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23.Sm diagram or addrboW wen demob: .
S.For Gmpmbe/DPf or Clamed-Loop Geothermal Wens barmgthe smme You may use the bwk of this page to provide additimm %eh6 a info
comtoGim,only l GW-lis needed. mdicite TOTAL NUMBER of wens (add'Sm Ovdm Rona&Ba4 You may also aMm:h mmmmal�ullct ifttsrmey
d0ed. 24.SUBMITTAL 1NS'1RUMCINS
9.Totalwen depth below land surface: 160 0 (R) Submit this GW-1 whMm 30 s
FormAaple we!<r&o aII dydagd (amg:e-3®200'mu'2�/00� days of wen mtlo per tkeSaBowog:
10.Static water level below mp of rases: �i (ft) Form
An Wells Onp ml dbffi to Dmism d Water Rmac. tm (DWR;
q,+ Indtsobow®,y..(. Ptocessiog Unit,1617 MSC,Raleigh,NC 27699-161'17
IL Borehole diameter: La l8 (m.) 24b.For Iaieetio®Welts Copy to DWR,Umlegmmd Jn)e-m Cmhd(Ric
Pia 1636 MSC,Raleigh,NC 27699-1636
12.Welt emtrxtkamebod —ehd.., _T Geal�mlRe�a'iYeHeCOPYIDth the000rdqvam
CLe�.1p�'•C"(rod pock m) wFWm ma FOR WATER SUPPLY WELLS CONLY: /( 24d.For Water Wells o�r_IW,0406 Copy tp DWR CCPCUr
Lis.Yield(gp* LMaw of test� Petmrt Ptq�tmm,1011 At::K-t�l,r.0 i0» 1011
13e Db�n type�� Amount
Faro GW-1 North CmDba Depammt MMmanaomGl Qoalhy-Dirisim of WaterResamom Ravmd 66201