HomeMy WebLinkAboutGW1-2021-00803_Well Construction - GW1_20210215 WELL CONSTRUCTION RECORD UW--1) For laternal Use Oni3r .
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23.Site diagram or additional veil details:
8.For Gcoproln:Mff or Closed-Loop Geothermal Wells having die same You may use the back of this page to provide additional%veil site details or well
constiutxion,only LOW-1 is needed. Indicate TOTAL NUMBER ofwelis construction detaft You may also attach additional pages ifneoamy.•.
dolled: _ SUBMITTAL INSTRUCTIONS
9.Total well depth below load surface: 14L For All Webs: Submit this fbmh within 30 days of completion of well
t••ornmldple incur&I all Apda tfdj8am(hanoe-3@200•and 2@100) construction to the following:
it Static water level below top of casing: S (ft) Division of Water Resources,Information Processing Unit,
Ifanrerlerrl is ahoveeartng.are•=" 1617 Mail Service Center,Raleigh,NC 276994617
IL Borehole diameter: 6 (in.) 24b.For Infection Weiss: In addition to sending the form to the address in 24a
above,also submit one copy of this tbmt within 30 days of completion of well
12.Well construction method: 4:12k -.j .a.✓ construction to the following:
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FOR WATER SUPPLY WELLS ONLY Division of Wafer Resources,Underground Injection Central Program,
1636 Mail Service Center,Raleigh,NC 2709-1636
13s.Yleld(gpm) Method of test- i��$�me 24c.For Water Bounty A Infection WeIL In addition to.sendimg the form to
�9 the address(es)above; also submit one,copy of this form widit 30 days of
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.13b.Disin6edon type: Amount: completion of mill construction to the county health department of the county
whereconsuucte&
FarmGW t NorlhCaroftDeputtamtofEavimannsotel Quality-Division a Maw Remutes Revind2M.2016