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HomeMy WebLinkAboutGW1-2022-03686_Well Construction - GW1_20220321 WELL 9W.m.KC_b1_0ffJW=JtD Nam Cwdms DgmumW ofEwinonmemt sad NaVad Rwomoes-Div m of Wdw Qmdily WELL comiucrOR cmimcAnm# ' u.+caNrRACno msmFEcuft AtaoanR�. Smote nrana Pl�np LLC. a WATC-R 7t111E$( r - - We9 t�ortbaraor'(btdiVidrr�Nmrre - F�r��-To _ _ - Wfidmd C.LeeFrom TO From TO V"Ca Im ew company Name FfoM--T9 SMUMTADDRESS 204 Tom Ave 7. CAIM Ttddurmef Depth Disomw Casale-Rayne NC 28429 From��ToFl_1�L'� City or-Tartu Stale Zip Code . From Tb Ft� S1� 0 �231-66�8 Fran To Ft Area Code- Phone r M*w X WELL I MTiOA: a GROUT Depth mabod Method, SITE w�t� T> •�+s FOnm�_To FL &nnA � ff'` t r1 From To F3 WELL CONSTRAJCTION P EPJAIT* tt w Fran To t OTHER AssOeu� PERMf 1S{if eppta) s. SCREEN- Depth Dkm*W Sint Sine 3.W@LL USE QChedr Res jdet1r6a1 VIPsAer Sttr fl Frrom��Q Zo% rL�� _V:) h, DATE DMU.ED I_' Fm=.� T>>IIE L'01NLE1 ED i AM 1 PM I Frattr . ,_To F�,_in. iq. 4.VJEl*LOCATION: i L 10.&MDIGRAVEL PACK stan NT1f Material CITY. Qf��I COU � From- To ,Ff, #Or Cs� Q1QY� 1 B f) Pi su M - t mod m ma Numbers.cm=m ty. mi La Nos.Parent.ap Fian Ta TOPOGRAPHIC I LAND SEi'i1NG: t:'• t r 1 Slope I Valley 1 Rat 1 Ridge 1 Other . W ++.>TRLUkG LOG MAR 2,1- 202? UtT1iUDE Msy.be in degrees, Fran To Formation Deson . manft&semWs or CON(ATUDE_ in adr cimml 6 a - �, Lam. y , Ledimdellangididt sauma: 1.GPS . 1 Topographic map* �5 . "�3 •-•i1P- 1 ►of wall must be dom on s USGS Aopo nW and aftdwdtaffftJbmffrWudVGM A 0WN9 NAME _YS&Ca 1 MADDRgss d� Apr ar:arm state 27p coats - . Area ootb- - u, REMARKS: - a WELL DETAB.S: � • Z TOTAL DEPTH: — _ b, DOtr'SMYELLREPLACEEit>STRIGIAIELL4 NOI 100 Wm'QsffFYTw►T7MWRLYM0W&=lCrfJllN VM - 15i111CI�CFC.W81001B71e7CIlOr1STN011R06.AW7H11TACOPYOF7teS ' j a WAT111:1"-M'>3e m Top of Cam `5 FT: raoor+u►as ear mo�7o atttte� AW4P If Above Top of Caft) d. TOP OF CASWM-a' 1 Fr.Above Land sr�e• -'Top of a %"*U 6ed aft below laad-srhfaee may require SIONAWRE OPTEITMED VVELL CONTRACTOR DATE _ e woe in bm udaswe with l5A NCAr,20.0118. Michael C.e. YNLII{gpm* _METHOD,OF TF,ST PRINTED NAME OF PERSON CONSTRUGTM THE WELL t S i A - Sint the W%Onal to the Divhion Of Water-Qt ulily wiu n 38 As M Affix: 111916 cry �617Ma8OerviceCett761r--RalelAh.�iC 98=181t P ftneno.,191917.3-7Daa.