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HomeMy WebLinkAboutGW1-2022-03469_Well Construction - GW1_20220323 WELL CONSTRUc�nON=CORD fGQP 41 ForlitteinatUstiO ,<e.���,:.u I.WAI ContractarinP M MOM UWATERZONIN Nell CanfractorName � TO IL arc Won Canh=ercaffimt;.--- —� Wa•4G(— li►l6 �l ' ��s 1i8� -✓, ra Drard>� Comt>aAyNemo fG 6' 26.Il�IBRUMMORTt}BINGfiNdhemmildoMMOODL, %-Won Camsleacdoa permit: into Ta Dr R .Fctat�ss n i. List aiiopplicxrbletveti censlrtterionpemdrs(ia tlfl a srm�fla�arce,erc} ft. IL 3.Well Un(dl=kMM�): R. ft la. Watersapply Wens =T.s A3rioalt;ual �MatticipatJFolfifo o , t3got hennal(I3eatingrCoaiiagSupply) idential Water supply(single) ;� StrIaUCUmmetcle2 DReddentlel Water Snppiy(shared) Irtt on FROM ro a-nnauvNr l�Ton WaterSupplp Well: % Monitoring Q taivety tt tr: AquifLAqudfler u V and Rcomay D9ati WDan3cr MM RQ MBTI�nE it. �fStarrawaterDi>tinage ft.wTedmalogy DsubsidemCmlrol &l(Dosed Loap) Tracer 2U Lilts atfuhadditi lNo sWhq Co Rnm 3ller Iaatmder62lRemads) E. ft gate Wells)Ceatipleted: '��" t.::.Well m sa.weIILaeeRoas k• � - _ . hn � ft. MAR 2 Facility/OwmerName % M ft: 13 COU* PeEsxlldentifiaattmzNa(P1N} lib.LaMade and Ionglta:de In (NOU field, d.apalaillongfs s/n ���j ecQoads or de!ci�ma�i degrees: 6.18(am)the GIs) t or 13Temiwrary Stgoattus;orommed Wau Cnb atvr Data 7.I8 this a regairtoan By sip drtffar M I �dw the VMS)�vaF(tme)mnsnucted k mace exi tingweU.- IMYes or [3NO 'Wh15AMCMC41WorISANCACO2C. MVaCoMrncdmt&Mdmalsmtddwa IIz*Jsareparr fittouthmmwellcon pucBonrnJotmatroamdapralndtetmureofthe -FYRfdt hasbearcprovkWt*dtesaertoump: repabwtdcr#21 reraarrssaaGionarartdmbarAafthisfarn:. Sit$diegtsmaradditiaitsiweltde€a,'i� 8.I br Qeuproba PT or Qosed•Lw,p Geoftwmal Welts basting the setae You may use the back Of this page to provide additional well site detafs or Well eonshvetion,only IG}7U!isaeeda indicateTOTALNUMBERofWells constracdandetdILYonmay also attachaMpnaip ifneassM. drilled: 1 �_ Q 9-Total well depth below land stmfaee: L)i� An+ePeitr. 3abtntt this tb¢m within 3Q d of Formur*k svells W aQdeprhs rfd�erent{ezampre_3@2001 ands@ro0'} qs completion of won const=nctioII to the fonowing; 16.8taticwaterlmibelowtoporcaaings (ft) D�mofWater, oaFmcessingUsdt,ljw revel t4 above aaysng,use>+> 1617 AM Servfee Center Rsleigb,NC 2M9-I6i9 II.BoreLtole r` D') 24b.Br—Infection Wells: In additi(M m Sending the Erma to the address in 24e U.Welteonstrwilon Me8tod: � abat?e,also submit one copy`of this foam within 30 days of trompletion of well coastruclioato the fadi FOR WATER BUITLY WHIM ONLY: Divfslanofwatery vtzae>�roma�te�oaeom�tpaogs„n, YAMaiS�t v3ocCea�r,$ale�6,NC 7G�9-ib36 13a.Meld(p,Pm) Method o8tesk 24F-BWX"WsB=Iv&ftd29IMWeUM III addition t4 sending iLe form to 13b.Dlslafecdon 1 thesddma(� ►Ausum � atao anbaniE Sae copy ad`tLis fmm widtut 30 days of m A /334 NIStPPWO Ua w boa to the candy health dgmftent of the=nW Fomm GWd NottTsCeaalioa �P���avtmammCalQaalitY-Dfv?sloncfWate;g Beviaed2-21-•2018