GW1--05473_Well Construction - GW1_20230821

WELL CONSTRUCTION RECORD(GW-11 Tot Wend Ihe( y:
1.v►'ril 1ba111atttat hibtn.iisl:
Nick\bung la WAtitn Lass
MO to otatRlrltore
4605-A IL 3 s5 R. 3
11CVtttiCCarenituteovai ttireaTlydee IILDlftaltal iR71lat scolds lie IrIPmtIP'
12011*
N.W. Poole WON Bred Pump Co. um 10 1111#fatit
.( i �31 it. (, bL i-r G
Correa 14wome
tr INN11/1CAff'S Olt 1t�16�«ndd) rb Ll
1%A;11 Camera alloy Parse let Z gla?y `(Rena -To UM1K.Cl ttorams ,Hari PLLL
iAi die Arehosie sea ontor.ttw.prim ga.t/tC hoot ado lava stt t► it It to
4_ 1
S r►!1 Ule(titetiwt(oleic "
It aaUtino
lit j woo ' In `MAMQat 'tor fat E IlliMagla I ltwio9M.
°Aramaean Oelsokiipineilla a a k E
OIliaa lt ialryossoitmat Water Mk tr t h"•.'1) — I
IX.GItUI(T
DI1i as ❑ ,ii% • 'woo Gil) ' IRnM ro l'sans m. ,oeuximmi11[1M016 imam
lgleellar ara; \\0l' n. 7 7It 4twLiek . _ --
i, ❑Res:D+Cr\ IL IL
lialteduti N%ell' R IL
Magda- 17hruund++sler Rcmultstion - t
to.sA.t7LCRAVICL Pa C_tittorlMeeWet
males' Same anRorw, ❑Sslutity•datner FROM I r0 LlarTtataL rataAr-rvIENTalma!
Claagiviiir .7.Shtnil\ut T Drainage n' ri.
OlepramanTaltiaolog+ CSuhstdenceControl n. It.
: losVittosa1(Claatl Loop) Ell'inccr 2a.011I1.1.1NG UK;(enxlt addatunal sheet,I r traceuarp)
F11
0+1 ro DFs(RIt'ItO't(color.Rader,wlie tttarr Mk Mk
r C.=;.elm Itrial( It Return) C(Ahcr Wsplain under 421 Pram(}.) R It _ r C.L IooS,rl CC1 1. ;Tate Wclhsl Completed:_..- ZC<' -?_T wet''Do a 7 n' //i/I f[ / r
;�.\\al Location: 7 R Vas" a 1.�-4nI re 4r L.
��77 n. °. AUG 2 1 .)23
.,,,:,, tt....L,,-;cA n. n. �_
1,„\.....'ane Facdtty IDIf(Fllppltcable) _ UOi'fitlfi±sn D...__--
`i i.. y t h�t1 :l �C / �a r l v) R _ DViC?IAC)i', �'ti
( IL n.
ay�..,: l..k.A:Am.C .and Zip _
21.REM tRSS
r..t!L`il get Used steel hardened drive shoe
Carat Parcel Wen tticanon No(PIN)
Latitude and longitude in degrees/minutes/amends or dcelntd degrees:
Pre:: ^c hiloog is soli:cmnr) 22.Certification:
725°54+ Zr " 3so it,ztgo
ei.Warr)the%ell(s): C'Pemwnrnt or ❑Temporary r',rstgn,t colt' t ‘„--„)
cllCii,
Lett
tiyntr tht,Jirel.I herebyag...4 urn ru+vdrrairettairrotmtri per.aii
7,Is this a repair to an existing nen: CI'Yes ur QNo /5.1n'C,tt-o:C or00or1St WIC IXJONO Casineasur ardor*owl ars.cept,
rasa as re 411PX,,Jill oaf known sell constructtrn inlormanon unS crplarn ti:c Mine.:raj ti:r ''(Iny rcco'd has hen pm,dblaf dr urea...re
4.1p11/0y1rn'¢`:.vnt<nha,canon w cat the bark n%t er form. 23.Site diagram or additional well details:
r.For GeoprobedllPT or(.]fled-Loop Geothernnl Wells having the time You may uae the back of this im ie to pro+lot a,irtiti0aal ea aonstaceee info
a:xci,only I 6W-I is nadul. Indicate TOTAL Vt1A[BER of t+'ells (aid e Osts.'in Remarks Box).You ma+llso wadi tdiaonet petrtifneoeasary-
c.;ti:;x;_ f 2J.stinm1TCU.INSTRi'CTIO\S
9.7rrrtal ucil depth below laud surface: Lpls��s��� (ft) Submit this GW-1 within 30.Lai of well cat�itdtle per the luifuaine:
fiirgn.:.'.., �.4eltltrrtt to rr• s.i(,sample_Sip m1013 •y�0
24a. Fur :W Wells: Origuial tint to Distal's'at MIa ar Ramos(I7R:R).
Se Ark tederltadMew'toporcasltty: Z o (it) Inronnation Processing.nit.lei?MSC.R.Id.NJC276994 I7
(Pr
tab.For injection Webs:Cops to DWR usaaract d wages Clotted y)
11.Bo'chub;ilia roc ter: 6" (iic) Program.I4 o\ISC.Raleigh,NC 27e99-1616
a.*di 4 V1UtrlKiluu n Rotary
2.1e.For Water Supph and Open-Loop Gcnlhernni Return Wetly CApr to ttC
e a.4u.c ,s.lae..:tvi en) county environmental health department of Ih::;a•n.mnaC mstaliad
Mit WATER Stliitx WILLS O .Y: — tad For Water\k'exs p� ucln•• .er,l (:PD Cgybd111li.CCPCL"A
BLOW I ermit Program.!F 11.t�SC.Rai.�t tC Z7 1611
lla Vigil�y UMW at last: --
1J\(ieilettbotplta 5.HT I fA� .--
Flee,40,'.: TietilltlVe Dgpn otrttt atFR, •u,wsti(NNW-DwdeodNeat iorse Ravrod -o.20t$