GW1-2022-07586_Well Construction - GW1_20220815

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23.Site diagram or addBloaal well derails:
S.For Geoprobc/M or Closed-Loop Geoftermat wells having the same YOU may use the:bit:of this page to protide additional well conshuedon info
Ooa tictiou,Only 1 GW-1 is needed.Indicate TOTAL NUMBER efwelis (add Sm Ovee in R==Ics Box}You may Also Owl additional pqm ifnewsmy,
eh'1Zled:
24.SUBMITPAL MMUCTLONS
9.Totalweil depth below land sadace: 7D y (L) Submit this GW-1 w;shia 30 days FOP radapls-nIIr&neIIdeWOf4b-&(� ms o-3@200• d2®100) w ysofweR Completion,per the followbW
10.Static water level below top of eashtg:_ Q (R) 24a. For All Wells: Original foma to Division of'water Rmoun (DWU
Ij«ordrkrdsasowc=ft•w•+-,/ hz oaP==in9Uni�1617B&C,Rddgit,NC27699-1617
1L Borehole diameter.- (o rY {m,) 2411 For blection Wells Copy m DWR.VU&4mtmd htjectien Cnvtlol Mq
Plagtata,1636 MSC,Raleigh,NC 27699-1636
12 Well construction method: Q I r 24c.For Water Sb and Lon Geothermal Re:tvn Wells:Copy to the
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FOR WATER SUPPLY WELLS ONLY:
24d.For Water Wells over LM GM.Copy W.DVA,CC=A
13a.Yield(gpm) I Metitod of test: al r Pamir Pmgtam,l 11 MSC, C 1 11
13b.D!s[v&cdon type: Amount: OZ
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