GW1--07784_Well Construction - GW1_20231201

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I.!s this a repeir to as existing well: ❑1''e! or
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rep de under ddl re trot samba.u•a,rAr tv„•.t gef7x.FKM 23,:tile dVgnm or additional well details:
You may use the back uC this a to provide additiatot well Rite details rn wet
8-ei r ed o. PT or is needed. in iGeothermaltoTOTAL
Wells NUMBER
the smile
construction details. Ynu may allo attach additional pages if natssory.
rnnttrLdtah.only I Gt4'-) is heeded. Atdicste'ln7AL NUMBER of well!
&Roil;_. SUBMITTAL INSTRUCT IQI
4.Total well depth below land sorbet: .27_S 00 24s. For All Wells: Submit this form withtn 30 days of :nnr,Jrt;'ton or. .r.Ia
Fo•water&w,,is no all cirpflxt tfdfre'ff(erowyvie-.t(2th0'and 2.g1100) construction to the following:
JO.Suhc water level below top Dressing: _) L/ / (ft.) Division of Water Resourtcs,information Prnetssiag 1:nit,
iy Hum,letel it cbo.r taunt.rut 1617 Mail Service Center,Raielgtb,hiC-27699-lull
I I.Borehole diameter: G" (in-) 24b,For intaglio's Wells: In addition to sensing the form to the ad:tTeas In'-As
above,also submit one copy of this form within 3C1 days of cmpietion of w'ci',
f2.Well construction method: l4k►''`f construction to the following.
file.poser,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection ControtPra rum.
FOR WATER SUPPLY'WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1b36
13a.Vicki(gpm) 1Qetbnd of tell:
?' 24c. For Water SYDEIv & 1nle�ioe Welts: In addition to sending the form to
;.‘yr
the addresses} above, also submit one copy of this form within 343 days of
e G 7- Amount: P completion of well construction to the county' health department at the count'
73b.Disinfection type: /�'i where constructed.
Pons OW-I North Carolina Deportment of Environmental Quality-Division of Wafer Resoiu'vn itemed 2-22-2Ott