GW1-2021-01709_Well Construction - GW1_20210322

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WELL CONBMUMON RECORD(GW-il For Internal Use
1.Wen Contractor iofbrmatlox
Gary.Thomps6n 14MATICILMOM
Wed CarmemrNaoa _ tmaot '°. .. -
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Aqua Drill, Inc. .
Company Nene. a R 9a tL u.1X red S1)ASt �ri✓ra..:<.
3 y 3� 16Hw�GtAleG ago
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2.Well Condroedon Permitik 7
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wabersapply Well: I7.
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4.Date Wells)Completed: 2-b- z( Wdl III, R 4a R
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By dFS I s dr faro.l hwcby c-*dr tie uvNM-a 6wrW arooarad Al acordoae
7.Is thin a repair to an eaptlsg wan: ©Yea or ©No rrd 15A NCAC OX.0100 ar IJA A AC'07C.o100 JAN Cxnvwftx Stardrrdr addera
lain a migmat.111 m hron wee connection 6glematan adcgor the wave ofde capyofA& aced ha,bampregddedradiwem
npoirmrdra2lrerr6armrwwdrback4fdrfG IL She dhW m or addhlooW wall ddags:
L For GwpmbdDPl or dosed-Leap GeoWermtl Wens having die same You may use the back of thin pegs to provide additional wall site dermb or wall
eam4ttetiayonlyl.GW-lisneadd. IodcamT07'ALNUMBER017wells. consummon dams. You myshosuschaddhtmmt police(faaaamy
drilled
9.Total well depth below lead surfacer >'~r lit) 24L For All Walk: Submit tics dam within 30 days of completion of wall
For mdr¢rndr bn all dspda i&TJ(hrmr(eaasrpfe-I®ida'aad281M can>Wedon to the Mowing:
It Static water lad below tap of using: ti b (ft) Divides of Water Resources,information Prow irq Unit,
lJmwr,dr above mmg sae"+- _ 1617 MaR Service Center,RaletQh,NC 2709-1617
1L Borehole diameter. (in.) UL For Inleetlnn Walla: In addition to sending the form to the Mdrms in 24a
12 Well enmanctioa method* roFto.- n � above,also submit one copy of this form ys within 30 dip of compledon of well
X _ construction mthe following:Cm sap,mm)t cow smatialk met
Division of Water Resources,Undagcomd Injection Central Provers,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raldgh,NC 27699-1636
UL Yield(gpm) C�5 Method oftest <04ib6 P i,•^c 24e.For Water Snook&Injection Wdlr In addition to eerdisg the from to
the eddrem(es) sbcva, also submit ors copy of this gmo within 30 days of
13L DbadW(on type: ff- 7,D Amount: 1 completion of vall construadon to the county health depamoent of the county
-hue constructed.
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