GW1-2021-04591_Well Construction - GW1_20210429

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a ft. & 6.
OcMhcmw(I,1eating(Cooling Supply) esidewlal Water Supply(single) to GtduslriatlC,tmltner i fresidenriat WaterSuppiy(shamd)
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lelf►n li'nlar Suppfv VkellI To
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Aquifer ileehat;c DGrrn►ndwater Itemcdiamm 0" R
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Aquifer TM lit
�Smmrwater Drainage IL ff.
izperimenral Tixhnplpgy E)Suhcidow Gontrnf IL 01. —
Gcothelmal(Closed Loop) OTrate:
Geothermal ifoatitt FROM TO
in Rehmi) Other is under d21 Rernevlcs)
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A.Date Wolfs)'•ompletrd;-g 1:5.-."-!,Well ID# it. ft.
Rq.Well 1,ereortinn:
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C•wu Parcel ffieutiiirgtime No.(N1Pl} cS1�
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R.Far G 2:3..Sifc 4%graro or addlidofmt wendetatfla:
eolsrohe/Bs7•nr cimed-1 nop GeothertanI Wcli+having Itre were leote may usa the hrtck of this page to peovide adlgo,nti urdl sUe daealts ter we0
ddl?anrctian,nnh I t:W-1 is neede I'n,fmato TOTAL NUMBER ar.vclls cot gMwAirm detaiis. You nAY also afth!Addllionai
driliud•�.�..._� d pages 1f ntJceai9tuy.
- AMMIUM",11SIMIGMIN
,9,Total well depth beloW land sw7Hcct__- 1-3,nr matNpl,-elft Mc elldopylo vaff rani,r l;Z okn-3(iI?7lJb'mur iLptea� —(R.} 24% JPm,%! yUsllo: SuM*Otis form Ivithia 30 da��of�mplidion of tvrll
Consttp�lion to the JMIOlehtg:
1A.StaGe;wallet Joel helm,tap of taAltew .
!1 rrordrDncl 107 rdw,veawnW,ne 00 Divitioa of Water Resmwees,In%rmatlon Procefsiag Uidt.
Ib17 Mall SaWvfce Center,lRaldgk NC274"-1617
1D-Bolrholydlameter.
�n') 24b,For 1yrion Wdla: L►addition to'Wontling the torn to dler Warm in 249
12•Well etot"raelfnlf Iae16od: //��.�/ ,el>ove,also submit are:copy Of this form j within 30 days of cae*adon or Nell
(i r,ea7le•mmn,,rook,*04 push,etc•} ". *Xzft Ilion to the fol losvirC-
F1pf1 WATER RC PPF y l 15 tNNLy: DIvlaion of Heater Reaeurcrs,Underground 1gleetMa CUMM prMnM4
l M6 Man Service Ceam 1
r.i,A'01 ,AW27bh9.•1Glfi
I Ja,Yield(gppq T`. iJf+etlltgl of test: �
tie Ear Wstar Sundy&for -Hon Wlte- ii2 AdMian to sunding ft form It,
t.ih.Ulfinfcctieml type: Antotmr the addrass(es) shrug also submitone copy of this form within 30 days of
- cofaptetfon of tveU consuuceon to the county beam depattmcnt of the emtty
u heua comttresed.
1°emt GW-1 AMtih fyRmffrtn- IJopnmmont of Einvlrtin MUM Q:vlJIy-Afvistm cewmer lkn%mcnc RnvraeR3-yl Zarb

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