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HomeMy WebLinkAboutGW1-2021-00385_Well Construction - GW1_20211228 KESED '. U41.WELL CONSTKUC ON RECORD '- I-Tm*CemEaa Department of EavitnumenR ad Natma1 Resamoes-Divisor of Wdw QuaW WELL CONTRACTOR CERTIFICATION# L� �- 1.WELL OONTEtACTOiir /I d. TOP OF CASH IS�_.FT.AbM Lend SWb0e` _ -Sin , fh avvadance in acmdancevift 1 NCAC2CW All8& . Web Cu*adbr(MOveduat)Nbm e.YIELD(gpm):._-� METHGD OF MWF , /�c f vey -A L.�,*_ L'tr. �..c. f. DWNFE==-'Type Anowt �• c•c�'3 v"Caftedor Name STREEI'AODRESS Flo- 11'�Gln tc l� S- WATLRZ�ONES(depth). FWm_M—To Y11 R= To h L d2 U,Z.7 Ff�m 1Sci To_j 0 Fmr!—_To Ct3y Toren Slide Code Flom 2To Fiore To q•L?- q!j 2- +CG Thic3� Area Dade- Phone number7. CASING: 1 Malarial L WELL RD'IM M 70W. Fmn_�_To �r _:d_ is SITE WELL®it(d From Ta i Ft WELL comet ctio N PEraAmmapfficatie) $� O Foam To Ft OWE R ASSOCIATED PERM[[ W UPIW eb16-1 IL GROUT: 0810 Nwft" M 3.WELL UW Pm=kAppsir.dble W U AgriW ROMMIdE �^To �-0 FL 0 I a trtgatiDlS OthetU .(IistuSe) D r►� r f �: FronL_To DATE DRLLLO 10-�C - 9-I From To �F). �.— TM COMPLETED 3 : 0 0 AMU PLO a. SCREEN: Depth Dialneler 19W s-ae Maul 4.WELL.LOCATION: Ftom To CRY_ a d,S Dr, COUNTY--—D Ot PS , To hL h+. j0y5, ,'ree. k vLA." 7 D s From To Ft N. In. (S W Name.Radom cmunw.awd*0.IA Na..Pdroei.Zrp Code) IL SALNDMAVEL PACK: �Smpe U Valley 13 FM D Ridge LL Olher Site(dn*gpsopriare bW* fEi , FtLATITUDE D_.Ua o-L 0 .�b ate.seconds ora Ft LONGITUDE l., D 0.2- ,031 ' inaaeciamlfoanat sonrca^Ps 0 TopWWbie map IIMP IM LOG . (Jose[m ofwe8 nwstbe shown on a USGS Nopo MIsP and Frain TO `)/c J I r,r/.�� attarJred to Las for111 iFfWt using GPs1 _ ,J�2 al1 LL G`f" � i 4/i:�G 5.FAI ILM-r wn namalva bohowuhm daumismcdOm FACtU1Y®IfappEWMAP NAME OF FACILRY - STREET ADDRESS C11yorTown State zrp code CONTACT PERSON (-'Y a r r e TT M r- Ln MAILING ADDRESS-!0 ys Gr e e Qce-A ,etP. - ci ✓1 C D.2 S 12 RE>LIARLGS: .` 3y'pBi�,� if' (Sty or Tawn State Ap Code Area code- Phone number S.WELL DETRIS: rooNSMrcemFrniffTWSWa:.WasooNSFRt=Wer W►'m 15ANCAC2C.WELLCOI'IMUC MSTA"DARD&AteTHATACOYQFTM a TOTAL DEPTW o2 a- S P OMED, THEVOULO NEFt. tz DOES WELL REPLACE MUSTING WELL? YtE-so NO WATER LEVEL Below Top of Caskw 7 d FT SIGNA,Tt1RE OE WBl CONTRACTOR LATE o` (Uss"P tf Abow Top of Casio P OF PERSON CONSTRUCTWG'D E WELL Slbt6it the orWwMtD the DWbIofl of YYAIef 30 days. AUc-I -In c 1189L, Fam GVW1b 1647 MO Sew C ender- ,NC 276-1617 Phate No.(N9)733-M6 ext 668. ttev.92W