GW1-2023-02522_Well Construction - GW1_20230406

WELL CONSTRUCTION RECORD(GW-1).. For Interniel Ilse
1,Well C91-dr4cor bwormation:
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13F�sjdmtW Water Sppply(shw-4)
Its flora FROM I TO !ZATERLAL FmWjmwmrmrmaD&Am8u,,,r-
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Non-Watcr Supply Wdl-
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"ifigpowbax-ge [30mimdrzler Re-rne&afion
AqWf-,r Sloiage and Pxcm-ery DsaumilyBania FROM Xd--- I MAWTOUPt I EWWACEMMAETHOD
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Geothenna-1(Closed Loop) 7.
FROM TO
Cmthemal coolin Retum) [5m (.e -yader-'m Refflarks)
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4.Date NVell(s)Completed: c4.,r-
15P.Wen Locatimr. I 7-7 (c,
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(if%vf--U field,one lat/long is sufficient) 22,
or F3Temporany M—,mm of Caffiod W41 Ganuavor Date
By 41SWIlz 9-jbm;J hereby caWf),i1W the xKO(s)uw{sere)vongracrcd in accordance
7.1stWa.rep*toLanex1sftWC& r3yes or 140 with IJANCAC Q?C.0100or1SAXCACO2C.0200 W471ConsWcffb,7&mzdw*ondjhWa
Ifflos is a repair,fill ORI bmw Key Construction hformanoft hqPwn am nawe of fix Pqpy vfdrw record has-been provided to the imll owgr,
rqpmr im4ar#21 rcmar;4 sallon or on the back offtform. 21 Site dk-mm or additional well details:
8.For Geoproba/Dffor Gosed-Loup Geothermal Welts having Ibc same Yon may use fw back of this page to provide additional well sit:details or 1Y411
amsawtion,only I GW-1 is needed. Indicate TOTAL NUMBER of=11s construction&,Wits, Yon(nay also attach additional pages ifnecessary.
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9.Total wtU- depth below Lmd surface; 9LZS- —00 24a, For all Well-2 &bmit this form Nvift 30 days of completion of wdl
Fornmr0pic awls lin all depths jrAfereff(e=710-5@2W'aAd2-@1M construction to the following;
10.St4c Eater level below top ofcaft;. 3 —(ft) DIW=of Water Resources,Wormation Focessing Unit,
If water level[,F abam casin&=e".1- 2617 AbU Service COnter,RAW*NC27699-1617
lis Borehole diameter; Ye (m) 24b,E or Inigz9on Wftls.- In addition to sending the forma to the address in 24a
IZ Wdl construchan nx-thod; above,also submit one copy of this form within 30 days of completion of well
construction to the lbHowing:
(i.e.anger,rotary,cable,dhva pusk etc.) INwision,ofWater Resources,UndeWamid Jv4mdon Control Frogrank
FOR IVVATER SUPPLY WELLS ONLY. 1636 MR SaNice Center,Ral*A.NC 27699-1636
134.Vd4(gpm) Tiiettlod of test ---- 24c,For%Vhter Simdv&InleMon Welh- In addition to sending The form to
ft address(cs)aWvc�also,%Auk one copy of this fohn "ithin 30 days of
13k INsinfecdoitt type ran u,;,i,�e-d 07-, Completion of 1,W11 con*uCtiou to tho�County JIM%dqwtmont of the county
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