GW1-2021-06844_Well Construction - GW1_20210429

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3.Well Use(check well me): & is
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4.Date WeWs)Completed: Well M# $
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22 Certification
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7-Is this a repair to an emit well:- nwY or O ISANO C 02C 0100 or ISA ArAC 02C A200 FeZ C u&zc m Sosdmdt and thr a cap
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np�a>sdo€JI tearmis seeiart os the ba�ofSasfara 23.Site diagram or adfiriioaal well details:
8.For Geopmbe/DPT or Close&Loop Geothermal wens bavbg flu same You may use tite back of ibis page to p mvide addhonai aeu oonsttacbm fi&
ta oms dion,0*1 GW 1 is>cded.'i&c to TOTAL NUMBER of rills (add'See Ovee in R: Bm4 You may also ate additional pggm if necessary
�� ^^ 24.SUHMI.TTAL RiMUCTIONS
9.Total weR depth below had surface: d+ 6 A)
Fosamlupte vet&a aff dgda ffdff-n(—pk-3W00 and 2@100) Submit this GW-1 within 30 days of well eompledou per the fellowiag:
10.Static water level below top of casing: 610 (ft) �• For All Webs: Original fours to Dmisim of water Remum (DWR;
If,�Ienits dbox 'we„f_ bf-matinn ftmsdng Unft,1617 MSC,Raleigb NC 27699-1617
IL G Ye 24b.For iaiection Wen=Copy to DWR,U-kWou d Injeefton Caat:d(1LTC
• BoreholeCm•) ftgram,1636 MSC,Rateagh,NC 27699-1636
11 Well!t even medod: eIR t:}a� ., .�► Cr- 24c.For Waftr&gIft and eggaiM GeoffiermalRum Weft Copytoth
FOR WATER SUPPLY WEDS ONLY: 24d.For water Wens over 1 Gl'D:
Permit 611 MSC,RaleigE, C 27699-16I 1 Copy V D��`
13a.Yield(gpm) /O Method of test: '�"
13h.Didnfeetfon type: Amaaat:
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