GW1--06286_Well Construction - GW1_20230926

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23.Silo diagram or additional well defads:' •
&For GeoprobeIDPT or Closed•Loop Geothermal Wells having the same You may use Ma beck of this page to pro`vide additionsl well site details or well
coUed:ction,only 1 GW l is needed.Indicat;TOTAL.NUMBBR of wells construction details.You may also attach cdditionsi pages gm:caamy.
C�1 SMITTAL iiVSixtU(�7(�N�- 1 -
9.Toter well depth below land seam -
- rmaw�rc 4 futarTd r ldpe e,,,( Q• •�1�1 — 24n.For Ail Wells: Submit this form within 30 days of completion of well
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eansnDetion to the Mowing
10.Static wool level below top of casing 1 (IL) Division of Water Reaoursts,Information Processing Unit;
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1 1617,1�fail Service Cehter,Raleigh,NC276991617
11,Borehole diameter. �4/ ,,(Uh,)
Vb.for Inlectlon Welts: (n addition to sendasg the farm ao the oddeess in 24e
12,Well consthtctfon method: /�v4.r yr - above,also submit one copy of this toms::within 30 days of completioa of well
(i a astir.rosa dam y ratio, posit eta) construction to diefoUowiag: -
• FOR WATER SUPPLY WELLS ONLY: - Division otWater Resources,Uhdeegroumd Walton Control Program.
1636 Mail Service Ccntek,Rslrigh,NC276991636
13a.Yield();pm) Method of test: 0. //'�i P
pr 4 i�, Zde.Far water Sunaly&Infection GVella; To addition to sending the form to
13b.Diadtfeetion type: 1 , Amount: L-44 the eddress(cu)above,also submit one copy of this tams within 30 days of
completion of
constructed ll construction to rho county health department of the county
whereFora GW 1 North Oodles DepatehtetaPEayseameonl Quarry-Division ofWee/Romeo
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