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HomeMy WebLinkAboutGW1-2023-00513_Well Construction - GW1_20230104 i 5 A WELL CONSTRIICTION RECORD W¢ NM*Cm%aDVmft tofEa hums dmdUa mdRmmcs-mvmonofWatwQmft WELL CONTRACFOR CERTIFICATION# -� . 1.WetccNiRAG'tOiZ; d.TOPoFCAsmgs I _Fr.Abo Lmdblrrbw- J� nyAl ;:�/ -rapofeasb9 affar larwaubmmaymQuim Well Con6rar r(hrdnr�dtsatj a vaft=In aGcarbnceWM 15A NCAC 211 AM 11� y� I e:VIMM(OPM): 8M7N0D OF TEST 1 Well 00411adorChmpanyNam DISINFEMI M:Type ' Amoua c 8. REETADDRESS_.� [Ln.t t z/ �`� 9- WATERZONES(depth)- Flom_L&e Tom_ RanL To (may(OrTown State Zfp Code FromO---' To 7J3 Fratti_To q J-7- VV Z �• From To Fior2 To Alen offfie-Phone number 7 CASING: Depth Diameter vftk sM li Materiel 211ilELL IlTFORNATt�t: snEwe.Lm , - Fnom_O_Ta WELL CONSTRUCTION PERMITIM J. -o 0 From _ To Ft OTHERASSOCIMMPERM SW Rom Tc Ft. 3.WELL USE 93MMAMAmbb B"M=QoftU MmA paiiPw&n GROU.P. Depth MOM Method AWftftpgl Re+roveryp p 11 W9811Orp cwmn Muse)- 1)Dry r5 f1G From 0 To �D FL Cr!lc�.. ��c^ram DATE DRILLED �J�--%/- �� _ F _To FL oc�f 1_ qs ' Frommm To Ft TM COWLETED Z2 : 19-0 AMU Pof n 9. SCREEN: Depth i M ster Sfo um Lida" 4.WELL LOCATiQN: J CRY: a.(.�;s y r- COUNTY N D C it ka"I �---To 1�i_a In. .� From To br. hL Fi ll �;'✓c,"5�v� 1�G1 oZ7�L5 From To FL in. In. (sued ram tarts.Canaryw. let w P4 wt zpco" TOPOGRAPHIC I LANo SETIlIie: 10.SAND161MVEL PACK D slope O Vaft p Fiat 0Radgf3 a Other Depth Size Material (dM*aPPwPdzftba4 Erorn To IATRWE � wrihnims swan&or From To FL LONGITUDE q' 7. Z b inadeamal fanoai From To FL i LatitudeJlongitndesomc CjpS 13 Topogr Inc-map 1i.DRILLWGLOG (lbcatian ofwell► tWbe shame an a USGS tMo'reap and From To �o�rr�Descr"on aflsdwtio hwer rm ffnotusvrg CPS) - D -5 �� �'/�►y S.FACiI]T1f_feriarma+aotme6u�v�et7ieyrarisiocared. I, . FACILITY ID E(ifappt ;e .NAME OF FACH tiY -- STREErADDRESS M arTam Sale Tr Code .;`- CONTACT PERSON CD ILI1ic RA PI 0DD6/ MAlL[tdG ADDRESS a e Lr-la ,.ti rw Yf J7D z QWorTawn r rstats 2pcode 12REMARl6: (33 to Area code-Phone munber r:4YELl.DEiAB.S� ItsDtERE8rCetnNTHKTtMWELLWAsCONMRUDMIN CeWtnH a.TOTAL DEP m 02-0 0 r 15AS At: WR- F[ONSTAN�A1mTMTACWffoFTM ff � -ro7-7, iaw� IL 001=3 11�ELL REPLACE EIQSTM YiiELL? Yao Nt� c.WATERLEIIELBeIaav Top ofCasing _FT (Use'1e IfAbmfe Top cf Casng),3 0 � I j ACTOR DATE OF PERSONiCON5TRt1CTiNGTHE WELL Subudtthe WOW to the Maim oar Water QUWW wMM 30 days` AUn.-bdbmnff to MgL, Farm GMb lets Mtea9 senrTlteCeder-�eTgTt,NG -fst7 pttotte fro.(9f9)mots wd ass. } i Re►12Mn } I