GW1-2021-03720_Well Construction - GW1_20210823

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tS.ls(atr.)the well(SOP-monent or OITemrpnrary $fan tar"af(krtifrodalrellCtnttraator VOL,
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7.ly 111is it repair to nn el:Wag trill: Ives or Pi<n u•JIN/SA VCAf.'0).C.4/fif)far tJA N!AC.h7l'.O2/1D Well C-Wfn araa SvPmb?Lr ami,haf a
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a�rair mMar A?!remrurke aucrymt ornrr d�c hark njlAfr jarnL• '3_Site dim O.84161119tal Well dMlb-'
R. nr Genprnhc/DPT or Classed-l.nnp Geofhartmtl Wells having the same *1'Qu may Lisa the link of(hit.page to provide additional well site detDih or W11
r:4nslrrretirm,nnlg I CrW-1 is needed rildicatu'COTAL NUMBER of wells conaatruGitasl J1Mails. you may a<Sa Rftech adtli(ianat pegs if nnt�9ru.
drilidd:__ i,rtenarrrAl 1{�tTR3It'1 LO1HS
AC—R depth below land sudhcc: _(44 ;14 Alt
a. C W M: Submit tics fdm within 30 da3%of COMA lion of well
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Ail."Static•rvmvr tevcl ttetaw top of essingr (ft.) Divislon of Water Resoureeis,Information Pmessiag Unit,
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t 1_tp,nelrntediameter:_..(0 -_(In.) ?.db.Q ILA-I"ctign Mr. In addition to Sending the form to the nddM in 249
t�fJ�/� li i 11mve,also submit one copy of this form within 30 days of eomplewon of well
174 Well construction metbnd: l i tl-t.�/I conmuction to the foilnwing:
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Division of W»ter Rea4mrm Undelgronnd i ertion Control PriMmm,
PM WATER SI:M V WF.I.Lq ONLY: � ItiX mail Swdc*Cant",Reitelgh,NCZ169%.1Gt6
13a.Yield(gpm) LL/ Method of teat_ _ P.1e Rnr 1Mafrr Rattily&feiee8an Wdts• (n additieb Fn sending the fttrtn Ttr
lbe nddress(rs) abnvi; also subiniL One copy of dtfs fo m whIlin 30 days of
13h.ptsinfectfon type:. _ Amotmt: completion of well croisttuction W the'c0tinty lividih t RMImcm of the eolmly
Where comfMcled.
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