HomeMy WebLinkAboutGW1-2022-09645_Well Construction - GW1_20221021 i
WELL C0NSTRIJCt`ION gFt�(1(� For btemal Use Onbr
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4.Date Wens)Comphted: $�I�� Well ID#_ l 7 1t�{'y ! R ft
Ss.wen Lodation: R R t� 4 V.
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5b.'I,atit. and loagitude in
rrfweII Selo one Wonates/aecoads or decimal degrees:
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22.Certification:
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_. t%is(ve)Aewen(s): permanent- or OTemporary S ` eIlCamraaflr Daw
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23.Site diagram or additional well details-
8.For GeoprobeMPT or C1osed-1,00p Geothermal Wells having the same You may use the back of this page to provide additional well constructim in%
construction,o*1 GW 1 is-needed.Iadicdte TOTAL NUMBER of wens (add'See Ova'in Remarks Boxy You may also attach additional pages ifnecessmy.
driIled 24.SUBMITTAL PMRUC IONS
9.Tm&wen depth below land surface: ( )
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Fora u Submit this GW-1 within 30 days of well completion per the following:.
�atple weAslivaIIdgvlaifdf�naa(eaa+Ple',•3(t�200'and2�100� "' i
10.Static water Level below top of essiug: d (h)
24a. For All Wells: Original fomi to Division,of Water Resources
Inhnm on U ' � �
Ifwatclerrlssohons�aae••+- +'_ _ PmcessaBg n�1617MSC,RateigH,NC27699-1617
11.Borrhob diameter. ! (m,) 24b.Foi•Injection Weft COPY to DWR,Undagound Injection Cont<ol(IUC)
L Pmpram,1636 M q Ralwgb,.NC 27699-1636
12.Welt construction method: (t,r
(Le.�,rofa�Cal*dna pw%�) — -- 24c.For Water Sagyk and O I;000 Geothermal Return Weld:Copy to the
Minty erivironme�at health oepaiDaGnt Ofthe courdy where�mstalm
FOR WATER SUPPLY WEI:IS ONLY: 24d.For Water Welts Prodaismg over MM t:'PD:Copy tO.DWR,CCPCUA
U&Yield(gpm) Method of test: rd Ga d. Permrt�0g�'i 11 MSC, C 699-1 11
13b.Disinfection type: T Amount: —2 C a r—
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