GW1-2021-07631_Well Construction - GW1_20210903

SPELL COMM- UMON RECQ UGW-1) For resat vse oaiy �.
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6.h(are)the**S): !�'ermaneat or ❑Teziporary Sigemtme w �r Date
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4r*j is a repdr,AII ee¢brown wet11 aeonatsrra7ar' on mid ewlatn the ttmroe ofthe of this taeordhas Gmt provided to the weD owner.
nepatr to>der 021 nmrmb srtCan or on the bad of� 23.Site diagram or adetitio�al well de:talls:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional adl constructim info
eonshuction,0*1 GW 1 is needed 3ndiche TOTAL NUMBER of wells (add'See Over'm Remarks Box}You may also attach additional pages if necessary.
drMed 24.SUBBMAL INSTRUCTIONS
9.Total wen depth below land surface: 8 o D
For eradttple we&An aUdgvAm jdffi"M(esomple_3 00'mid 2@100-) (��, Submit this GW-1 within 30 days of wen completion per the fellowing:
10.Static water keel below top of easing: Q _(R) 24a. For All Wells: Original form to Divas m of Water Resomoes (DW4
Jy levd itabow�� +i bf 1;7(n Processing Unk 1617 MSC;Rale*b,NC 276W1617
1L Borehole diameterr, b gym,) 24b.For Injection Welts:Copy to DW1t,UndeMmund Injection Control(IUq
ProF=61636 MSC,Raleigh,NC 27699-1636
12.Weil construction method: 643 Y 24c.For Water Sup and Loon Geomermal Retvn WeQs:Cepyto the
(Le.�.�divedpeesb,�) owny envaonme aw hea'— 02the m
FOR WATER SUPPLY WF,LLS ONLY: 24d.For Water Wells rvdn ' over 1 GPD:Copy to.DWR,CCPCUA
1AL Yleld W* Method of test: 0&1 r Permit Prograat,1011 MSC, 1 11
13b.Didofection type: 01/ Am ut
Foam GW 1 11 Ceffolina Department of Eavaonmearal Qwl ty-Division of Way Resomm Revised 64-2018