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HomeMy WebLinkAboutGW1--00685_Well Construction - GW1_20240125 1 • North ofErv .RWaterQuality WELL CON ACTOR'CER 1FICAfON#44' 9.A' 1:It3.CONiRACTOIi: , E.• Dant and Pump:Sendoes LI C. "— ---nmoant Navrne : • F -zoNES(depth. • • - . 3 • -uric C;3#ge - _ To. i F� To - �_ From F•-•. 4itoctl 204 Tom Ave _ 7 _ To F- . Castiefiayne - NC• {.910. -}23'l-66'89 Fran Tu � • Areacpde-PtWrrei�rrnber Ft_.";,,To _ $.WEIL t*AT1ONi - -S_ Depth i - Material. • Method ' srrew�L_m. � • - �TO To LF &Pn+Ol\ ehi C - . WB-I CONSTRUCTION PERMIT*D-SW f-W P--a3--0cQt{- - From 3 • To - oTtEER ASSOCIATED apnteote) -_ {., 1) �\['Cx - 'Nl i 3.WELL USE{C ck/A` gam}; Residential Water Supply 1 •a :% - Depth Dom`•��ot - Matey . -DATES 4-aura - Frant10 - Ft..:.__in. b. nip 4,�q � F"°"+ _._._F m. �1. Nat • nan.. _T0 FL in, it.,�,._.� 4.WELL LOCAnoN: {p SANpIGRAVEL PACK �:lL-A-Lj1.‘MQ aloA COUNTY- pP.•., FI nr,c . - S,thiaian.Lot No..Pared.zip Code) From I - ;"' TOPOGRAPHIC/LAND SET nNGt TO • R, _ ;n 4 .qY. I SlopOJ.Valley -i Flat i Ekdge I Other c •l ,arlr le . • it()Rump Los JA N 2 20'4 tATRUt)E __ mimps.seconds or - - Rom To . Formation ,nDeso iga ^`•s^? LONGITUDE _ .: ;NCI :_ .s; ;�Ina decimal 6 dlei �'34� . • Latitoddiongitride•swea; I•GPS .I Tope /1 r1r,,. _ C d- . &i OW'of l�must he shown on a DUGStopo � - C rc .. - .at lachedio!/rfsformftotusing GPS) . 66'7 o _ Li Met th WELL 5.Owt.,R4 NT+AME• J�1) l� gn.. to P rA Koc K. SEr iREADnREss 5I e -Fh •-r 0.4 r l6 - %ti.N1,9 ri A-eN ne f ? . Gaff-''Nab - . . _ .Area. '•' rpartysr - . :• t K : . , • ,s.EARL nuts: r i � • • a.•win,DEPTH; . =br DOE .W G 1ELlTYESI rtro knew mom inkr rn�yKrxtaA c waLoo STANDARDS.AND TlU1TwCOPYCFZ15a WATHtMAO >�TOO ofCasLit -an - n NS- _ ./ Nse+dAboveTo oCa$ g. - • _ - d. TOP OF CASING Y$. . FT_Above Ldand sue• - -'Tap of 'tanni tat d at abelery tand:sride ce SIGNA OF "i DATE ei..variance In w�i 1 A NGA 2se.m 1 CONFRACTOR DATE i} Mee. ' • e.YlE tppm): • .6. : iiliFniQD• op TEST/4r F 'I, ' PRDnED NAME OF PERSON CONS7RUC>1NG n4E . i {to the Division of W :Qualitywithin 30 rs..Aunt. 1617 Et SeMee-Center: aSo»IRgs., h. tC �1T Pfrane•No:i819):733�Oo :t�__ . r_ c� .r.