Loading...
HomeMy WebLinkAboutGW1-2021-00388_Well Construction - GW1_20211228 . �'jDF_1V'J'lAT WIML CONSTRIICTION RECORD 5=� NaffficamumDepaltmentafEuvuofgnmtandNandRmums-DivNenen fWgtcrQuaTty r WELL CONTSACTOR CERTIFICATION# --2-6 y 1.WELL d. TOP OF CASING tS/_Fr.Abom Lana Sty= // 11 Top of casing Ww blow iaW swbm amy ceWm ti,zfa :/l i!� -�n�, , a vafoa in accordance vtb 15A NCAC 2C.011a Wag conttactor(tiMtridtmi)Kam e. YIELD(gWo): _f I1 IMM OF Tr F '� STREETADDRESS Il 3 r..t. z I �' a WATIMAMMES(depth): Fmm _To 9V Ftam To M a.4 ri h n L a 7 0A-7 From To Fran To f Town State Nrode Fwm To From To ( ,} PNJL7- y2y P q ` ,�, Area code- g11e number 7. CASING: Depth D-temei+� 2.WELL OAMRMATLON: From D To D_FLU :Sagj--- p1c5)" SM WELL ND;W Fnm_,,,_,_To ! FL VVULCONUFRUGTtON P Qno�r�te)ENi>P�/D3-of T _ Ft Fwm__ o OTHER AS9ociA,nm P6MIf *W IL GROUT: Depth / Method 3.WELL USE((Xm&AppM:ibie Box)ICI �� f"D r��a h� /'D u Kos AWku&+raO R cw m U From �? To!�:4 � Ft. t NIl�gstQWit 0809 (bSt 1p5e) ®M e s f L F�__To fI : DATE DRNLLED /2 ' J 5 - -2 ) Fran To FL TtiM LEiED a, ; D o AMO PW a SCREEm: Dept Dmme Or StoiS"me VMEdal &WgLL LOCATION: __To -�� - tn. 44,9r, e ,J;lJ c/1 OOUNTY o k;�j lam From To__! Y �rL irl IfL 63 v p;D 41 ---7 D V/8 Fmm To FL im In. (SEtee!Name.[+i�atbets. - .P*oaL iQ.SANDIGBAVE L PACK: TOPOGRAPHIC[LAND SEMN : - Deplh Mahal 0 Slope D Valleyx Fiat D Rtdge 0 Owes F To Ft (dM*d9ptop,alabmc) 01 bem LATCNUDE /_lotto° �'�. :Z (o U11MgM SCrn Igor FMM co LONGITUDE V D?9° SS• 3 3 3 From TO � m ToSon= �GPS 0 Topographic map 1i From LOG (Nocat w ofweff musthe shown on a LW3 fto map and ! attacks fo Mft farm Wnot osbW GPS) d S e / g - yo So ND e' n: 5.F?1CILiIY-tet,enemeaat,oauioeis.heretne+retiisw� FACUM W 4W$pp ) - NAME OF FACILITY STREErADDRESS t-:�: fuel Cl3yorTown State // zip Code IP�F CONTACT PERSON A S f Aca la(G r-5 �h G MAILING ADDRESS S. CI(yorTavm State moCode Area code- Phone madder tl.WELL DUMB: � 100199MWcetnFrTHi►rrMWau_waScmNS RtIMMRiACCOFMUMW / 15ANCAC2C,V LLG ICIICNSrMMFMAtD'MTACOYCFTNI a. TOTALDEP b R o IL DOES WELL REPLACE EMSTMG WELL? YESD Wit WAT c. ERLEvEL( Top amsaaw D FT /- o� SWA OF ! waL CONTRACTOR DATE (Use''+'ffAbareTopcft PRKTEIY NAME OF raqgm CONSTRUCTRMTHEWELL f Subadtthe migind tp the Di kdm of WaIWQURW4WWMM 30 days. AID 'MbMWMRMgL. FarmtWll SAW%AIN19292_dRr-V at— Menem?i4_1acm ,..E AM& e....4-SAM