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