GW1-2022-01618_Well Construction - GW1_20220203

WELL CONSTRUCTION RECORD urn 1mLr.
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FormdgWehoew=oraat-umersspfywdrsOMYwNbdwseareomr you cm
=bndt onefom.. SUBMfTrAL LNSTUMONS
9 Total wet depth below Lind surf— �� (ft) 241.For An wells: Submit this form within 30 days of completion of well
For mnWe we&Im aff dqn&tf4prew(—WA- cmmkucimito the following
10 Statle wares lewd below topef eastag {o ( ) DWWoo of WPater Re w=vcs.IntaraaIhw Prorxssmg Unit.
lj,ronrlsxllsoboreears9tgtax`+• 1617Mat Service CeAerrFAkW NC27699-1617
IL Borehole diameter. q i t (rn.) 24116 h ONLY: In addition to sending the form to the addres s in
_.. 24a above;also submit a copy of this form within 30 days of Completion of well
12.Well construction method: 011L `A"1 Comstisn*ion to the following:
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FOR WATER SUPPLY wEus ONLY: 1636 Dw Sd=vice Ccatel,R:Ie NC rM9-1636
�) 24c For Water Supply&Liecam wells:
13a.yield � Method of tat:���' Abdo submit am copy of this form within 30 days of completion of
13b. Mw W e i I '6L41-ve Amount: a O y well oonudncdmi to the cowry health depathmeot of the wuoty where
Form GW-1 Nanh CmoU=Depaedm 24 ofEnvvaaa -and NaUmI Rcwnrccs-Dm==of W—R Revised AgvM 2013
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