GW1-2021-00555_Well Construction - GW1_20210226

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L Well CoaDactor Information:
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4.Date Wcfl(s)Completed: -]3- Z 1 Well ED# R R
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$b.Ladtwk and longitude In degas/minates/secoeds or decimal degces:
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6.Ware)the well(s): armaaeof or IlTemporary
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8.For GeoprobdDYl or Qaed-Loop Geothermal Wells having ,e You may use me bark of this page to provide�tmal cell mom
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dulled 24.SUBMfrIAL INSTRUCTIONS
9,Total well depth below land surface. 1 ?' A) Submit this GW-1 within 30 days of well completion per the fellowing:
porvad&*w.a.lire od agapefdffv 3@200'tu t2@1W)
24a For AR Wens: Ongmal fom to Divisionesa6ces of Water R (DWW
10.Static water level below top of— (R) Irk oii ftomting Unit,1617 MSC,Raleigh,NC Z7699-1617
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1L Borehole diameter. Y rm) 24b.For 16i MS WeLLx Copy to DW$ uo 6desgod Injection Coned(IUC
L Pmgam,1636 MSC,Raleigh,NC 27699-1636 -
12 Wen construction method: 1Z d l 'ci.0 ;+� 24e For Water Se and D-Loo Geothermal Rates Well=Capy to th
Cie near,many,able dinetpah.ecn) t wwty en - the co�Y where.
FOR WATER SUPPLY WELLS ONLY: 24d.For Water WeRi prudvde¢over GPD:Copy to DWR,CCPM,
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13a.Yleld(Spec, 15 Method of test Arr _
lab.Dlatulecdon type T I �o Amount 12 �-
Fomr cW-1 Noch Cemlma Deparimmt ofE6rannmczual Quality-Divvnn of Warr Rtso a Re.ised 64201