GW1-2021-05313_Well Construction - GW1_20210615

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t ru n exi,.eft ov�arsu�avr mfordr�an a>d the Boa o�rl+e of Scs Teec�d har h w p owded to d6e veU owna
roa9er¥21 rmmEs saetfon a,on the bdeYoftlrisfonv:
23.Site diagram or sdafioaal well detals:
Yon may use the back of this page to provide info
8.For GeoprobrJDPT or Ciosed-Loop Geothermal Wens having the same (add See Ovee in Remarks Boxy You may also attach pages ifnecesm
men. 1 GW 1 is needed.tndie'ete TOTAL NUMBER of sells
dnIled 24.SUBMITTAL IxSTRUCTI01!iS
9.Total weII depth below Ind surface: 5 20 t (&) Submit this GW 1 within 30 days of well completion per the fenowhg:
Forv-ftki elk&Ialldgdnif4%rewl�k-3@200'arm2®1�
P 24a. For All Wells: Original form to Division JWater Resor. (DWR;
10.Static water levels below top of easing (�) hrfutmaiion Ptacessin$Unit,1617 MSC,Raleigh,NCI27699-1617
4rwaw kvdfsdbM=$ft'rse action Coatcal(IUC
24b.For Iniecdon Weis:Copy to DWR,tlaaagart�bu
1L Borehole diameter: ten) program,1636 MSC,Raleigh,NC 27699-1636
12 we>f eoasaaetiea meth�odt: 24c.For Water SaDnl7�d DPe-��°n �W�Copy to th
p-=8W ro my�dived vu*�) ommty enVII•cume�l beam Ortne COImLy1vhem mS0;LLed
FOR WATER SMTLY WELLS ONLY: 24d.For WaterWells orodu&C aver,ISO GPJ Copy to.DWR,CCPCUe
permit pmgam,1611 MSC,Raleigh,NC 27699-1011
13a.Yield(gpm) Method of test: I
13L DESaiftSon type: Amount: Z'✓
Rained 6�-zol
Form OW-1 Now C rotma new of l Q�Iar-D;r;�of Water R ;