GW1-2022-03208_Well Construction - GW1_20220310

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23.Site diagram or addiaioaaiwell detilfi V
8.For GeoprobeMI T or Closed-Loop Geothermal Wens baviog the same You may use the back of this page to provide additimal va eonstntction h&
consftnetion,09y 1 OW-1 is•neeaed.Indicate TOTAL NUMBER of weIIs (add'See Oven'itiReniar3cs Box}You may also attach additional pegs if may.
drflled 24.SQBMIZTAL P SPRUMONS '
9.Total wa-deptit below land surface:_ D ( )
Foramtnpls,.,rDaaadgday�nae(eo Vk-3@200•a„d2gi00� r Submit thisGW-1within30days'ofweIIeompletionperthefonowhW.
10.Static water level blow bop of easing: Z 0 A) 24a. For All Wells: Ongmal Bonn to Division of Water Resmoes (D%n
rwatwkndrs alimK C=ft)No•+- bfamtationPmrasing Unit.1617M5C.Raleigh.NC27699LI617
1L Borehole diameter. 24b:For Infection Wens mu Copy to'DWR.UadeMnd lWeedon Control(IUC)
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Pto$am,1636 MSC,Raleigh.NC 27699-1636
12.Well eonslractioa method: "R o 2,T _ ,✓ 24c.For Water Saaaly and Oren-Loon Geothermal Rdma Welic Copy to the
Cie .may. ti.daeetpmb.etc) ": county—envaanm epa[tment covuly "ad
FOR WATER SUPPLY WEl±1S ONI;Yi, 24d:For Water Wells 'rodug'
_W over 10AW GM..ClpY W,DWF%(;=A
13a.Yidd(gpm) Method of test: Permit Pmgam,l 11 MSC,Ralei 11
13bh Dlsh&cdon type: Amount: Z �"
Fomt GW-1' Nadi Carolina Dq==ofBmft==W Quality-Division of WaterMo==_ Revised 6&MIS