GW1-2022-01036_Well Construction - GW1_20220107

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7.1.Ibis A repair to Rn existing well: rAYrs or oNo aJrh 15A N X.'07C.1000 n)•MA NCAr if7C.'.0200(Pell('onrJnrr7in)r SlnmlorA.r mill thnr r:
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R.IFnr Cmprohe/f1PT or f'toaed-I.Amp Geothermnl Weilit havfng the.same )'oll nlay us:nu:back of Ibis page to provide addillonol well site,demils or well
ix?nsinu:Nnn,enl%, I GW-i is needed, facticme TOTAI.NUMBER of xrlis construrainn delffiN. You May a{SO Wkh additional pages if Time- ftry
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111.4tnth:wnterltwel below top of esslnn; Q V._ (ft.) Division of%fer RelottreeA information Prot,essiog Doll,
lI a•nd•r tal'o a'rAml cpaing,rear• t 1617 Alail Service(Center,Raleigh.NC274"-1617
Rorchate diameter: _ (fn.) 2,%.Tor jajer•ti }Yells: En addition to sending the forni to the addrm in 24a
I?_Wet(ronstrnelinn method: — abhve,alw submit one copy of this form rvifhin 30 dayrc of completion of Wr11
ctiq%strurtinn m the following:
0 c.aunt,romily,e,•d,lc,dircet;nnh,a(c.)
Division of Water Rramrtcts,Underground lgjection Control Program,
1`t)R WATER Sf:PJ%V WF,1,15(N111,V: T -_r.. 1636 t►1afl Qervfa Center;RArcfgh,NC 27F994636
I.la.Yield(gpnl) ul etbod of test: 2.7c, r r Cond> ate ra)�n n Wetie: to addition to Swfding tht:film)to
— the addwss(es) above, also submit one'copy of this form within 30 days of
jokinfertfon type: _ Amount, MJnpleNnn of Well cnnarructfon as the connl)health dePanrneM of the Monty
- whore constrncted.
i+arm Cw-r North Cnmlinu rxpnnment or'!!n�yrdnfriratnl C,taali ty-Divi sign or Water Ralmancs RaOW 2 74-Z016