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HomeMy WebLinkAboutGW1-2022-10269_Well Construction - GW1_20221114 WELL CONSTRUCTION RECORD t�Im�ll> oru.Y Ibis f nacenbe,acd faraa&ormolpplewdls 1.well Contractor Inw.matios 14.WA1'S ZCDW i well C�ta®arN�e i + 4 -�-- -3 ei l 3-7 7---j4- s Ncwalc ce,ura nl Mouret<casnvc tur i a-a�s oRLeam ' , }�} FROM i+o u>A� •ram MAIMIMI-. Company Nano I6.'INNMCASMC.ORTUBING FROM 'W VIABUMM Yffit>UOM 6tA'rk3tL►t. 7-WeMnstrnc"Penn tF- 3 wen Uw(drocicvtdl nse): 17 t;CMZM W2ftrSzWplpWCM M 7o MUNO&-M aI=-%I= �e� MwlFttutt. OAgaiCidt aal OMunicipawablic l� ❑Geo0a�1(H�CoolingSwty) OResidea id Wa-Smly(sin&) ± �dedi4 Water Supply(st� tacxovr FAOM m II�IncF�erM�eanfwerom�rr aim iz tl_ Non-WatMSappty WdM $ oRcCavay f3AquderR=luuM OGroundw�Remediatioa ID.SANDIGSAVSI.PACK FROM 't0 NA'[E�IL OAquifWSto-vandR--y OSalinw%1 ier OAqu frTeA OStoemwatrrDaainaW R $ OBWait�Mdumlogy DSubsi ImmCcubd 26.DBII.LDIGIIAG amshad�taiarBs7 13(1 al(ClaaedIAW) OTrwer V,/� :LL -IO nasasalmN imdae�aoaliadc ice. aGe dwmial(ll�CoolmgRetam) OOtlar(cWh inunderfi2i Rcmaft) 'v tL " Z�% IL Div 4.Datewell(s)CompiRed: / -1�'?�weIIIDf1 sa well Lrication5j'Q fL a I-AiD �► ��I b`u>-f _jam �. _b a, fz3. wYC FaraTtq/th—Namo. / raality. M(,fappli-Me) . . v ' & Z�l , 13rysalAdd,ess.Cayaad2ip Z'72J�j 2LBEefAB]LS •M — Comty Pmod Id N,(I" Sb.1.aMndeaadl rndeind /miaut�s/sec�dsordecnaaldegrce� - yy - Itiv`,�t�i�:'�+���PPr7.ocze0ing Una (if,Vdl'fscld�one IalnOIIg tSOdiiCimt) V'J1J4lI C�J�I,J S%MftieafCCW&Mdwen t (i.Is(at+e)theasII(sk or OTaaaporary B, Airfanq IImo,cvulr,[-d-,ems) &—J c fd m aeo F&— wI&ISAArACMC-0l00orISAAVACo2CMDO]yellCo SIm=&w&addrata ZIstbftarecurtonnezdslingwelh OYes or anpyafw--moQ,lGaAernp eaviaadmrhe,cxluoem� _ Jfrhtelraiirpafrjlllombio�rnmAmmv+attna6fwma�nmidapta6+dacamtmtvfdte .epoirmrdera3limimi�udfaroranrEee6nckoJd6isfw�a 2 Mledagmznaraddt<ioaalvradtly'f YOU'may use the back of this rage to provide addti-anal nrIl site dem or well 8 Nnmberofwdh constmcnandc aals-YanmayalsoatrachadMomilpagesifnwesmy- FornaWple6 aormn-,rmw=SWlywe&GFUP,ritbdes=w }mnam snbndtawefmm SUBNff fALHaMCMNS 9 Total well depth below"surface: v� (ft) ?Aa.For AO we1Cs: Submit this fmm within 30 days of completion.of van Forma<aple,neIIrlistaQdrPtlatfd�oau(aaam1do-3(d�20D/mrd2®!00) conshuc6otto the MOVA g: ( ) WwWouofwaterResommrr lufosmefion Unit 10.Static water level blow top off .. ljvaterrevdirabmxaoo +se(�'f� 1617 Mail ServiceCentel•,Raleig6,NC2709-16I7 i1.Bnrshoiediameter: `[ t� CHO ?Ab_Far IniecSaa welt3ONLY: In additian to sead'mg the foam to the address m 26aabovq also submit a copy of ibis from within 30 days of oompletimr of welt 12.WeA aoastrue6oa m�tod: �� _ i`�' omsftnctionto thefoRawing (—Sct , R nLG;,daeetpatb,eoe) Div�soaa of WaherResoaQoes.Unde>gammd Iojee6a®CautsalPmga9m, FOR WATER SUPR Y WELIS ONLY 1W6Mn1SerYiae Curter,Raldgh,NC27699-it36- 13s.Ya-dd fgpm) Method oftesft�u� TAc For Water Sappls&Iniectioa Wells bL i J Also submit one copy of this foam within 30 daysofcomptetion of 13b.Disinfection type: "K�' Amormt: :9 &1 r wed to the candy health ducat of the cmudy where FmenGW--I Nm1LCsmrwaDe�ofEmmo®cidmd Hand Resourm—Di mmofwater Revised An= 2013