HomeMy WebLinkAboutGW1-2021-03198_Well Construction - GW1_20210625 i
WELL;`eONSTRUCTI 1 (GW-1) Formal Use only_
L Wen 6w trseior Iakraestio I "
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is 0U7X8t?A3ZrfG mii'aL0.e�n`eai Be odtI�t�' ;,.=.
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2.Wen haetioapmdt#: C.. 11 ({ FROM ILc oR�IL �- ��
Laroff oppBesETe reII WE C.W.,%ft Yart m an) ft 23 & $ Y ma lCh. rL-
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rod k c l-: FROM ro Y arAM� st er� KA2xui
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OhtduTtti�iUCa�ae�l { DResidt i l w ter Stipp13'(shffied)
fl I DWaM>100,000 CAD FROM TO I=K&MO uLR IDDSACIDOW MCIEW&Aa90M
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3h.Latitude tail loagitade is " ulaWseconds or deebwd degeees
of"a Shcl ooe hvbaisa�eieotI I 22.Certificatioa:
3L '22' 11 � ' w '
6.Ts(ue)!the.►eIl(sk or DTemporwT ! D►d sip ofeanfmd W�coat Date
7.7stbisi boss �' ftftm r6y'oo rhirrlr—WS)xmtwm)eam--dmacs vu
repair Cis •My'. or ago ISA)C-4CO2C010barLUICACO2C.02003PdfCvnvmd=Swdadrmiidmaxp
.yd*isa fiQ—bowipeQ erforma%=wdapfaber46a="V%by ��,eooraTi�bmiprvviaedmaheMllavno
xp�rmaderlll rmr�se+ertonar aftlashrm 23.Me dbV moradditiond weD ddamLs
&.For GaopeabdDYT or Cseotheratai WcHs having the same
You may use The bark of this pap to paovide additional well aaastemcdm fi&
aonsZracapo,aoly 1 GW-I is. TOTAL NUMBER of VM]k (add'See Over in Ratans Box).You may also zMach s i itiaml pws ffmcca"
daged-
t 24.SUiBMTITAL DOMUMONS
9 Totdvw depth bekw hmd I ZO r (�) Snbngt this GW-1 w;thin 30 days of wen completion per the fonowfag:
per radtlpLerills6staII�r,Y .�200'omi2®100')
IO.Staaelwaterlevelbelowtap ($) 24a. For All Wells: Qzigmall£om:to'Dm:doa of Water Resotaoes (DWR,
� � f�matian Processing Unit,1617 MSC,Raleigh,NC 276WI617
IL Bmvbok diameter. G , s j n,) tab For Isiectioa wells Copy to DWR,U-dagvimd Injecd-C�outad MX
Prwgr�,1636 Mat;Raleigh,NC 27699- 636
24e.For Water2n aid q2 4M Gad Beum weBc Copy to th
(m a a>� eahk dsxtpar>w,i )i cry health earmiq what ode
FOR WATER SIIPPLY Y: 24d.For Witter wea Lr PD:Copy to.DWR.CCRCU.
13LYaW i E Method of� Pe�iirtoga�,1611 R NC27 16I1
13b.D�eetlon typ, Amount:
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Form OW-1 r North Cw*n Depatmes ofBviraomrm d Quality-Divmoa of Watcr Rmomus Revised 6-(r201
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