GW1-2022-09480_Well Construction - GW1_20221014

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L Well Contractor information:
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it. ft.
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DGeothertnal(Closal',Lvo ) 13Tracer 20 DR[LLIPCG "OG'attach addltii nsficiieets if;necesss
FROM TO DESCRIMOK color,hardness,soilWck type,Oda slit,cte.
13Geothemial(AeatingfCoolitig Retum) OOther,(explainwiderP2l Remarlrs), h
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danty Parcel ideiitiflcauogtJo.'(PCN)
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tue`otCcnCfiedweltContmcror Date /
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7.Es this n repaiYtbun existing well CYes or vo C9G O2G.OIt10 or lSA 1YCrtC OdG;02f10 iPell Gonslructlon Standards and that v caFy+
Ifthk Is a'repoir,fill out&rraitsr well coustructrorr hiformration w erpiahi the nature ofihe of this record har been provided to the uvll owier.
rrpairund&#21 remarkr,sectionoron the..haekofthisfomi, 23.,Sife;4iaernen or•additional well°detaits: _
..Far GcoprobciDPT or: losed Loap;Gcothetrniai Web liavuag`tlte wine
.Y.ou�tnay bse the.back'of this page to'provide additional well construction info
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constrpction,only 1 Cr%L!- C l is needed. Igtiicaio'T.OTALhiUItt s T3FR of welts•
(adt1.'See Over'in ltemaiks Sox).Yon inayalso attach additional-pages ifneaessary
drilled 24.SUB4IITTAL INSTRUCTIONS
9,TOtal{vela depth below land,surfacc::,... 04 Subunit-this GNY'1,within 30 days,ot`we eompleHon peetbo foltowiag
Far arutttplt xells hst:of6 dtpilu ifdifJerant(r�nntple=3(pJ2,'rm®ZQIOU7'
1-1 24a. For Ail'Wells. Original lbrmjKtti Division,of Water Resources (17Wt2)
10
.Stutic Avater level,below top or eosin(;: _... -.- (tW 'Inforniation Processing Unit,1617 MSC;Raleigh,NC 2699 IGI�
Iftrsircr-level is abovuiasrn�case'"+" .
ItBorehole diameter (fie.).
t3 246.•For Injection`Velis:_Copy to DWR;Undergrotntd"in}ection•C-6 (IUC)
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} y Pro„rani,1636 MSC•Raleigh NC 27699 1636.
12 Well construction m;rteUrod: t Y$t. t'f t 24c For:\Vater Sup afid Open-"op Geothermal Return Wells:Copy to tile'
(.a aagei;rotary cable,direct push,etc.) y environmental o untywhere in lted
count o � health drparhnent f the co
FOR«'ATER SpPPI YNYEi LS ONt fir' 24d.For Water W.elis Produdhe over1100 000 G ID;Copy to T11YIi,GCPCUA
Pest Pt `1611 MSC,Raiet i,NG:27699-151 t
13a Yield(gpm) '13b Disiufection, Amount; " $ 1
Fenn Gw-f• Nonh Carolina L)Omtnientof tnvironi teidal Qaaiity-Division of Wate-Resources Revised G 6 2Di8