GW1-2022-06980_Well Construction - GW1_20220725

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quifer Stmrflic lard RWA)vrty CjSulinity Barrier
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tlquiti:rTcst _� -• � ft.
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i_lx this a repair toane sting well: L, c„t afthlrgrandhnsb�pro►wdlotlu:Wall nw)ru•.
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rmrolrrmdrrf:l rematktwzTlanHelmrin:oarkr¢l�lsjomr• a._Site+Sagramoret MV111a
1 u pixy use ltta lack of this J»I !to Provide adtrIRANi%vdi alto derails ar weti
R.roe GeaprobdllPT or Gttaed-1.nnP Ge°t>t l Wcllft t►Avingthc sxmc e1?Oyt lnll tillers. Yblt MBy Also.fiN&Cb AdtflltoT101 popaii if TIMM ►Y•
unmglnicgan,only I C•,Wt is needed. 1'ndimta TOTAL AIUMEMorwplls c;tn�trrt'aI iNaPlt 141�
V.aot�twdt 1.L— —� } !1u. 6or Alt Welts: Suhmit t1tf+farm within 30 days of completion of toe11
acptA trernw inner sterfitera —^
t�rtr rirutdptc�•rJ).e ttxr wt;d.pthr jrl�'arnmr(kurmplk-d(n?IIJO a,d�i tang eon9rniclien to the Jbriolvtng:
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* r iwle V'don d In additSoo to sending the form to The addiaset in 24n
above:,Also 5ubmn one copy
li.Ttoneltolediameter. hm r 6"lis form wilbin 30 duys of compldlm nr well
above,
MWeilconstmetionmetkod: __ comstructionto tile fallowinr,
(i,nn ,rntnry,-*'plrm Ptt2h,tKo.) Division ofWater Rtaoarces,U1111CMmund 1T111tctton C-OMMI Program,
POP WATFR SLTPLV'WELLS ONLY: I636 Mta119enrtaeCcntrr,Italeigi,NC�'!�T636
130..Yit ttl(Ri►r11J iKl'tiNN1 of Ie4G.- lac lrnt��con+av 8�lfermnlon Wdls fa addt�ion fa snndlut;the(brm ro
the oddrtsc(es) ahavtt, also submu anc copy of ft form wilitlr 34 der of
nmom+r. crrmplctlon of well coneu lltt nction to the co►mty hea tkpe[Ittt a of tale county
tab.T))slnrectian type: where connlrrcte&
I+ram cW-t worth ca-ifnn Depm=ani of l:nvlrrinmmufl Q+ranty,-DMISIOn oP Wotcr AM414VES Reuiiedt2�4 2016