WM0100479_GW1 Monitoring Well Construction Report_20201111

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List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
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If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
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For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
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By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.

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Digitally signed by William
Walker
DN: cn=William Walker, o=W
Walker Environmental Services,
ou,
email=wwenvironmental@gmail
.com, c=US
Date: 2020.11.11 14:03:41 -05'00'
vilerca
Project No.: ZS7-Z9
BOREHOLE / WELL LOG
/W i Borngell No.:
W-�" }
�.o.
(Sr!
Project: Delispf.Wf• 'rql
267- 29
Address: j jt?s
fik 14W:1it
Drilling Method:
Equipment: �O
d
SoI;15•prrter(uCr/c
,pr
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7111,
j J
be, 'nab-rSampling
Date: t0 /Jp ! 2_p
Logged BY: 3 •
LDevelopment
Method: i ‘ P
Method: (ow_ F w
*Drilled By: WAKt
Driller: V✓ij( � �
—
v
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1'�•G,-
Drilled Depth (tt bgs): Wby�
Well Depth (tt bgs): 25 4 Lac
Water Level (tt bgs): ( l .J j,
Casln9 Y i� Dlap� e : q,.
Depth Interval: Q - is IL k b� S
+lefe't)lameter:
�Sloottsize:
c./ •
Scree,lyziV&1gl��V'e��ot=i;-
.-s.r;-erval: 15_Z3 cf- b3.,
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Grout Interval:
Depth
p
Recovery
- I1„ y.
(ppm)
.seal Interval: it - / 3 {-� b< s
Flit 5ck Interval: / 3 - 5'Q (+ to
Llthology
Well Schematic
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