HomeMy WebLinkAboutGW1-2021-07524_Well Construction - GW1_20210903 i
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L For GcoprobdDPT or Closed-Loop Goothermai wells having ilm same You may use the back of this page to provide additional well site details or well
won,only Lt31N 1 h needed. Indicate TOTAL NwAisi It ofwelbt oonsuuedon details. You may also attach additional pages tfnecessaty. .
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g TON well depth below tend sar111co: otoC (6L) 24%Z'ar& wens. Submit this lone within 30 days of completion of well
rr=46 walk ltuatt&Pda f4bw(amtpla.3®ZOD'wd 2@10n construction to die MawkW
I&Statle water level below top of casing; Division of Water Resoureee,Information Proceesias Un%
I"d&abaysasft are-+- 1617 Hall Seeviee Center.Raleigh,NC 27699-1617
1L Borah°fe diameEere ®(in) 24L For Infection Yens: In addition t0 aeMhtg the farm to the addnss is 24a
ahoy oy also submit one copy of this form witldn 30 days of moplWon of we
it watt constrnctton method. A:r
f�sari rotmy,esbtR aoeetp�,�) wnstrtrction to the followiu� .
DkWon of Water Resources,Und and I0j"ou Central Program,
FOR WEITI;R tI[iP1'I.Y WELLS ONLY: 1636 Mail Service Center,,Raletdh,NC276991636
-13L.Yield(gpm) ' Method of tesa,( kb+T. 24L For wager dnnniv&Infection wrens: In$Mon to sending the foma to
136.Di4latZidioa e: the addresses)above; also submit one'oopy of this dorm within 30 days of
type: �O% amount:-,, �EoAL completion often constmethm to the caunty health department of the counijr
wherecousuucted.
Form(FW-1 Revle 2M4016