GW1-2022-07023_Well Construction - GW1_20220726

;Prim Form
CONSTRUCTION RECORD YGW-1) h tr.i�t�ma1 t',t:(1ni� —
I.Well:(luntncnir Information:
t 14 WA"rER7.ONFS
-__ _A'illc}Iriliar!pr`.alni' ,L}7tOM .,-�_tO ___.._� � DFSI'R@TIOh _ •- [
ft :i ft.
\('11'eil�„iiara;hx r':`rtitieahr+n\rtmh•r
1 3S OUTER CAS Lfor mdti med web)OR UTTER(if
�..-- 1NG
ErV'1tONty1� '{tt) �(till,n � i✓t SGNf`t'Q ice .:tttc�M I:'it+ a nia+te?FR } Tft1(`�N-m.
' mpwin tiara.• _. ---1
MINI"(.4S1N(;OR 7-URINC(scoihutol dosed ropA) I
N All('onstrucucm Permit FROM TUMATMB
---- - --. _— - t
ry DIA,ME77Z2TftIC70s ty,
,cr.4l.'fpnlr.•rrhfv wr _.n rru::r .,+,il' •,i Z� It (t. —Z' to
•
3.\Nell 1_se(check-will user- —
NN eter-Nuppl% Well. _ 1�•S(R}F� 1 --i
FROM _y fU + DiAafE(F.R )LOTSD.F '�-tHICKNLSSI MATERIAL.-'--
Aencultuml u H !
rc �p R
c Z icy:
®;o
e'.,IT t T'.Il,t t•;a+'!t!"r :w.i Itw', .,nt•,• li:..,!e Ila:'Ktl'itii`. It:: 1
(L
' It.
!
lrtdtistnal'("•,rnrtt•:ral Rtviicntla:A•etef Haan!•.!sharedt
!m atu'n tltuM In HATER, FNPLA(EMPNI'MITHOD&AMOUh-iJ
NN'sterSupph Well: -
M,ml,trtnL Rcca!tnc (t © (t_ CTrc� -
IL ft.
lnjertiitn Roll: •" --------- ,-.- .._..-.._.--' - -
)
AqurferRmhargi. ©("r,vtndw'atefkcntedl.tuari. ( 1' . l ! _.
:)Aquifer tilma c arxi RecndenL!'B un. atTlrt I
19."SAND/GRAVEL PAC KCaT FRO --Lf� . U 2
_yfVI�
ury _— f_ e3Aq Osint-rrm,,im'D in3+c fL - 1l7FIIM:AC�1ffi'rf�r-
ROD
p
h pet-imental fc}Mr 1 Lti
ft
tt.n,l l ft.
(ientheim tl l l'1,r•inr'r ,�'' IT pr R DRIl I IN(;1(x attxh a"iwtal ) '
�I�^1 --- '
Ge4ithertnxl'(Heattn�(, ;hog Riiiim (nher t ex01atn under:'=!?RI'Marks, ' }xoM rD_ � DF:uRnrnon t.ar r,n�.;y,.�tene ad,is ekt
------'- -
4.IhiteAAl(sr(:.0 piried:..� /'G�. JNell'IU' (t.
'5a:Well Lt,4.9tion: ft A. --
4nM•V1U ....
a,ht "•sm \Ira+ —. _ rr---uEi--,r—
rh�,lrat Iddr,•,•!• p. and rqt 1L ---ft. JUL �•��
i L
.21.REMARKS --
t '� haicr•'idrnitiicauon'..,• ,i•f\
i
Sb.(At tude and ktimitude in.degrees%oiinutes/seconds or decintm degrees:
n +�I:firld..n iat'lon;:r:.aufhi-rrrit i
.22.('e'rtificstion•
'6 is{arr)the a•ell(s) Per...ent ;or -)[)•i'emporary wll Cotor Date
ii .r�nr a ihr /r rm hr•rk ertr( tlurr rh ,.ehrlu rear(werei comtructed in accordance
-.Is this a repair to an existing well Q!'es or \o »uh,!± 4 tC t_r 4+nf.rp r;q(, 7( r 7n R'pll r'nnsirvchon Standards and rllOr:
:lfhr.'a i.•re•t,nr lilt tot rn ni'r.,iv(:;•rrn<fnr.•1u r.!nlormrNrnri unu ri•r4lirt fhe n•rrurr n •'rim nr m<•,i 1y;1 ha: -
1 lnr' keen�+rnvaed lrl'lhr,.e,.rl,igFr
�efMir,railer remdra;ceclturi nr'nn rhr nrri'k.�:;ih:�!.••+n
23.Site diagram or additions!Weil details:
'( for Geoprohe/DPr or(•toned-l-cxtp Gf'Otlicrmal Hells haemC Ii-e same Yrtu maY'use the hack ,f this pare t .pt„vlde additicxial',wtill site details Or u'cll
G mstnkilnn. vt(: ' i U :,nee]eu iraftratc'f(ITAl %!'!;ifii'R.)I well, n�tnrrw n dctutl, YOU:ti.lc.ih-smash additional pages ifnecessan'
1 llcd. :-- -'�N - . .
1
1 ]ntvl'w•el{depth helow land sarfuce: 1 r mu:feMelh:arn p / r7 ! ; . ' lft 1 14i Ior all We tnnthr� 'form •%ithin z( div,nC cnmpletiiiit cif well
l!"Sl life!!,it I,,-the lidi.;u lni
AO.:Static Hater Irxcl below top'of casiti€:ware.ire er 'uhf:v -- eft r Division of N'dtcr Rrs4iitrcec•[nfolm>;tioo Prticesairtg 1 nit.
,- .r.. ...:_. • _.. ...._ _._
8 16i'�fai{.Service center.,Raleigh,N(`-2?699-t617
11.l3oreholr diatns try: iin.i ?-ih_ For inlectioo Heils: tnaddl[lan to'sci>dlnE'(he fptllj'lp the'2ddtCss in?48
12 li'rp constructiondmethiml 1 15:� �'e. +Iv ;tlhrnit ,me ci,mt'o:-.this t,•,lhm ')Q,da f ys vtf"ciimp{euiin,ii wel l
S ee«jro(an, Coastructfnn to the t"tllct'xing -
..ahh•,clri�a push.letr: „ .... .__. ..- __ _._,
FY)R ER SI'PPI Y'ATA 1_S O•\I 1': - --------� Division ofWiiier Resowcr s,Viodergmund injection('ou&W proMIn,.
1636 Mail Scrvicr(:enter,Raleigh,NC 27699-1636 .
f3a:'1'itld(gpm)_. _ _ 'vlrthnd iif testy 24c_ F'or APIEr Sunnit & iniectioo We1L+: In addition-try sendme the titi•rti to
— --- - the ;addresmesi'sf .c. alk i uhtn it t ric cops til'this firm 'within 3U days .if
136 Ilzsiofection type: amount: complettun ul'(Colt cunstnh nrxt,d• the.eiltinty behlth depamnent of the 4:nuhc,
ivitcrc,:unstniciud
:!onnri:�"'. �o'rtl:r`arr.inutil)rneninrnr..)'!-rictinnrtic•nsxl(?uahn r,)Tv wn,i!'s.'atrrV.rdoun••:
'R&iscd 2,27�2016