GW1--05457_Well Construction - GW1_20230821

WELL CONSTRUCTION RECORD(GW-I) For Use Olifr
L Wtl Ceaw+ewr Id r.relir in {
Landon Philips It
I WATER
3441A a' MO
wCwelCLmeotrClaiarterWiaid l IS TrafASl flsr ati oft lass�/-_-l1r1' I.
fAntl rd �� 1�1L" 1
NW Poole Well and Pump Company r , R. ,, " �1T
Came*Nine IA tV,YER C.ASitG Olt 111:St G
rsl 3 ta2G room
r� -- in
2.WelCiaitti lila!Matraft rt__
t+talPpoli� itwrla�lrsttw/ar�rAe VIC Sim tit R
t or) h. _
3.WA Use(aloekwell en* 17,seniEN we e:ow. ._
rlen.t 10 QIANLlrY
Wait Swots W' m
QMunttipo111YNC R. ft.
13Goodhenost(I{aaeletttib nil surplvl fie-tdottraE Water Supply(single) R. lm j L
!°Wellsenual Water Supply(shared) Irl GROUTElAl._____rp A
Clionsiabor QWells>IO(yJ10(1 GPGPI) fL
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r\or-ll attr Srppiy Well: , rL � tL /3/, Y'I k �'1 r r -
IL tt.
Injccti.•1Welt, R. IL .-1
..Z.A,;,a11cr Recharge °Groundwater Remednabon 19.S,INDIGRAYF.L.PACK),I eppilrable).AI.
Z;4Kv$:rla;e and Reut.Cn p$1lnuty Burner MOM m
xtifl14 �It�
ft. � f
(y takr L.,: OStormwater Drainage
CiE.Senmemal Technology °Subsidence Control
ft.
I ft I
❑Tracer :0.DRILLING LOG(attae►�litteaai r�1�1�*���
�t rotL+emtal(C'!osed Lnup) FROM TO t
'eoe:xrr:tulIlle.t:nt:�(•cmiin•_RAlm) OQther(explain under 421 Remarbl (,r R' 2R, Fop
Ceti
4.Date Wcll(s)Contpleted: .gr/Cr-2J Wed IDS - L R. 5-r R ^d
R. t/�"IL (idA.,I/L .�. ,.� ..b i L....�...
�� r \��sLi V E' •
Sa.��ell Location: ft. ft
jir:. RCA IOP jA ft. 1116AUG 2 1 2023
Iitp0..�Woe FaaL LOA 1y Uf spplhle)iu
t^ Vie, ,,, li C 1- e 2.15R7 fl. ht. Inforir,o5ion?meat. ,eg Unj.
ft.,: iddwr,CHI.and LP DW�
21.REN1.11 AS
MOG
7: �•`[ 1 s ft Used hardened steel anvil thou.ceurr. Parcel Woo ltealu]n No(PIN) -
51,.Latitude and longitude in drllremlminutes/seconds or decimal degrees: '- ---
.,:a:;ad..,o,Wt Ione o.udrw oo) I'.Certifecati
5,cfDZ"?!I N -7b. ati-Z►`f g-ice-2i
.,,gnome ofCertlied Well Contractor Daft
L,arc)the..eil(s): I.:Perm:mem or Q'frmporary
4).Arm rnjur.+,f44tsrAyet tWdrtShe wilkfrposiw eteaVemo nemaal•aiatvatar::.
-.I,tltea eerie to Mtaisliu;;sell: 0Yes or i'1 Nu ts.1MCC 412C 111410 r Li AC/IC I2C./t7o6 fRiCisare S airiralolu..--
.ra.qp.aat. owllo wed,..ftr.wuoa otA.rant...:u,J,y,nttodic mow,,.Idue .(✓rdeaer 41.0 wrjrra kaseilhil irwe►
,,,r,....ace,.21 a aaarea Waar.r I .
w+the n I.'.1 mA 1;,. 23.Site diagram ur ad midi
.'k,,/:eupr lottU rf'arChlad-l.nup f:eeihernwl Writ,ha.mg the s.unc You may use the hark ofMis pee to provide additional t•+elconstr Cisor.:..
•n..iota$'I WWI tameeled hldi.t&tM Al.NitiNII3C:Rnl'wells (add'See Ose'inRemariaBlt)You rosy also much addonnal pages sEpeer.
24..SC BSI ITTA I.1N.1'r RC CI-10.\S
It.trial will&yak fob r band sadder: (I b C (IL) Submit this GlS'-1 alibi*3l day .a1'r►el Ilte frlrr'
3........aparaelre reraiiidgtar 4•almari ferampk. /)tar emi luelnu') eampteura fear *4=
24a. For Alt Wells Onsiml MIN M tialasaa of Wader Rdarcrs(G.-.
Ir.5as`raattatkve!lealepdtodllf' �� __fIU In Iiirmanon Proeitudig Usk WWI MSC,Raleigh.NC27699.1617
e..m.i..daiwreruy6 re
11_llavekdetkrrcaes:6 (mod :Jh Fur Injection Welke Copy Se DWR.lis to dagiad bseetioa Comet lit.
Preci am•In if-,,tISC,14alci,hft•2 699•1636
12.Wen IWartltmlla mertitrC ••eAaa 7 ---- Ur-liartt al.,wpl.l. 9a�•!a1w Gas*eaoel Resrsw Hale Cagy t:.it.,.;e s.�c.r,.n... Br ono pr.e4.ac/ ,otampetm.o.mme.ltal baud&depeafamed dir caries whoa aerated
it Olt N 1•I l x +1!.Y vrktlS OAE.Y: F1ol Fes.►Wa er NeRI pia pm=QM-
mil CalrY io D .R.Cat:,
14nan Newels.wdaeIdif1LSC Ralmr�
IIJatidltoad u(1 McMrdrrsnt BLOW
i 1s4 Dirarrciea mllpr n," si♦.ra e 1 b.
•,s.,41..I Mani CarerIat9olwa./Ha....r-w/Q.r ig•IL.r...Irrara—.-- *word 10•:.,.
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