GW1-2021-04170_Well Construction - GW1_20210827

WELL CONSMUCTION RECORD tt:corn.Y_
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8.Number ofwdh card acted: ) congruCtion deals You army also attach addLLi®I pages ifneoemmy_
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9.TatdwdldepthLdowlaodsofa= Z� (R) 24a.For An Went Submit this form within 30 days of completion of wen
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10.Static water level below top of a (O (K) Divison of Water Resaaicc%In =afion Praeesd:ogUDit,
,lfwaterkwJ dsalurveembr&><w"+^ 1617 Man Service Ceutw,Rah*k NC 2709-1617
11.Bodiameler: 1 d [ur.) 241L Roc Inieetion Wdh ONLY: In additioDto send-mg the form to the address in
24aabove,also submit a copy of dds;farm within 30 days of complctkm of well
17.Wen coushmerno mAhod: i'Vliay�Z� cmmwtiontolhcMiowiax
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Division of Water Resown-,Uadergraaad hacc l"I Coubd Program,
FOR WATER SUPPLY
�WffiySONLY: 1636 MadServim Cmtec,Raleigp,NC270!9-1636
13a.Yield(gpm) %` Method artest &*ID 24c.Far water SuD !v&mice,;=WeSt 4
Also submit one copy of this form m thiD 30 dtlysofcampielion of
13h type G/ { Amow¢ti YLl/� well county h rot of the comity where
couskuCtCd.
FormGW-1 NmOiCauffiaDgssm =afEuviuumeutandNanaalResuumw-DivisionofWaterReaamces Revised A 2013
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