GW1-2021-02339_Well Construction - GW1_20210722 (2)

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8.Far G�hrr or Ckwo&44wp Geothermal WWk havhng flu same You may me the tack of this page to provide additional well site details or wall
c nstr u t iao.ou*l l3 l is aeedeL lultnma TOTAL NUS of webs aaoatnlotion eletat7a. Yost may also attar additional pages if necessary.
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9.Total wall detach below load sadsae: ®" (D.) 24s.For An Wens; Submit this foam within 30 days of compldion of wall
F-m=A*k walk ht all dqwdv#'dMansr(amspk-3 M'a d2@100) construction to the fidlo ving:
IL Static water level bdow top ere:ntag: (1l.) D Mal=of Water Raroas+eaw,lafaenaHoa Pi ecaso g Us%
ywor kw el&awwsemft me'�' 1617 Mall Service Caner,Raleigh,NC 27699-1617
IL Borehole diasaeler: ) 24L For LkMM Wells: In addition to sending the form to the address in 24a
-� �---� above.also submit coo copy of this form within 30 days of completion of well
12.wen oeeartneeflrra own.n.. construction to the.fohloeving:
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Dlvldna of wales Resoarea,Undargromed l4e ctlem Cow ftgpaas,
FOR WATER SUPPLY YFLS OILY: . 16M Man Service Center,Raleigh,NC 2700.1636
13a•Yield(Was) a Method ottest: , W Far Wa/ar&Ok do Inlecdon Wells: In addition to sanding are form to
!die adrhaw(as) above, also so11 it o6c'copy;of this foam within 30 days of
13b.Diemedlem type Aareaat: canpltnttm of watt coastmotim to the camty bealth derpa went of the county
where constructed..
FamOw-1 NO*CKan Digralmeet ofEmkoommW Qasnly-D'wsim ofWatwRmomm Revised 2-22-201a
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