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HomeMy WebLinkAboutGW1-2022-07971_Well Construction - GW1_20220826 t WELL eONSTRUCHON RE99�rC�y_n For,�al Use only"u L Well CD .Information: wCnCC=CwwNsme POP TO DESCRUIION NC eIlCmmaeme 8 $ OODTE8G1SR�iG 5�*moLes4ed+ielEs ORL771�8[t' .c•?.,,•_, • JAAL TO DLlD�iIIB 7&03MrAr- CampaQy-lddme _ ft S ia. etmlt$': C� Li ou cA.sart:ORTC�iG "'et-ar3t pa2 ;. A,"2.WdLCoashactloaP ro- Dwmrnm sceT�reL ZtrteIIoppFfea�fevrQaraare8onl (pt ZQC Co+enY.sft%V=02m unJ ± ti 3.Well Use(chwk well use): sL m- Witer Snpp1T WdL• .:'• ra,i ��`jas��-�-ar•.r�v wn �z=`s;�5et'1>Y n.Yrs^-!_ QAg<iCBIpII81 FROM TO _:. D?AMSrEQ SZOTSIZE "T M&TIMIAL O�Mjum��eipel/Pablic IL $ is QGeot3�aI(He�/Coohng Shy) 06:em_alI Wa4erSupply(fie) g ffi im QI (�I,RIT'Sl•IA� eat WaspSupply(&med) t7 oa mwells>100 000 GPD .IFB�GROZTl :• ;4' _:;•__'d�' _ ru um - - --- l�oa-WitrsSapplp.WcIIa R j � rwcs�rr� o��uffiauKr D ' �3. . CtMomLotmB ORecovery g - •InjectionweII: � aCuouadaaterRemediagm $ QAgE frStmWandRecovery" QSaliaityBamrr vI9 SANID/QtAY.3LPAC 1 FROM TO nf&7vrrr4jr_ ^�Fdfsrll�D QAqutFa'Test .QStomzvraterDramage $ ft: Ql m®mlTerhaedogy QSuSdde=Cm ml QGw&=ai(ClosedioP) QTraoer E?2Q.'DBIIZifIGbOT' siliei►i3dia Lisheib' �aI vim, -Y �• QGeo (HaatinpJCoo]mSRdnm) OOd>Pr( uoder#21R ) 1Bnnr TO DON 4.Date Wells)Competed: 7-2> pyeII ID# f it 5a. dlLodation: & , � $ a• ...-ems. 7•"`a -1 a--+ F lOwnerNmae FaalltYMg(ifsppHoMe) Pl�vulAdd� .sod.Tp '' �- - -" ft $ �•• � CO—Y ,� P11daaaNa 5L Latitude lad longitude in degrees/mm degmm- hVimeis s5B�) � � �� 22.Certification: 6.Is(are)the wdis): 00erm,nent .'or ClTemporuy SW==ofCectifred RreII Duo 7.Ts this a repair to an aastiugwdh- •CLYes or —_-/ II7L1�" y '"�s1"�p.aej ooramr�edtRaetirovd�onrtrli L7P16 I'AAI=4C 02C:0I00-15A1VCRC 01C.0200)V,ZCp=.L�nwt&.d.*..I d.a Dopy If3drlsasga�r,�IIaal�mwn�rllari+Jorn�mimdecplabilheic�osoftls ofrhfsrscmdhesGeaipgvvidrdmthewrIIoiniv '�c►r�mdvt`Ilr+evrmissaaronorontheb�eekofthsforos - "sy , 23.Sift diagram or amaonal wen devils: 8.For Geoprobe/DPT or Qosed-Loop Geothermdwe%haviagthesame You may use the back ofthis page to provide additional adl tract iafc =stn�Qn,only1GW-lisneeded.3ndieitm TOTAL NUMBER ofweIls (add'SeeOveeinR=mdmBox}Youmayalsoa &addiaaalMMifneessmy. dnZled: 24.SIIBMITTAL Il1�STBUCTIONS 9.Totilwddep*b&whndsarfice:' 31b ForraduplewJlrGsscIIdrfrta j�,�e a a� _g�00'�Z��/ppi (�� Subnfdthis G•W-1 within30 days ofwca completionper the followbW 10.Static waterkvd below top of a (�) tea.For All Weal: Orignal form to Di7mm of V7d=Res=ces (DWlt)� xeu,Tendtso%Neo +- Fnfa�aVcmPmcesia9Unit,161720C,.RdciSb.NC27699-16I7 / I 1L Borehole diameter. V / O (m) 24b.Po' �n We>!s:Copy to DWR,U'-k4+ot nd lajecd6o,Caahol(IUC) Pm$ram, MSC,Ra10 96 NQC 27699-1636 .. 12.WelEconstrucfionmethod: ?AaForwaterSa and0 Loo . CLe:�ugr;sot�3, b dunRp¢k ems) f - GsMheranI Retma WeIfs Copyto ttx unly POP covaiyeaviro me=hesimaepativaeara�tbe � FOR WATER SUPPLY WE MS C ONLY: 24d,For Wrier Welts PrOduci=over I GPD: tO.D 13m.Yield(gpm) L Method oftest: PAP mm 1�11 MSCti Italei C 1 11 13h.DW,&ction type: '1 Amo t Z W' Fa=GW--i' NanhCarolina cfFsvitonmeaml Qualiey-DiviQoa of Wa�rRes«aoa Reviwd 6.6-201S