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6,Ar Geopmbd=or Closed-Lioop Geothermal wells having die semo You mey m da beck of this page to plovhte additional well site details or well
Con--actim 0*L OW-1 is needed. Indicate Wra NUMM of%%db eonsauotiott detaft You may also sttedt additional pages ifnaommry•. ,! r
1Jti SUBMEM RiLIMMUCPMM
9 Total wall depth below land anrtaec:_ FL) 24n.Far A! Stdnait this AM!'within 30 days of Completion of well
roramruPJemalhurraudoarhs�ir rrla(ea�fa-9®200•arnlz®1o07 cmmktmdontothefollowing:
A Static wder level below top of easing: ::�b (tL) Divlston orwater F�a' mra%Iol'ornmtion frocessbtg Un%
(/hwterlamilsa6ovaaosdUtg ars'ti" r..-161711611 Service Centnr,',Relelgh,NC 27699.1617
1L Borehole diameter: (in) Z46.For Jniactlon wells: In addition to Sending the film to the address in 24a
12 wen constraclon method: rb r-11 p�
above also submit an copy of this tbmt within 30 days of completion of well
ft^»��v.ubk�tpus%@a) eonst'ttction to the following
FOR wATnR SUPPLY wELSS GtVLY DMdon of Wafer Resources,Uada I&mnd boactlen Control frogram,
1636 Mail Service CCoter,Raleigh,NCa709-1636
UL Yield(gpm) Method of test: --24L For wager Snnnly dt lniecfim wry ils: in add an to sending the form to
a b the address(es)ttbove; also submit aneloopy of this tbnn wilt 30 days of
Y3b.1)t4ltitieotlontype: h D A,ntoante [; Completion of Melt construction to the only health depmtmatt of the Co
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