GW1-2021-07227_Well Construction - GW1_20211007

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WELL CONSTRUCTION v rGw-n For .mat Use onir. �.
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Water Supply WeL.
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Ukdaltim DWells>100,000 GPD MCA[ TO MATERIAL IMPL►CEIGtRAMMOD&AMOOMr
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Sb.Latitgde and longitude in deVreeshnWates/seconds or decimal degreew
C>fwen seta®e hVIM x suffieieot) 22.Certification:
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' 0 - ' 58 " / wiw* _ �.30 -Z
0.blare)the well(s): ffie DTemporarp L '3 0-1 S'g�`° weII� ` DM
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7.b this a repair to an eeaft welt' f O.Yes or IIK ISAhrGiC 02C.0100 or 15AJVC iC 02C.02W WCH CaNDUCIS►+SMM*n&Wd AV a COPY
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xPmr rondo i�11ls satlon arm,dtt baelc of dcsfarai 23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide addidonei van construction info
c=uuc:ion,Only 1 GW 1 is•needed.Tndicibe TOTAL NUMBER of wells (add'See Over'in Rematis Boxy You may also sttsch additiooel pages if necessary.
d Med: � 24.SUBMITTAL IlHSSTTRUCTIO1wS
9.Total wA depth below land sarfaee: 3 2 d (n) Submit this GW 1 within 30 days of well completion Per the fOIlowing:
AMPv-dpkweArIwaUdCPwfly(arn Ppk-3Q200'and2@IW)
o 24a. For An Wens: Original'&= to Divisim of Water Rasaaoes (DWI),
10.Static,water level below top of eating: V A) bfomation prooming Unit,1617 MSC,Randgh,NC 27699-1617
Ij"Workad is 4ovs oasing:rae"+;
1L Borehole diameter: fin,) 24b.For Inieetion Wells Copy W DWI,Underground bjeetion Coutrol(IUC)
Pmgrdar,1636 MSC,Raleigh,NC 27699-1636
12.Well contraction method: A 24c.For water Sanal9 and Odea-Loon Geot>Krmal R�tu�n Welltc CapY do the
C3.e.Roam"my,COWdaatposh,W-) =mty envffa=enW heaim 'O oathe OoomY wnao ms-mM
FOR WATER SUPPLY WELIS ONLY: 24d.For Water Wells Ug&wx over 1 GIxD:Copy tp.DWR,CCPWA
Permit Program,1611 MSC, 11
13a.Yield(Ppm) i a o Method of test: y
13b.Disn type: / Amount: l 2 w
Foos GW-1 North Carolina Departtoeut ofFavi:o==tl Quality-Division of wawResour= Revised 6-6.2013