!)Completed: Welt IDS/ l.Q.1/4.t It. (• m
A.Well Loes►nne: Rvl�f� 4. (0300 R. a q _ •
bni-Vag4 +r1lil ua l 14E11' 6 -Wu e.
radily:Ownatrama racilibp Mil n, iL •
PhysicalAddt eae,Chic andZip R. R.j1 M P - 8 L li 23
14e. LQJf sc1r 21.AgnlAlttS
Cawley Parcel identification No.(PIN) ..Il :• ^4,,•.,t,3 i In.':
rib.]Latitude gad rem I L`la#QiBOG
(ib Lotfield,one tstno>sg ie eM d 14 dcgree shainutea/seeends or decimal degrees: 1
�35 a 41` Die-�l N ?�'5 4 SO .OD w Ham:
I
6.1s(ae)the wdt(r l�el'menent or DiTectravorY she. taelrlTr4 Lof eli
As Miming obis form,I hereby cot*Mtn the we*,I hare)cormercW in aemndaree
7.le thin a repair toao relining rill: fifer or rrlth13.1 PC.tCn2C.01pYorMANCACh.V.0200WaNCaraln:WonSoden*and that rr
fill* sarepo/n,RReerboawnwetbonamtlfeea+>f rmallwr Pill Aerxuur'velk: lop)'aides Word MO=pfOileasithibmwelleltdier.
Moir order All rwunr*estxtlmt ru`Artthe bath of fhb jarai, 23:tite diagram or additional wan eltarna:
S.For Geopro6e/OP T or Closed-Lonp Geothermal Wellshaving became You may use the back of this page to provide additional well file details or well
canatn'elIena rally I OW-I Is next ROM TOTAL NUMBER dwells Ertl details. You may aim attach additional pages ilnoeedauy.
drilled.
--�•• � W1BMV7TAL IiivIt'RIKarat$
h.Totat wen de( Mow hind Salim: (B:) T,gta. For Ali Wtlhtt Submit this farm within 38 days of complexion or well
Foreautuplewedeue0endm+h*ttr.arm...r +ra staLloo•..,d way CamAtiUrAIRIIDIBCIbROWilli:-
il
k Stark water level below top of aatog: -• . (ft.) Division otWuter Resrtweee ldbtrtaLtlon Processing hJutt,
(waferIorat Is above Mire true"."1 Borehole diameter: 1617 Mall Service Center,(� NCa7619-iti17
ILu; (In.) �,� rtr e e In additioo to
4R7Ysending the form m the aldtttmty in 24a
!2 Welt coa>:ta7sc((oa MINI rn.f J�,Q above,air submit one copy of ahl�foam within 30 drys of eotaplWen of well
It e•ousel rosary. e.&ad push.ela) R "t •
construction m the following
FOR WATER SEPPLY WELTS ONLY: - Division of Weter Resources,Undelgronnd lute tint Control Program.
paa)
e/t' (O6 Mail Service Center,Raleigh,NC276'M4636
13n.Yield tow Menton ortem FC.f 24c.Ivor WitterSOrtalar&itkettan We& In Won to sanding the tam to
1 the sddress(cs) ntrove, also submit ono copy or 1hi9 font within 30 dsj'e of
13b.Dttdnfeellan type Amount - completion of well construction to the canny hoeith department of the county
where eonsttuctnd.
rmm GW-I Norda4malinuDapnrtmantoflinvimaimintnlQaality.IDivhannofUintaResources I IRevised2-22-2i16

•
Will Dtilhw`SaiMirout Carlifkation
owner: u, o0vowal v
Permit tA)
Fberelsy cect3fy that the above fined w l vas groom in appearance in acandance with
all County Well rules.
Wen Driller, ...---
SiPerk
Ccxnstructton: taut:
Toth
casing Thicknesse--,
Diameter.
Wei, JTboicic,— r-.
Height
Drive Show
{