GW1-2022-01883_Well Construction - GW1_20220210

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WELL CONSTRUCTION RECORD(G%-1) For homal use Oaly.
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2089 FROM 110 M r,A�.
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7.L thla a repair to an eilating welt: Dyes or MNG wUh l5A NCAC 02C.OlW ar iL4 NCAC 02C.020O Welt C.omsnucdm Sea dm*w d that a
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Z3.Site diagram or additiond well detaHa:
L For 6eeprob0Dff or wed-Loop Geethermal wells having tiro same You may use dw burl;of this pop to p wWft addl wd well the ddO arNa
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9.Total wen depm blew Und swftce: 04 ]-For An weltx Submit this form within 30 days of cmn kfm of well
For�na�avdtsilatadld�lhsifd�ua>sfe�ama�e-3(a)200•a�7(�IO�D17 �adstsadeoa>3otieafolto 4 �.
IL S' If waft blow tap off I • l (itj DhM n ofwater Reaonrea,won Prod Unit.
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1L Barebak fir: (in.) 24b,For Madan wed 18 boa►to=Mmg the fmm 10 the address in 24
of well
12.welt cons�tion method: �a also submit and copy of tbb faana willdn 30 daps of couple"
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FOR WATER SLIMY VM"Ob1LY: 106 Mail Service Center,ltdeigh,NC 27699-16M,
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13a.yM wM) Method of teak 24c.For water SaoaW&bdection wells: In adMM to tendm$rho fam W
Me a&hc*es) above; also suhrmt one caPy of this Am witie>n 30 days of
UL DhInIkedon type. Amount. vcompletion of wa MUMMwa Ito the county health depwuncat of the,cmuty
Fo®GW--1 Na&CuWmDgmmmtafFina Q=W-DivismoMaraRaoorm Revised2-222016