Loading...
HomeMy WebLinkAboutGW1-2021-02788_Well Construction - GW1_20210805 asy^+Ey � � 5'7D 1VI`fr�L WELL CON�CCn NO RRCORD ' Nm&CwafibaDgmtmalefEiiwi tmdNdmatR=muoes-DWid mof*dwQmr* WMLL CONTRACTOR C$RMCATTON 1.WC3L CONTRACTOR: d 'tOP OF CASLNG tS Fi:Abm!said SasbW % 'Tap of f GLbr lh dow iand wAface may m4uke J 11i42 Sin a vradmwe in acoanttai+ae vdh 15A NCAC 2C.01I& won r L�G I L°d. ZF.► e.YIELD took ! #OD OF Tt:ST J ,r We>i Caiiractor Name is i)ERM1Fl�3IDN`�' AMOMA STREErADDRESS Jlo3 )y6o tteI /eof 9- WA'tER�INGStdepttt). & � ���� Fivm /©t Ta 1tl F�,_„_To `` C. 7 Haut Ta Fioii� �To Cdy�Town State �Code { 36}. V.L7— �2.1.� ROM_Ta Fian��_To e Ana Code-Phone allffd m 7. CASOIG: Depth Dimnetesr 7ftlo esYsAAtaW MaMiiat 2.WELL 0!&�ORIRATtOii: To f� ` FtL f_ !,� SI P L WELL CONI57RUCTION PE III t t Fcom Ta R, Fk= To FL OTHERASSOCIATED PEWNIi S(ifapptiot w) 3.WELL USE Ptw*die�Moromtinea � 5' = Dom' Ma�oa 9t1 OthesD•(iSi use) f16n g From,,,,Tom Ft 6 Ftdr�,,,_To �usl DATE DRR.LTeO ff'-Z�z ,rr,�l _ Fronti______To F L TIM COWUMM __I.*CO AMU No g. iC EEN: Depth Diameter Sid.4VZB Niak2 4.VJML.LUCA M- CUT ..5 JDh c V/ Z e� COUNT}'!! �b__=r� se,� Fmm --�-Ta 61. ^ems y` t�ti ToeR2LI m in_ �d p� 'e t Rzo oL A Fiani To FL ifL NWnbGMCW=nipt SWdwiWtattQoi.MootZipCoft TOPOGRAPHIC I LAND SET701M 10.SANUMMVEL PACK XStope a vOsy O Flat D Rirtae 0 oum Depth She Mato" T (d�edc+appcopriritecimc# o o LATMIDE AxW j +4-72 nsaa seocEltlsot LONGL3UOE L+f D9` .�•. . O fO inada�il format From To FL l.atituddtongi—Son= PIPS o Topographic map i1.aRn.i�ts LOG -, (JbaitFarsofti Wmitsi'bi sftw air a LM fto in and TO armed is ifiis farm ifnat os8sg GPS) "" c d C a gg qp j' rr b.FACU f-i{s�Yaen�meattakatoeas�heceftumislac FACVJff ID etad�MAW OF FA^� STREErADDRESS M orTown Stele ap,cOft _ Nut;a � CONTAICT ,-c. ; ;i. 1�i` .,.@62aSU_n MAILING ADD � tl� ADDRESS C��� .ke 1 5�re t� iC►��Rn 5S�i0(t C?iy arTawn State TV Cade r g/a )- :!�-©ly- 2? 9,:L Area code- Phone n uiiber ELLO LDETAVA". ioommwcmTai ymwTmwaLwAscaimicimei*=atiarit wrm a. TOTAL -2o iis +ipiaavrrs>�is%wAc7=wmLcONMU� Tt STANDAM aNDTHATAaMYoi=Tres 0. UM WELL.REPLACE Ei0ST8iG WELL? YOU NOV, S-2_ -2-I c.WaTM LeJM eekmTop of Castn¢�Ff. SIGNAMMEE1F WEi1. CiQR OATS (U$M W fAbMTapOfCa*O 1 r PRINTED NAME OF PERSON CONSTRUC M THE WELL Subfdt 6w OrWWtD the DkftloO of VJMWQURUIYWNfft 3O days. Aac hdb nadan NIgC, Farm UW-1b 1S ET!�Servile — ,NC R7�9-tU IT Phone m.(mq)T.13-Tm wd a&l Rev.17M