GW1-2021-06265_Well Construction - GW1_20211123

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WELL COMRRIICI'ION RECORD(GW 1] use 0*.- i
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'RDL Drilling Inc. I&WA'!8R?rMM
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2089 > TO nrAso.rrce MAT�t1AL
I&WWRCAMNG ORTtIBDiG
2.wen Chan Pamdt 0: FIItOM To nrAMMM I iRICKNOS I MUCH"
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1.
I wen Use(dock well� & R. �'
watsSapplyweth nsCMM
rxoM TO B14NMM a60Ta= I 7MICOUM I MATZHAL
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�Resideatiai water attpp�r( ) ltr ca=
t�M TD MATZP�IAL H1MElHODAcAMOlJNi
Noe-wad ft*well: $ J p R• �slolit�G m•t�
o g a tb ft.
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�� 19 SANID/GRAT►l$.PACSat
7' FROM TO MATWAL EMP4�CB�tHiTMSTaoD
Test waterd)raina�ge O R' a. 3 IWO& l'QeM,•C'.
Ta boology OSabsidence Control tl; tt
(Closed Loom) DTracer 206 LOG falincls odditiond steels It
Cieothertrml MeatWOm
firtgReturn) ( tender 021 Remsdcs ISM TO eoMr ra8harl< dee,a�
fL 10.0ft .5 It
a.Daft wdd(s) E1`Eb-G4 Well'dDU fL s'�`P-W C 5A
Ss.w�_Laq6am & te. ' !
ft. fL
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aV`-���, 2L REMAItitB u � "
county Pima s? IP?FGR;aIA ! u
5b.l adtude t ad iongitade in I t 6 ub or chins'degrees:
Evrd1 tteM.ace bdAaaB is sty) p 2L t y
6,1a(are)the well(s)(3Permanad or Rremtmrary s;�asnte ofCertiW Wen Contractor Hate
7.1a this a By�h►8 del fit.I here wo&w Me wedoo wor(weep)oD a aooardow
repair to as rs well: QYn or xMM wuh)JAW-AC 02C.0100 or 13ANCAC 02C.0200 WeU Cmnundhe SYandoadr ad that a
fjBitstsonp�a�t fif1,amtbronnwv/c�vnaulan.6�6r�atliom�da die trreOfdw COPYajdrisxaordhasbaerpnonidodta&VM9o~.
rrpairsodb621 nwaThsafion arm dobmkofMrfirm
23.She diagram or addi6omd welt detsidm
L For GcoprobdDP]r or Clow6I,00p Gehl wdh having die am You may use the beck of this page to provide additional mil site d-Wb or weR
ooaetr00bnn,ottty 1 GW-1 is aeeM. hWuxte TOTAL NUMBER ofvxb conAsuctiondefi& Yon may slsoatth addifiond pages if aecessaty.
dnikd: % SUBIH F ITAL HLRtTQ CpU IONS
4.Total well depth below toad rrAee• C141.51or AlA 11Ars.ftr All wel>m Submit this form within 30 days of completion of well
uv to wellslttt oUatg � (e tc^3�d 11 1 r constmcfioa totbe fonowiflx
10.Steele water kvd below tap ofesshir. (ft} Division a?water Reaomem wwwation,Frooaaisg Un%
Ij«ute.kad taaboveaadit�ere"+• 1617 MIS Service Center,Rddgb,NtC27t�1617
t&
1L Rortbok diameter: ( 24L For lideedas w In addition to sending the form to the addrew in 24a
12.well construction mmdoe:_ �"kv-one(L abarm adsa On O w of this form within 30 days of compdeteoa of wdl
{ie sugm mtery.esblgdnse3pmh.ete.}
.tatdte 5oilovriag
Division of Water Rearaeaa,Undagronad inj"m Coats of Program,
POOR WATl;R�JPPLY W6LI.S ONLY: 16M Man Sw is Cents,Raleigh,NC 2709-16M
13L Yield(gpm) Methad of feel: 2de.For wets sandy&loiection welts: In addition to sanding the farm to
the addte*es) above. Also,4 1 n- am copy of this farm within 30 days of
13L won ft m Amount: boa of seen construction to tie oouoty health department of the county,
where conshu tad.
Far&GW-1 NorthCarolioaD ofEavuoewmtalQuality-DividonofWacrR Revised2222016