GW1-2021-01885_Well Construction - GW1_20210429

Feb 1619 05.43p ClealwaterWell Drilling 828622-7241 P 1
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2:3_Site+Hsgsain or additional well delafls:
8.F'ar GeoprobeMpT er Cl(rsed-Crap Geother.. l Wells having fiesxere ),on may use file bark of flits page to wovide additional well dile tleWls tm well
txiaslnicficn,anh I GW-J is needed fndiom TOTAL NUMBER af,.xlls ctya9truction driails. Yau may also attach additional pages tf owzmary.
drilled:
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9.71'otalwclldepth iretowland surface: (C-) 2-11 gr All )!hells: Submit this form t+ift 30 days of completion of well
tartdolNfleK•rile/:zrarideprlu+fdl�ermr(tcampAe-3(F±tJlJtl'oati4a�100� con92tUCfionto the folloitag:
Ill,Static water ltva below top of tasing: 00 Division of Water Rewurce Ldbrmation Pr mmiag Unk,
lfxnhntcrellydlvlvecWngOne "� 1617 Man So-*oCenter,Raleigh.XC717694-16t7
il.ltomJlotediaeteter:�LQ 6 _(in.) 2411 R-Injection Wells: in additioo to onding the corm to the address in 24n
17-Well cnnstruelfm method.-_ ataove,also submit one copy of this form wilbin,30 days of completion of well
(i c• ate.mom•coblc,ditrovc push,+.Kc,) ��� amstmetion to the following_
Division of W ater Rearturm%Undehrunud Nectlon Control Program,
FM WATER SCPPi V WELLS ONLY: �p/�� 1636 Mail Service Center',Ratelo.NC 27b99.16 6
13a.Yield(t;pm) iltctbad of tesC 1.:^'�-i 2aa r Walcr Su»°is&9}eeHon R`elts ln,tddition to wndirrg fttc form m_ �- the oddriw(cs) above; also submit one copy of this foot within 30 days of
13h.Disinfection type: Amount Completion of tvdl consttuetion tr the county health depanrnerit of the county
whore constrmeted.
Farm Gw-I North Onnirnn Daponmont ortim•Ircinmental Quality-Divismnorwhaw Ro"arces Revikd2 2T2a16
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