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HomeMy WebLinkAboutGW1-2022-09068_Well Construction - GW1_20220923 Jan. 29. 201E 10:58AM Env. Health . SF F4'0 No. 6111 P. i 2022 ALL CONS MUM ON RECORD!�11 use only: 1.7codmewItM don: TO 61111arnm a8co IL ><All n NCW Co ctorC `' 'onNmaber . GM TMO tnnm 2.Wdl Gb11ftYpiilOn 1'pa+ir&- 0 J / iH07KTO I DIAVOrMu.�r•r Lprafl oppTimbkteell tararra�e»perarty JLe IAC COMY..&M YaBaaee;wj It ft. lo. �Well Ust:(cheeitmQuse): .n. tr I to - IG-MUMS' pptyWeu: '"i_ __ '-'.�-- __ _ -_ _..'�•',� aQm *a� R � - aUCer$ell:Recbarge OGmadwaterRemedietioaSto •ra suz�w.Tat OStmmweterM-aimgo rL tt .c1swameMCoMol tL IL Md(Chttea Lrop). D'Ptaf:erMSi(Realm Mg M!!9 OMff mtft#2i Ramada d.Date Well(s)Completed: WeH 1^0 sa WcD Loeattam m 3Go n n FaeOi Innte PacditYIDg(iEupytieabb) m e. M p4a.-A Add-O Qi gd4 w..wI�•MSPiMNM Sb.Latitude Rod Ingttade t0 degraatIDtaalesiseeoads or dtdnmt dtgrees: (.fweQHeld.aeeLdlm�gusn&amt) ZZ C ban: 7� Nf /• /G�qf w 6.Ia(9ie)IhIYOU(a) os QT"--y- g' of weaCoaotc'L'4rowaeat Die d e� his a tepstr to art BysF 7.is t �ygrJ.ir Eons tY tlar r6e tro>f(p rar 11 otmm�wralas oocordwea ttagweft: 13Yes or, iz +.;di III X-C 02C.01WdrIMir.4c62C.6woWe#Coarrruaamt50*0*Ow*ato J/Adsrsanpoh;J111ma6,a�,.dtmmn,ram, os�.eplenrrheRaaarajdx �PY9lrhrr.eaerd�ssdaupwrudrsrorhemflam� rv*wder021seamrixseatacrorantheha&ofdf ikm. 23 9ita dbgmm or additlonttl well.detafht &For Gtaprobe/DPT or Cloud-Loop Cectitemml Wilb hwiog the abme You may asa ft back ofibis page to pmviae addeWaW IwA sth details of van COWMMdM aMY i V-1 is needed.rndicam Tt7i A4 NUMMM of utik mwtivc(loadwils.Yau may also att m sdcuonw pogo JEmsemy. dtiued: Sf7BNII1TAL tALS't'R CTLON.$ - 9.Total well depth beb>tirlandaodace: (R) up,For Ai1 Submit this.fonn VdIlik 30 days at comjgo ion of wolf emnMwtion Foranefnylevdkkrr6►Jd :Jdr ,rfeameyle-)�Ipp•ard�lo0) to Owranowing 10.Static waterbdotr loop ofeashtg:_ DhidenofwaterRaouremintermatlonProeesstngpa4 '� t^ 1&7,11ait Servlct , I1.13oreholediamettx: ! ,.Center NC27699-161? �') 24L Far in_leetie_N In iddtion to smog dte A mto dos addram is 24a 12.Well constrnenott method: sbawy do submit On Copy of fhis ft=wifirm 30 days of cmlpkft of wen CL--agar,olay.cable.&wPuih VA) rot�stmaioato dieEpUowmg Dividw ofWater Resowces,Uadagemmd fidadon coa toiPsogram, F9R WATER SUPPLY WN"MY: L8#email Setvieti P.entei,Beieigb,NC27Q9f�Gifi c, 13L Yield(EPfi) z BHethod oftaC Far Water Sattnhr&InleetlQg We=e is addition to aw ft the tatm to ft eddren(ev)•bevy also submit one can of ties foam MAin 30 dogs of 13L ftlIthetlan rype: - Ain.= Completion of w811 w Metion'to the ... whtaee�ltuetrd. COMW heanb dqutmmt of the wary F=GW4 No CmofmaDepaneat•!FmbnamsaolQmfiry=DivuianafW�arRoomem Betisad2322A16'