GW1--00104_Well Construction - GW1_20231228

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S 23.Site dingrank or additional well details:
H. S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the rar}c of this page to
'' r i P a provide additional-well ces details
construction,only I lrW-1 is needed. Indicate TOIALNUL4F$ER o€ construction detai}s.'Fali may also attach additional pages 5€necessazy
dril}ed:
s SGSMTI`� 14STRUC IONS
?;, 9.Total well depth below land surface: i��
I;1 For multiple wells list all depths ifdil/grent(ermnpte-3@20W and 2(4100) - � } 24a.For �[r jg: Submit this feint within 30
1 �I� cOnstlaCtioIIto'i Iu ming: days of completion
i; ; D Static�vater level below top of casing: 'V i
i I er lever is above casing. ( ) Divjsidn of VitterResources,7nfbrmation Processing ZTia
11.Borehole diameter: kirIrillail Service Center,Raleigh,NC27699 I617
the form-to
[� '-2:4b•For Iuiectio Wells: 'In addition to sen.ding. the address
{ I .12.Well construction method:/'Ii(- Ratc t. above,also sub " one o this
'( • Cie.ouger,mtary,cable,dmetpnslt,etc.} '7 c � �in f h n 30 days of completion
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r `' FOR WATER SUPPLY Division of VfTa Res our €Ind I
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1636 Mail Service Center,Raleigh,NC 276991636 •
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i I Method of test:/ !it L g 24e.For Water'S B n;v&?aieetion Wells:
the in addition m sending the:
;' i' I35.Disinfee[ioa type: Amaan� 3�� addresses} alrob; also submit tin,•copy of this form
I' completion o€welt+eonstruetion to the county.1tealtb 3o c
� where constructed. departme `of the
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