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HomeMy WebLinkAboutGW1-2021-02777_Well Construction - GW1_20210805 _ l�.L'.SIDEIVZT�LL WFJ.L CONSTRUMON'RX"RD Na h CaoRioa Dq=mca of Eu andNakz;d Re mom-Dividan of Waco Q n ty WELL CONTRACTOR CERTMCAUCIN# 1.WELL CONTRACTOR: d. UP OF CASM IS i L FT_Above LWW Shoe" oot �jwtmQi `a'aoitar 8urFaMteW*e a at aoaoTdaTTce tetDT 15A NC/1C 2C.011RL •f ` li L.J, C 4. �•.G. e. YIELD(gpm): �t� �RIiOD OF TFST i r f� %VA C,oubaclor Cbmpany Namme t DOMFEMION:RYpe And v1-�q STREET ADDRESS SP.��L n cc I I�r[ 9. WAM,251 S(delft f FraM SD Ta A: , Fran To L .�7 U From Ta FtrtTTR,___To Cdy br�Town State Zip Code ( 3&)- Va-ne 1-� (/�ZJ& Fivm ro F .„�Ta Aten code- Pho nwTiber s 7. CASING: Depth Dimmmar Thk1crosaWW1911t MMa�ul �� 2.WELL ORMATR4Rl: Faun Q Ta�� l� _�.d_Zt�' SrTi'E WELL.II?a(f�in) - - WELL CONSTRUCT oN Pt3mTRRN Fmm To Ft,_—____ from To FL Ol7�tF�tASSOCIA'tEDPRSttNITWapp�ie) $. fsRAR3'R: Dot d Rde9tos! s.WELL USE 92wM swo o ' t ) PB FmmkdusbiaVConmw _.Ta 2-0 FL r ! 100afte O� .(W Use)A k M tS 4iG Fmm _.._,,,To ,j j DATE DRILLED � .L-b ^�_ From To FL �fFi h QS — Tam 41 SCREEW. Rath Okumder Slat Some We" 4 WELL LOCATROM: Fww _To FL ut. in. CITY_s .� COUNT? To in. kL From b Fmm To FL #L In. (Stttsat Nuntiets Gommw*.Subd don at No..P*wL Z1pCode) 1IL SANDIGRAVEL PACK TOPOGRAPHIC I LAND SEMNG: $ Maternal 0 Slope a valley 0 Flat,KR2tdge O a� _ /� (d-* �� May be in dqpcm 1 -----To E LATH UDE 1D° ..l 7. D' mumess,szcan Is CW FromTaDX, qq urea l non FTon TaFL Ia3ltitiyclQ%n ib 2&sau=,X GPS n TOpogc I iC xasjf 11.oRRLDEG LOG (Iowan of rtu m1wbe sahmn on a USGs"o instep and m To C F�amlrtatian ti tiara aft cf Wto 9*fiprm Wad 6PS) FACe.Rnt® te, NAW OF FACILITY y1 _ STREE'iADORR_SS T -- C*y arTotnm State zv Code —j' u A CONTACT PSMN 1_ ��U 1 A e rl n CesstStg Ica h� r .� MaILasGADOr�Ss SST" � JJ,*v 9V 8 o f2 Ssc�►an 01y or awn u State zo Code 12 RENUUUM* Area code- Phan nturiter S.WELL DETAILS: toOttt cernF^rTMT'rtesVMt WASC o+srtnu=WINACCONDAWMvM I FA#CAC=V.IML CONMt=TM SiAtAR&AID THATA r�Y OF TM a. TOTALDn 25 t TmaVazo we3t b. DOES WELL REPLACE MUS M WELL? YESII NOe a�7 a WATER LIMJM Below Top of CasMF_ _FT_ SIGIMATURE WELL CONTRACTOR DATE. (Use+"If Above Top of Cam) rZo4 �& , PRRflM RAINE OF PERSON!CONSTRUCTING THE WELL StRbllilt 60 artig'Rnd ta,So GF1tielan Of VftiW QURW WEM 30 days" AMC Ildbimatbn WSL. poem GW-1b 1617 MaN Swvke Cenler—Raleigh,NC -1617 Phone No.(919)rss-7 i text n& Rear 1?fiT