GW1-2023-02246_Well Construction - GW1_20230307

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WELL CONSTRUCTIONRECORD(GW-1) For NandUseOnly-
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S For GeoproheMPT or Closed-Loop Gil Wells having the same Yon may use the beck of this page to provide additional well coostruction info
construction,only 1GW-Iis needed.Intricate TOTALNUMBERofwells (add'See Over'ilRemadsBi)_Youmeyalso attach addtions1 pages Ifni:a:my_
24.SI lTALINSTRUC IONS
9 Totalwdldepthbelowland= /-/a
Farm+dtrptele &ltat7drpdu f f, „g 30200•arl2�dj10,0) (ft) Sobmit this GW-1withia I drys°Peencoimpletiosperdeelt w}g
10.Statie:water level below top Greasing: Z4a..For All Welk Orgmal'foam to Division of Water Resources (DWB)
. If hrriberlaatioxoamn�ase+-
P. / (u) nProoessmgUIIik'61714SC,Rak NC27699-1617
. 1LBomholeeffimeter: /r (m j 24h.For Injection Wells:Chpy to DWR.ITadageound Injection Control(WC)
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1636 MC,RaleagNC27B43-1636
; 12-Well construction method: .11_f - f4 1 4
(«ag��ay, aaacp�etc) 2�ForWaterSepelv and Open•LoouGeodher alReteaW� oPC tothe
comity enviroranentathe thdeper�ntoftbecormlywbeaeinstalled •
.FORWATERSDPPLYWIIZS ONLY
Welts24d.For Water �: ;:...LIL L . over 1'I +' GFD:Copy toDWR,CCPCUA
13a-Ytdd(gpm) l O,r/ii,,�l l9 h) Metbod arrest 11-i� F®mP y 16I1 MSC, ':.?`tS, 27699-I611 ..
' 13b Disinfeeion type: t ' i. Amoanh ICJ p't .
' Form GW--1
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