WI0100645_Geothermal Well Construction Record_20240503

For Internal U�pp11.Y:
for UCTION CORD
WE L CONTRex�melaPk•�el�
This form can be Used
1. Well C"i scior Iaformitioo:
Josh Plemmons
Well CorKreclor Name
4137-A
NC Welt Contnator Certifwatia+ Number
Clearwater Well Drilling Inc-
compeny Y40Q1e lI� �-
2. Well Coasiructios Permtt R:. IL�t-3-�nan+Pglver
Varier
e�e 1
List o11 WpfkWl -ellra,,,rt,rC'"
3. Weli Use (cbeek well use):
Water Sweply Well: 0municipaUPublic
QAgricvitusai ORcsidential Weer Supply (single)
> ootherntaI (NeatinglCootnrg Sappb') pResida►tial Water Supply (shared)
Okwusrria ial —
NOD -Water SUPPLY
t rvs�mdwstcr Remediation
GAquifer RcchW pSawity Barrier
OAquifw SuxW erred Recovery OstwM aw ihainAle
❑Aquifer Test DSobsidence Control
OExP nnwnW Tech=AW
Dt,eatisa,mal (Closed Loop) OTracer
._ _ i_:., .ruder N2 1 I
d. Deft Wows) :
Wes tD11,
Facility [DO (if applicable)
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p wel Weati5catj
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SU81►dt3'i All•STUCTIQAIS of well
s Submit this Iona wig 30 4ar Of CQMPWM
?All.
Opnstrwtioo to the foltowinp: Wl�
Diviswe of Water QUA8 .12fo t?
ifrt7 MaS �e Center. RAW804
Nc in addition to balding the ice` to"addIM f wolf
uk- of dill tMU within 30 days of COMPlet
above, alas rubWt a OPY
eo>naywiott to rho fullowin8l t prograa><+
�vblioa wowQ�ul>igr. Uader�roaad Igj«a coatro
1636 Mau Sovke Cash", riaieigh, NC 2iog-1636
addition to Sending the form w
4c. of this ftxm within 30 days of
the addre"(cs) above, also submit one COPY health depattll it of ft County
"'..Iliad of wall consouction to the cauaty
Anto,tatt where etoltsuvlCtal-
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Revised Jaa