GW1--05752_Well Construction - GW1_20240926

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5b.Latitude and lunedtude in degrees(rdnuteslsecurds or decimal degrees: a
•.. ..[.c,G,re tit I.,I(.,vdti.lent) 22.Certification:
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o.A(are)the wcll(s): C ln Pernnent or ❑Tempuran
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By srgnm this from.I hereby cc.jv that the oell(o)w:a.!a re,;unar:.a J.r. r.......,..�
' 7.Is this a repair to an existing well: Cl'Is or OI'u ISA,SCAC 02C 01(Xh or!SA 1:C.IC u-r.u2t(1 IFe/!t'ue .rrru r:nn S.r,.i:rail..•,I::+...,
. r.pan 'dl our A-no.,,a e it cautrucrrun information and er lmn the who,.of the ojtlus rccvnd has been p.maded to ISa ayU Goner.
r ..»il✓.2;rema•L::.a'cnnn or on the back of dui rr.rnt E
23.Site diagram or additional ne11 details:
I;.For Geoprehz/UPT or(hosed-1.uup Geothermal Wells having the same You may use the back of this page to provide additional wall ua:an,;;'rr._n:.
crmatruchurn.only I GW-I is nexdal. Indicate TOTAL NUMBER of wells (add'See Ova'in Ranac$s Box) You may also attach additional pa_:..a na:•..:� ..
dn'hud 24.SUBMITTAL INSTRi C.TIOSS
9.Total well depth below land surface: co r at.) Submit this OW-1 within 30 days ofwell completion
?w rnualp,t .clL•het,ell depths rj rbf..rent(..romple-Ste'00'and Nd160') per the following.
024a, For,W Wells: Original form to Doi ision of Water Rcs,sac:> ra.le
lb.Static water h el below top caching: (ft•) information pros•,,,,g Llnit,1617\(SC.Rat iL1n,\c':7,09_u.I-
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I I.Borehole Illanietl:r. 6" (itcl 24b.For Inlection Wells:CopyS to
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Prognun,1636 MSC,Raleigh,NC 27ov9-lo o
Rotary
12.11,II enu+trrlctitut method: 24c.For Water Supply and Open-Loop Geothermal Return IAelb:e'.'Iri to1!:
,, .•eery,,..rile,Cvrtt pmi.do 1 county environmental In lyaalth departm ni of the county what LLbr.11lwI
IOI<b1A IlIlt Sta'PI.Y WELLS f).^LY: 24d.For Water Wells pinut uclue u,er Link UiNI(P1):Copy to IIN R.LI.Vt.;
BLOW Permit Program,loll\BSC,Ra l.; ,NC ;))•lol I
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