HomeMy WebLinkAboutGW1-2021-07494_Well Construction - GW1_20211116 RMLCOMMUCTIONRECURD(GW-Il Fa�Lm tUseUnty:
L VeRcantraehvr
WHIC
O 63 o
IL
a3---AML s. fL I ,�
�; s I
NCWCR[,1 wbxckdjjcdjmj4mnba
006u'6 Well OrI l 1ifte +1 �3 S 6�� .(88' - �M I vMScmwmyx l l
2.Wdp c Pww* :_Z(d G 3 �[ 10 nrae� mm®s s ffis.
I}�aDt�pbm6le,w�aon odanP ��Ca�Y}t �a CoriIL $ a
3-Wenuse(awkwen� a tz 1 h36
watevSaff FyWdb o mft -
bum 10 nas S=S= mmwss` su>atet
m a t..
oGeoftmnd S Rlw bimaeomid Water Sappily(sin&) m tt. tm
awe&>l(WOMWD - law 110 ETLTEEsL �a�rs�sauoo�
Nor!-WatwSapplyWdl: 0 0- Z p a. !4 C our
ML
mfee � a.
aCuo®dwa6erRn S e.
aSaTmityBaaner -FILM m arszt$uL - �aciaearrr�
❑Aqo fw Test a
CF-VC&lcddT=hWlw aSnbd&=cCaot<ol tti IL
aGwft=l(ClowdlmT)UGwfficmd
tJfiaar
-
Retnm) QOlber �der#21Raos lae= maox admr. ae7hedc: :-
O s 40 R Over. b ra w
a.tom Wd )eaa~•h I I w21 Wea tm 40 $ G CO $' se tin k
S:_Wen Loeagm n. $ -
lmmx/ello, Freeman $
276 ales (ones RD NewlAo 2 96 s
Ph_-icdAdacs%,Os.=dZjp A.
sb.Lztif�eaad
1"FORMA'"^"OonrPrNINIG UNl'
c k(UM)thewsk �amv oTeapdrary s afcwtised Daft
7_bfhaa �� �' �.�•Il�j'ow8��i°rtbereu�b5lrsa(rvq�aoe�r�meds,ascd�acr,ratr
+epstrtons wdL ayes or �PMo M WrACWC.OIODarISAAGtCOWAMW.dQwn&ecftn OWdxda apy
/ft&&&asepairfiiuowlnorswa P m tg6 ?I aidaphendie 4dw of&&sm hwbimpnw*Wtodmwaawmcr
raparm�dvP2!�mmLsseraimarmthebar�afdds,J6sea
2i Me dbWm orb wA detdl�-
L For GeoprobdDPP w Cveother d Wdb h&viog the:same Yon Uy ow the back of this pale to provide additional vmU mo wuctim k%
(addsxOva'inRsma ao onlylGW-lisneoded lndiroteTGrALN[A�MMaf dsBaa}Yonmayal9u�chaddMiaoalpq�esifneoessaey
/' 2a.SLgNM 1TALIl�l IICnom
9 Total will depth bells Mud suilaoe: j.P-t C)1 tg)
Farmtr�te.rYBrbatatldepdis ( 3�ap• owd WW) Sa ltfiist:W�wtthis38doporwdleamplellaperthekHowneg:
1LSbdkwmm kvdbdowtopofeasag: �V, OL) 24* For A9 Wdk OvOnd foam to Division of Water Rtson=(DWR).
lfi aar teed babaae�rn-+- � --- Uait,1617 M r.RAleW NC 27699-1617
t
1.L Bwebde : 6 I9r (I-) t tab.For Lleetto.Wells;copy to DYM IInhwoond huachoo CoMl MX)
12.Wdlep(' Rotary 1®6a�Ra1 ,,Nci7 699-is36
�LGIMi��4dtOCtp$U Ems.) s 2kFarWp .�ioan6ealharmalBaWe�Copymffie:
ooa�yeaivaa—macma e5—a�muepana�a�
FOBWATEB WELLS ONLY e �+� 24d.Far Water Wdk oea I ovw UkM CM cagy to DWk CCK UA
13a.7[idd(gym) D'lslhod o3'ies�i f ��7T PeaIDd�i��a�i Yi-�v"�.-�qg��'C ZlB9�r611 ..
13Lllldnfee6oniype: " Ammmi, SO or.
i
rormcw1 rramana�A afiavaoom�lQo y,_nvi9onofWaavBemaa BevisCd"2018