GW1-2022-03538_Well Construction - GW1_20220324

R'ELL CON;,TRUCMINT RE Y
L Wen Contra _ Forte Use OMIy:
ctorrarorma�os
a®b::®
pw' rI0.>40.0 a 0.>0
zaa�es�. 09
b �
xewetic�r..e�• ,� R �
ssoonsa[�C?ASMG!�' iie7ia OBIa�t' rn^,,._•_.
yN®e $ A �......e..r
� j m
2-we COnm%acdO2LP FPS:D Z 'CAS<1�IGORTOsnvG ( _w *Pin.,�.
OPI�IFC.Com�.,So- y =O 39A' zae� ass�aL�
3 We1lTise(eitee7cwen user �� fi $ h r�
w win: .� :.-.: �,s•�xN.�„�����,,�,.��-, '
..srorsrm �
o
- •p .� '�twya�/�/�s��ts•Cst�:ea) -
W OWeils>I 000 GPD $xoM +^-29�i. �Fr.r: _ �CSr Si�ry ;Vw :.•• y� '
PIoa-Wi2erSapply eII: *s•,�*••? �'a�i,►csa�tro��.taeoaxr
ORecovay eat ;
Injection
C S%rageaedR=;vmy D&ab hyBamier oa
pA40�r?ese p MsAL naa�ra�ea
SW=%W D g �
p ITerhndogy •Mafiddeme C *d .$
(aoscdLoP) OTiaeer 7A�DRII.LIIdGLO
a MCXMI( glC 9 ftRefum) 1O D sJ.eib' -- , ..et '•
fL
a.Datewe.(s)completed: 3-Z1-Z2• w unw $ $
. sa.Wen Lotafioa: 4'
A-dod�►�7-easy I
y�owaeerlmne Ymgcxf ale) fL , >i ,
`�21 - Dlol Ber $
daa1Mc,r.CO=ZT
S P=r11de xo.
Sb-Laf *sadlongitudeimdWtW i uhwjseeondsordecimaldeg,=
CxfwcnECK cm laoloaga sat�j .
.A 1 22.cer�aatio�
6 �the we1(s): �ermaneaat nr pTw�wrsry 114 �' sigaatme afCeafifie . Dift3-Z
• � �+?ebymtlJythotrhe�.r¢(s)+.�f'"vz1 amrmr�dthaeew�dmionrsrh
thisarepaictasaessHugwe>l:� I]Yes oY✓pNo MAhr-4CW:0100-I5AMCO2C.01001P�CquasresrarSL�mdsmi9nrcmpy
�a.ewertm��rr � afr�srramil,�bmipgwrdadmrlfeirrlfo�mv're�•�o�div�2l amrmbrsa�taroravrdrebarEoJrJdrfarac - '�
I.For C,eopmbdDPT or Qosel 23•Se&agcsm or sd& oral wen deb ..
Loop Geo&m=sl Wens bavhft same YOU may sse the bade of this page to provide sdd amd wen ooaftveticn m£o
° mLca1v1GW-lisneeded.-7adic3teT(rALWaMBERcfmD (add'Seeoveein?jmarlmBox).YoumayalsozMachs&&jasipega¢may.
dared:
24.SOMMALIl1iS=C-CONS
9.Totslwell depth belowindsmfuc Z 20
F3(a�00'msd2WM �ft� Submit$dsGW_I 30 days ofweneomplefiom per the fdbwfW.
10-Static Water Level below top Ofmsing: y-1) (�) 24s.For All Wenx Origiaat£oaa to Divisim of WaterRasmaoes(DWB).
If> 1e:atrabaeemin$p�+- I anPioe�g. 1617,30QRRIeM,NC27699-1617
11.Borehole diameter.: L ZY� gym-) 24h itoi IaiectiOm Wells Copy m DWR,Uadefgarnmd 7ajectia¢Caaahol(IITC)
ftvpm:61636 W q Raleigl>,NC27699-1636
12.Well=serecfiommethod:_I<D a_k•
CLG m,;xoe09,ca*fieetpaih,e6G) 24a For Water and LOOD Geothermal Betatll Wens Copyto the
•. �ymva+oumealalbealth oftheeooatyw�0—m�e3
FOR WATERSOPPLY Wm.S ONLY: 24d.For Water Wak du* 'over loom GPD: .DWR,CCPCfJA
m
13s.Yield&Pno_ Method of test ar p PIO 1 I1 MSC, e 1 11 Y
13L Dhh&cdon type: Amomt ! D h-
70 -
Fo=GW 1 ma a caurma D'q an mcm ofB-b alQaa>uy-DivisoaofWaarResnasoes; Ravifed6.6.2012
-� 3=u-�-r��®n—nFl�< z�1z�iQ?i -IpBQ���n�K�2�yu03��# i��'���$HF