HomeMy WebLinkAboutGW1-2021-05192_Well Construction - GW1_20210527 i
May
r =mow RE= WELL CONSTRIICTION RECORD
WELL CONTRACTOR CERTSPTCATION# y-LO
i.WELL. d"OF CASING 1S_.�_iT_AboMe Lw d Surfed'
/I. ''top of rang tewl d ellor below lend smtaos mayrequae
a uanoe in accordace n TM 15A NCAC2C J1118.
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Web COrd adOr(ft YIELD Wro):1 -- MEntOD OF TEST
Won Contractor c6mpany Nmne S,a WA7ERmIiES(deplb):
STREETADDRE3S � 117Q�ee e� Rwn LP To_ yl Rom To
yYf a��i iJ li.. n L a70).7 typm 2- To a- o FMM—TO—
OWtrTMM State zo t:ode Fromm To From To
3 T 3.7- yr/Z L - oimnete� l**Mms+wele�+
Area cods-ptane number 7. CASUtG: DePdr mat"
5
LWELLOWORMA110M. Ftmn L To Ft, 6`AL—
PIQSt,� ��a 1
SITEWBJ_®#t5 - �, To R,
W91 CONMUGI PHUr1Td(d E G7 ,1 D -G Raq.To Ft.
MHERASSOMATEDPEFWrJW ) L GROUT-6 Deplft Metdl MaWn
S.WELL USE g3mmkApOubb Bo*Mo O M+aeaip MobiM D p
o A6LariII F.L-D— o s
jw�p rp OMM (Muse) bg kn e5 ,G Ffom To FL
GATE DRRLED 4^ 1 u -a-1 Rom To Ft.
'<<iI�C00lLETED 5; 1 S' AM P4 S. Sl Depo D �ot�ae Malarial
4.WELL LOCATION: Rom—
eTo b+- �-
1fa _ ppUfdTl� lPock:n �, T43 k-
, 4 BopG.-r I�
r e,,l e r jfl oZ 70.Z 7 Faun To
(SEteetMe�ne�NrnWeis.t�aamunilr.Sm ltaRtdo.P�ioa��paode) ILSANDMMVELPACIL.
TOPOGRAPHICILANDSETTING:O �L peps She Material
From To
bale
IATifUDE �.•3—r I& /9.x y, IU!rA= or. � To FL
�-' �' �. inadedmelfommt
LONGITUDE o _ 1i.DRILL ING L.OG
Latitaddiongitude sours /�(RS 0 TopgMbic mapBorn F�bm Desm*ft g
pbwlTarrofwe5rmatbbaft
m on a 11Sf�S EOpo napd J TrL !� t
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7 t e l l
e.FAcnjTT-saarw=oi e6iatoeo b l u e f
FACRnYIDIW J.4"o -1 �o Ae I (�., e
NAME OF FACE ftY76
SiRi�TADDRESS
MarTmn Shia Epcoft _
COMM PEW //1 d.'C ry�Y o i a
MAMGADDRESS 3 0 2 / re ✓ ✓' Kd -
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(SlyatToam Slate Mocode
Area code-Pbm number
S.WaJ_DETAu.S: Iooaeas+r�rTfWTT SWULWnscors'rtetwreortA000 wmt
j-�D M.WELL
GV�=VW3J.GWNEP-
b. ^NO7rw7wr�oP+roFnasa.TOTALDEpilr ; 4 DOES VfELL REPLACE EXIS I WELL? YES0 No waJ.ooNTw►CTOR DATE
c.WATER LEVEL Lte�Of r:� 1�
Pr;n I NAME OF PLMN 6ONS7RUCtaG IM We.L
SLboat the la the Di WOU of W Mom QLiilW WE&130 days. ASM WO 116d011 MBLs Form GW-tb
1et7 MA SarA=tom- ,aC l7S994Ot7 PhaM Wo.(9l9)r33-7ois erd SB8.' Rey IM