GW1-2021-04222_Well Construction - GW1_20210415

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23.Srte diagram or additional well deft
L For GeoprobrMPT or Clesed-Loop Geothermal Wells having the same You may use the back of this page to provide additional wen cousistcbm h&
eomttstion,aoty i GW I is- 'adic'ke TOTAL NUMBER of%ens. (add see Ovee m Remarks Bc%j You may also attach addmauel pages if zemy
dolled:
74.SUBMnTAL PMRUCriONS
9.Total well depot below,had swface:—
For a> plc rolls tic all dgdr ff4tgrwm(clung te-�W'm,d 2@IM ( ) Submit this GW_I within 30 days of well completion per the folio d r
10.Ste water level below top of g A) 24a- For An WeILs Original foam to Divisim of water Resew (DWR;
Ifraftr teal is abiove iae-+- Pmoessmg Unit 1619 MSC,Raleigh,NC 27699-1617
1L Borehole di4srrf.r t�b jm) 24b For Iniectian WeRx C�to DWR,U.&M..d b, Cold(IUC
Pragtam,1636 MSC,Raleigh,NC 27699-1636
12 welt coastrtdea method: 24a For Warta attd Gtx1 Before WeHc
CLe-V4M rotor!,caw aed push,eb-) SHtroly ftg i.Ooa Copy to th
cow envaoOmentat health cep OrmecoamyvAMeffidelled
FOR WATER SUPPLY WELLS ONLY: 24d.For Water WeIIs awdncias=over 100.000 GPD•Copy to.DWR,CCPCti.
Lam.Yield(E� (J Method of test rycc- Putt Program,1611 MSC,Raleigh,NC 27699-I6I i
13h Disaafeetioa type: Amount: V
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Fom1 GW-I Nw*cmlim Depam-afTsvaom=cW Quality-Div m of water Res== Reviwd 6-6-201
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