Loading...
HomeMy WebLinkAboutGW1-2021-02784_Well Construction - GW1_20210805 lll'.,Sr'ID��T14Z.WELL CONSTRUCTION RECORD Nar#h Csvrwa Departutertt vfEnrvso and uoi NaWal Ramuas-Diem of Wster QuWFly ¢•�«c� WELL CONTRACTOR CERTIFICATION# - `j A- 'f-r 1.WELL COMTRACTIOR: d. TOP oFCASftECs is i FT.Awe Land 5>F bm- ` i 'Tap of� attar'below Land unlam may require ` n. h J!;42 -Sin a vra dance in awwdan6svdh 15A HCAC 2C.011& tires conlrac � L.j� 1 C .. e. YIELD CtmX NlETHOD OF IES I We0 Conbracbocr Name 1 . . G. f_ DISINFECTION: An ,-j- ny STREETADDRESS " .3 A la..".ce z I R- WATM ZONES(depth): Fran-� To Fin /9 ' Ta Cade From ly4 To a Amu code- Phone rtonfdw 7 CASE: Depth Dkone W Material 2.WELL V L'ORMTL4N: ' Fy�,r/ S�3�Z! Jt•St%e- SitTEWEI.LmtK� l: WELL C ONSTRUGTION PERM p 02>3 From To Ft. Fttutt Ta FL OTHERASSOCIATEDPERMITf(Wajig6, 1" IL GROUT: Depth vlakm its &to UL UW{Ch�wd App&xbie Bwo�O dCvmmefdW A�� il7t Ftom ToFt r ilrc� 40ga e Omew (list we) e S r - Fmm ____To 1C DATE DRUM 1- From To Ft. TIWCDaPtETED : 1' AtuB PLM 9�. SCREEN: Depth Diameter StotMw Material 4.WELL LOCATION: CITY: COUNTYexN` From TorFt�_I<t. ht. y� Ati,-v-,r.4 a, .L rt r-G 3, r From To Ft in. �. Monet Name.Nara,oomnuft SM*A*n.lot M-P&ML zo Co ijDPOC,RAF'i =t LAND SETTItAQ 1Q.SSNDr6RAVM PMK- f!'Stope B Va4sy[I tit D Ridge a Other Depth Sim Material (ctiedcappt no We boxj ybe in+ ---—Ta LATITUDE mks.saoonliar TO FI LONGITUDE�L b u 93 lv Z7 in adeemuai format Fmm To F# de soup= ;rGPS 0 TopWgbic map 11.DRIL.LRi6 LOG (Ibr awt ofweff rnWb a drown on a USGS Napo map and Front To Folcn'iott Desmipieon aftdwdlb this form Wrrotusrng GP'S) n~ J o 0 /D- !� a &FACLITY-issermaoaorve vewo govaisbceMl. 9 FACudTVIDSWuppkaw, ->�D�/;j � zlc� Ile�✓ 5�r1/ NAME OF FACT M 1, D a too All SIREETADDRESS City orTown Stabs Zip Cade CONTACT PERSON_'/L �► / Ros�� r G.• �" MAILING ADDRESS I Ly__Awt c,r.d In, .0 c ti e �s�►Mit kEd z ek �l tw -Z 7A.. _ 12 REEiRALtICS: tc�{mot 3pWR S ,rior City orTown Slate Tp Code Araa code- Phone nwnber S.VVELLMAWS: tootepmycERMTWTMWaLVVASCGNSnWCMINA=RDANMVM i 15AW-4C2MVVE .001x4`n UCrM$rA#MAWS.AMTMTAC13PYOFTM a. TOTAL DEPTtt: o D B1�I PRl1NiDE D Tt1EwP1t01A►hfFst { IL LIM WELL.REPLACE EXISTING WELL? YES.Ef N011 r~ VIATERLEVELBelowrTopofC;a� �- � ' FT S1GNA of = 1-MH.L�CTC}R DATE (Use'-FP Move Top of CasMW A,a PRINTED NAMEYOOF PERSON CONSTRUCTING'IfIEWELL t i StAOdt UW ottW"t*Un Mvid i of ZtilkMR 30 T - Attl c btiOFllia8on Ml@L, Faun tiff lb 1617 MO Seetr3= — ,NC 27N8-1S17 Phaue tsm( iq)?33-ms wd sdL Retr.lz