GW1-2021-01620_Well Construction - GW1_20210323

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4.DateWeR(s)Completed: �i
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rearwdo•!2Ireamfa mal9 wardwbaFofds)bm 21 Sift dogmas or addtonal well aetaHs:
8.For GeopmbrlDPT or(7ese&Loop Geotherml Wens baying tbc same You may use the back of tits page to may
also additimal acid p m if
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Vim,a*I GW-I is prated bpdicdte TOTAL NUMBER ofaells (add'See Ovd in Remar3a Bml You may also a�addmmil pegs ffae�my
driHe3 24.SUBMITTAL INSIRUCFRI)TSS '
9.Total well depth below land surface: J 2 O() / (R) Sabot this GW-1 wlthm 30 days of well coogpletoa per the teDowhW..
For nvRs Tin aU deptfe ifdl�va(emmrple-mar'am12�10�
2.4a. For An Wells Original fog to Divisim of Wale Rtsaaan (DWR;
lo.state water Ievet below top of omg: ? (ft) In�ataa hw mng Unit,1617 MSC,RWdgb.NC 276991617
Yf Ie.daabo true""
l 24b.For Injection webs Copy to DWR,Undagumd bnjectm Control(IUC
1L Borehole dblmeter. G d�('y Cm-) Program,1636 MSC,Ralagb,NC 27699-IWO
12.Wei eomtrwtinn method: R o+fie NI �ry" 74c.For water Sewh and Gvdbumd 8aav WCU Cagy to tb
c>-e Zqf rimy.able,dsea pmh a<) y eavammeffi bea5 IbecoumLymummsmuea
FOR WATER SCMY WENS ONLY: 24d Per Water Wells s OAR ovrrr 100.008 GPD:Copy m DWRt,CCPCU'
r Pemu poi1 NfwC Rsianys,:., o :6..
L Meffiod of teen� _
13a.Yield(epvt)� r
13b.Disinfection typo
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North Carolms D pntmmt ofFm"comamal Qably-Divmoa of Water Resources Revised 66201