GW1-2021-04321_Well Construction - GW1_20210404

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PROM TO D1ANMM SMSM :MMWM :MAMSAL
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oAqudw Recharg mmundvater Remediation
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1s(are)the welksr or oTtmporary l 176 ' ofCer6fiedW-Ul anIe net:
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rardot`2I seaionorotr dteLvoFojtFtafarta 23.Site dragram or additioaal Well deist
L For Geoprobe/DPT or Closed-Loop Geothermal wells having the same You may use the back of this page to paavide adddocal well amdnzdm iffo
oonstu dM Defy 1 GW 1 is needed Indicete TOTAL NUMBER of wells (add see Over'in Reemarla Box}You may also atffich additioael pets if tteorasaty
dnIIed: 24.SUBM TTAL mTRUC oNs
9.Total well depth below Lad sarfice: 3,t d , (ft) Submit this GW-1 Widhis M days°Ewen eom�rletion per the fellawisg:
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10.Static water Level below top of casiarg: V �) �- For All Wells: Otigimai foam to Division of Water Resaaaees (DWR;
1f � heron Processing Unit,1617 MSC,Raleigh,NC 27699-1617
1L Borehole dismeLrr. gym) 24b.For Iaicctioa Wells:Cory to DVM,U=kWmmd brja�on Coottol(IUC
Pragram,1636 M3C,Raleigh,NC M99-1636
11 Well c0ustrwfift method: 1`0"f c 24L For WaterSaudy and 211 � �olt Geatitermal Rem Weft Copy tD th
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FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells Raftax over 1 Gm-Cagy ta.DWR,CCFCUI
Pew Pmgrmn,1611 MSC, C 27699-1611
13a.Yield(gpm) Method of test-
13h Dlsimfectioa type: Amoumt: l 2-
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Pom OW-1 Nor&Carman Dew of Em*oammrat Qaaliry-Dividon ofwater Resomem Reviaed 6-&201