GW1-2021-05938_Well Construction - GW1_20211025

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L For GeopPobdM or Closed°Loop Geothermal Wells having"Ume You may use the back of this pogo to pmvlde additional well site details or well
eonshuedon,only6OW1 kneeded. LtdlowTATALNEMBERofwells conettuctiondetailss. You may also attach additional pages ifnaammy. .
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i►Total well depth below load satfacet ��5 f�) yqa,p®r,�tB YrJe➢le: Submit this term%i ithin 30
lrornmr*1eirells![ttalldaparirdip mn(aeon�p [e-mail]20fla D9 construction totheibllowittg days of completion of wall
26:Static water Level below top ofcaslog: Cl (ft.) Division of Water Hesourcm,Information lrocm1ug Unit,
(/t��terlsa�fl trtlbaveeafing,urn^+^ 1617 Hall Service Centw sleigh.NC 27699-2617
1L Borehole diameter., (c (tu) 24b,F®r ni ctian Walls: Yn addition 4®sending the fomt to the address in Zda
IlZ Well cottstrttetton method: �;i' above also submit one copy of this fort within 30 days of completion of well
CIA auger,WMW.aVe.dbeotpw%aMj construction to the following:
FOR WATER Si"LY wXLYA ONLY.. D"lon of Water Resource&8lndergwood Injection Control i�rogrom,
1636 Mall Service Cate IBolelgb,KC2769F 1636
I3s.Yfietd(gttnt) Nethod of test:P!1 tt h±T;en 8ror YAJater Sunniv Bnieetion W ttc; In addition to sending the foam to
o the addtess(es)obavq, also submit one'eapy of this f m within 30 days of
fl3[w IDlslotlscetoa type. Amounts �Gcht completion of-Wall censtntction to the county health depintment of the counW
where conatnicted.
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