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HomeMy WebLinkAboutGW1-2022-10268_Well Construction - GW1_20221114 WELL CONSMUCHON RECORD FartodcgcdU cOMY M&foomeanlicumd fsrslearnini are% 7w`a�l SConapge`m,�In�rormotion. ^(f`\� y DOH I NC WellCoutreumCa tianlYnmber 15�OU7ERCASIl�IG Cor wamb ORLEM FROM " DTAMETFA I MUCMaM MAMMAL fL c=pzw Dtamc I6 IPII�[CA�IG Og17TB1NG : / FROM [D DIAafE[ERMEWErams I MATtiWL 2.Wc9ConstracfionPan&i .- '� R R 11 1 - I a Lwaffwft &wffpermifsA,-ca=w swp-vat&=*ff-Mus,ar) 3.Well use(d=kwAvse): wa wsnpplywem FauM ,n mAt►mrett 5torst� srAratrAL �griciucmat ❑AVica um(HeawWCodmgSupply) OR=ideafia Watw-%wly(-W)c) R R f . DlndtsftisVComme cW r &Dtial WatcrSupply(s-ce Ia G>iotar Froora ro mAIFMw. s�rw�rratsratt>s�erlotusr � >ti R � .G �'ti✓ Non-waterSapply wen: R R C OR-may R IL OAquftRecbaw OGsmmdwalerRcmodiafiM 19.SA1V�uGRAv61.PACK lima 'rt) MA'IEliAL y�lLAmffir[lMTMD OAgwfa'StomgaandRcwvay OSalmotyBarrier R fDb. R J.^ie '�✓ OAquifwTest OSlmmwa wDrainap R R p6c¢aimtaffiITogy OSubsedatal:onim! 2b.DRILLII�iGIAG add'ddoosiahecbif OC-o&cwa l(Closed Loop) pTraoer *"M ro DF !>ffN tosdaeo s�tmdc >� IIGcmal(EI CDo16tgRdam) nOdw(e mh&- a Retook.) I Z) 4.Date WeU(s)Completed:l�' �J�yydl iD# u R 5a.well Locstionz -5:5/R /,�4'IL � tp % � r J i r J'FrL 1 yt�nPi�t S R 7 R Taa7aylOwasAIame Facft, rCi'aPPrmabic) g & 1�lAddr�tstl,mdz;p ZLBSMABKS ; cZ� 5Nny -LA - ��,y � Pmaa tac�iSc�aatJa(tom •- Sb LaMtdtamlLongitadtiadegrecs/miaates/seooadsordecimeld - ZL -.m ffriwa71[)V/ f:;fig Ur"(rfavdtfield,oaetaNtaagissdli ) t^�p / Q/t�dG Sigr�seofCaer6edWeRCmnaemr Dario c u(arel tl a wents): OPernment or OTemporay gy ,g dral6,m�l�,dy .rbu&c Wei*)Mn(W,24 aoam X-f m aaoadmma vuhISAIYCACO2Ca1lQDo�IS�tNGtCOZC:0100WdICaartrcc�iaaS{mrdmdrmrd�ata " 7.Istbisargodrtuane welt Oyes or A- Plo �PJ�afr/ar, mdAza pmvtd�aodreuzAmma lfrncsisa,eparfrllaml�rma,.rdloocmuarwrinjormatroaaadRplatatke,m�rofd�e_ _ . _ _ iepairuuder:Jrrmmisaaetlmraront/xbscEofthirfomc 23.Sdtd'��araddl6oDalwead� You may use the bade of this page tar pMvW*aMManat vwIl site detm7s or well &Number ofvWhconstructed: �asbnctioRdetails_ You may alsoattadtadditia®1paResifR=cssuy- FormaWpreh#ccmwermFwmimrrgpfyw&s4WUYridir6essmeaaaWa�a Jmaamr subudl ourfasm. SUBMITTAL T%SfUMONS 9 Total well depth belaw;Iaad surF— (ft) 24,For All Well-- Subtut this fim within 30 days of Wmpldi-of well rar wnWe we&1waSdrprlatf&jb=(-arpr-3@2aD'mrd2@IW) *on&uc iontethCSoIIowiog 10.Static waterkvd below topoff nl y 00 Divisors ofwaterR Ceww..IWeO6 C Pr' M617u !f►voterlevd&above aa &&w'+- 1(17 Mm1 Service CeDter,Rttleag�y NC27b91-1b17 iI 11.Borehole diameter. (ill.) 2OL For butafioa Welts ONLY: rn addition to sending the fmn to the address in 24aabove,also submit a cry of dais form within 30 daps Of oompietion of well 12.WeR asstrmfisa mt&o& GI /l oRto dwfoRowio& ("a,.camr. Pusk ctr-) Disision of Wa6RResoarus,Uade�ooad 7niedeon CmtiolPsagt�o, FORWATERSUPPLYWELISONLY IGNMERservioeCenter.Rdeftb,PiC2709-1®5 13a.Yield(gpm) Z Method oftest: DlllZ�2- Me-For Water Supply&Id-fin Weft —a Also submit one copy of this fain wiffiio 30 dapsofeompletionOf 13b.Disnfeetiam"pe: ktWJ Apmmt 0 of wed to the comity health ds�ment of the comity where Fa=GW--1 NailhauoU=ngmtmmtufFavaao=a—dtwatttssm=cs—Dni=ofWM=Rmmroa Re haA 2013