HomeMy WebLinkAboutGW1-2022-08602_Well Construction - GW1_20220419 WELL eOxST1tUCTION RED Gw 1
��W_4 For.Iaternal Use Otr�y:
L Well Conti actor Iaforma�m '
WCu ceotineez Q =J"�G h were �or�s. a aori
RECEIVED OIL mo ft.
x weneease.>;�x APR 19 2022 tt
1�Vy` DgRVIMG
Namo TOFROM
S Dia 1 17A7�W.
L G►SRVGOR7'08IIRG '. •-w- „. . .2>Well Co oap Ft.. 5 1' a&
l�aIIappliaa57ereIImraarela,pmx�rsl�t1rCCoroa�.smreYm�mxx,ae) & g Sate is scsar:rer,
3.Well Use(check well me)I. $
Water SUpplly Wel<: 11T >-���--e.
OAgtieolhual liC PROM
ILST.OTSttE ?tom L
8
CIFfs
( COOIms SuPP1Y) WataSnppIy(elagte) R _
Glodusttial/r` •n..cei . entW Wat,Sup*(shed)
� �Qn .I8.°GROI7f•t.: •.+?;`'::tc`y.� ,,+,i.•:v'�.�i<"-"�:.;�,.:::•+..z
OWells>too om GPD FROM so' MwziairwL'' �> twt rrMsrsaat.�comrr
Noa-warsr supply WeO;
aMaoitosigg OReeovay
1nJmfion Wen:
MqmffixRechmp 06roundwaterR=adisdin imp"
CAqmfcr Stele and Recovny DSdh;ky Bataa -tn. PA :`ar.i c., a-c :. •
PROM zn Ms�wL amtrcn�rrt�oa
aAgodaTest ag si ft
DE4xzftmmmlTechndov . C3Sbbdde=Cool S g
dal((Mosed Loop) pTrd=
?2tt•DRIId.IIdG•FAG s�aa�LtiBiell'if
t7Geothe=al( oolmgRemra) OOther( �mder#E21Remads) PRom d
$ zfl $ a
4.Date We11(s)Comp�ieted: '1 'Z Z Wen IDS R tz
5s>Well Lotxfiom - tt g
Bch d•P_.•.. U,'I r.L� IL $
Fs - PTame FacMyM#(ifappficaI ffi fi
J u IL
1 alAdd >d15:aod2ip }� g ,
PacedtdamfxadonN4(PIl�
Sh.Latitgde and longitude in degrees/mmntestseeonds or del degrees
Ill,tme ba/loagis snftieiea!) ' 22.CerdfiIop�
6.D(are)the well(s): ermaneat' nr E3Temporary J? O5(� s 210-fifQW-it n
7.Is this a 1iJ• +� (J) 11 eoJaoLaedDraoaavianon.Jtli
1el to�erd welh� ayes or �ONo lSdNr-4COZC:0100a ISdNC,gCO2C O200WedCprabram� bmafa�aQeavPy
IJrhistra�i�llaebmw�tvrllao�r�arrb�a�f�m�despfmsrlu,maoeojrhe �rhls�ac�mdl�bmtpwtdo3mt7ie�ornv_
'repoirander�ll>aaranlssaetfanarmiflJebm�oftlaFrfovm. _ "-w
23.sift dUgrsm or additlonal well details:
8.For Geoprobe/Dpr or Qosed-Loop Geo hamai WeIIs hz ftfhe same You may use fha back of this page to Watide addit and vmH oomhuelm info
conskucdoe6Doty1 GW-1 is.needed.Iod ciftTOTALMMBERofweft (add`see Over'inRJmmftBox}YoumayalsoatW&&Mmdpisifn==y,
d,Ma ,
24.SDBMI7!'AL.IlVSrRUC1TOPIS
9.Totaiwd depth beloslmdsnrface:
For•rarltlplersdrlistoQdepBaiJl(=ZWg@ 200•md2@M (t) SubmittbhGW-1 Within 30 days ofweIloompletion per the followhr.
10.Stafic water level below top of ease g LO (�) 24a.For All W� Ong'ooal fmm to Division of Water Rnsotaees (DWR�
If u+arolewdtsabaYeemS�'�!!e"+' 1n5o�2IIonPtoeess*Unk M M5C.Raldgl NC27699-1617
1L Borehole diameter: C� lI gym,) 24b,For bkcdon Wens Copy',to DWR>UnduV otmd Ijeation Ca*d UM
Ptoptam>1636 MSC,Raleigh,NC 27699-1636 ..
1ZWelFeoavhactionmethod:u�d�ai.l ForWatersa and -
(La m8a�9.�k daxtynsb>toe.) —� �• 24c. aaly Ooea-Loon h Geoth�Rettaa��We><s�Copym the
�Y emmmeatal eahh
FOR WATER SUPPLY WELLS ONI,Y 24d.For Water Wells do' over 10040 GM.Copy tbXMX CC=A
13a>Yield(Epm) Method of test: Perron ptogcii6 M 1 11 r,. C 1 I1
13L Ditio3fi don type: Amomt:
OW-1' )IM*Cm&aDepa=ofEnvfiom=Id Qna*-Dbi&n of W=rResomm Revived 66-2018