GW1-2021-00859_Well Construction - GW1_20210404

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fl , --MWeM;-lOQ,000 GPD FROM I TO 1001ACEMII ACCIEW eAMGOM
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4.Date Well(s)Completed: —y" welt DJ# R R
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,rpao-rc�dot21 reatanbseatmi oraa thebm oftLafmsa 23.Sift diagram er addbioRsl well dICtII :
8.For Geoprobe/DPT or Clsse&L-oop Geothermal Wells having the same You may use the back cf this page to provide addidand we41 oocstruction info
won,Only 1 GW 1 is needed fadicite TOTAL NUMBER of,cells (add`See Over i n Ramada Boxy You may also saaab additional pages ffnecency
dnIleck 24.suBmnTAL HiSMUMONIS
9.Totalwell depth below land surface: I O (fL) Submit this GW-i within 30 days of well completion per the fellowbc.
For amiuple ve11s list&U depth,if&p—(ample-3(a?200'and 2®10&)
10.Static water level,below top of a� too (ft) 24a. For AD Wells: original f 1. to Division of Water Rrsotaees (DWR;
bAmmation hwesstag Unk 1617 MSC,Raleigh,NC 27699-1617
1L Borehole diameter. d (m} 24b.For Injection Merl=Copy to DWR.Undag-md bjecam Central(OX
Pmgrmm,1636 MSC,Raleigh,NC 27699-1636
11 well conshvedn method: 8 6 2 .. A'fy- 24c.For water&M and a:kg Gw&awd Remraweft Copy to th
�aCa sogc deepa �) onty eavaoom the c:amty where
FOR WATER SUPPLY WELTS ONLY: 24d.For Water Wells gmtem over 1 GPD:Copy tO.DWR,CCPCUe
13a.Yield� r_5 Mthod of test /; - Pezmit 1611 M3C,Kali:tgtt, C 27699.16I 1
13rs Didn&cdon type:— ��-1-- Amount: D
FooaOW-1 North CarolioaDV ttnamtofFsnviw®enralQmbny.DivisionofWaterResaaces Reviod6-6-201