GW1-2021-00852_Well Construction - GW1_20210322

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WELL CONSMUMON RECORD(GW 4) For immnal use 0
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,ePMrw/era7lr*arhrreaan wandeeack4ifthisf m 23.Site diagram or additional well deOpNc
. &For Gwprob@MPTor Claaed-laep Geothermal Wells Imeing do same You may use the back of this page to provide additional well site ddnb or wall
consttuetimanly LOW-1 isadled. believes TOTAL NUMBER ofwells. aoumopiern demos. You may Who atmch addimed pages ifnaeamy.
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9.Toe well depth below land saehea G s Ifs) 2U For All WAM Submit this fame within 30 days of completion of well
frmd*k,dls lmalldgdir arJglmr feamyole-J@M*oad1@1007 construction to the fallowing
I&Static water level below halt of easing: (ft.) DfAdaofwaterResources,Information Promising Unit,
lfaearlend babe"cowng.vie 1617 Ned Service Center,Ralefgh,NC 2789-1617
iL Bosvhde diameter. (lo.) 24b.For Johnston Walls: In addition to Smuijng the form to the address in 24a
12 Well taustrwetlou method: r`o f-rn r y A% above.elm submit one copy of Ibis form within 30 days of completion of well
fins aaeetmmRuctionmethod-.w) _ construction to the following
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FOR WATER SUPPLY WELLS GAYLY: 1636 Mail Service CmRelagh,NC C2 Program,2709-16
13a.Yield(gpm) Method oftush ��•TM a 24L For Water Suonly&Injection Wells In addition to seodmg the form to
the addrm(es) above, aim =lmit ona copy of this Sham within 30 days of
13b.malefaction type: n.7 0 Lin Amount: �6�< mmpimou of wall construction to elm county health department of the courtly
whtre constructed.
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