Loading...
HomeMy WebLinkAboutGW1-2023-00514_Well Construction - GW1_20230104 WELL coN9TMC ON RFAMAD NorthCwol'i iaDq=tm=ofEmvhmmmt=dNstumdRss mcs-DivsiomofWaterQuardy WELL cONMACFOR c$RTMcATlox# 1.wta.L CONTRACTM d.TOP GF CASM[S ►/ Fr Abows Land Srt bm* kr, :il,a 9S,I :)(-/n 'Top ofe aSM9 0mr atforbalow kM srnfam may reggae vMcwftft(ftwj!duqKasw a Waft=in a=Hbfioe vil 15A NCAC 2C 011& -eg. ti L ! ed. e:VIMD(EMk l z!o METHOD OF TEST ,.,-/2e/r, Weil CantracturMawany Name L DMWFECTWN:Type Aram_�e r S'[REi=i•ADmmss A6 A Pla..tcte.,/ S- WATER ZONES(depth). �� rL�. � From t To 7`/ From - To J ��� � City Town State z0 coft Ftom�To 1_1 ' F�To 36.1- gJL7- Fimrr To ')I/ Fro .To Amu code-Pbm wmaw 7. CASING: DepthDWneter Tffidmeso&W NaEeliat 2.W E.S , _ Fmmm Q Tc G o31' Ft,_L_L/L 5-D R 14 n/f,511-1 WELL CONS�RUGTION PERMITIM Fmm To Ft OTHERASSOCIATEDPERMFr;W ) Flare • To Fl: 3-WELL USE g lleaftpkable W Umftfto & GROUT: Depth Nit[) 6Zathad Itig8hOlf� Oihmp (fist IueA�6 /�t t s Flom O To '�'b.. Ft o r-7/ AI Poo rely _ FwnL _To S—_ DATE DMAM / b �) 9- Z Z Fmm To FL U J TW E COMPLEM ;.3 0 AMB PNM 9. SCREEN: Mo j Diameter MaiSae MalarW 4.WELL LOGAT[0141: ff,, Fron1_T Ft in. hL - Ct]Y_--� S f�.�c J ..`1/� COUtYIY o�K�c� � n- )' �' From T Ft in. in. _ T 7� W h 4&s to n r_ a I'd e.K ,e a-'?O qg Fwm o FL [a. In. (5beetName�Nlmt�,Oansrfu�yS,�ulsion,LatAJo.-P�roeLT.�pCade)TOPOGRAPHIC t LAND SErnmGr 1Q SANQMtAVF.LPACK: D Vapey O Flat O Rk[p n Other DR& S+ae Ntatariat (d bM0 maybe m de� �—�FL LHmuaE ,�G° , �v D` mo or FhNn Ft LONMWE ° , 1y I inadmc'>dtn� Fmm To Ft Latjft=0M=S=,MX=j] Topoghic ffiap 11MILLING LOG aUSGStgwmapand � Sm To FFormalon Desertion Mwbwtothisfarm r7rlotusi lg GPs � 0- `!- d11131.1 Al.,ec f L/s SS I Ye flea 5 A e l &FACiL1'PY-rsumnammclmeb pieaeeiswr�ed� 5 — 71 �' r cc n."�2 FACILilYtDf(ifapp a 7-)- 7 4- I c -- ----NAMEOFFAMITY 7$7- STREETADDRESS C[tyorTown Stets , rwCode I CONTACT PERSON a cc n (1{3 Cdy►orTown Siate Zip Code �'RIMIAR>t3: 3 � SID -- Alva code- Phone number s.WELL MARS: GG��� 1DOMErcerrrFYMATrWr. rflsw�r.WASCONslrwcrr=DINAeooalAr�wrnr a.TOi'ALOEPi<H: 1 V ISAAC2CLWELLCONSTr�1C MgrANDAE A DTMTACWYQFTMS FECORDHASB NPRGVIr1EDTOTHEVVELLVliHM . DOES WELL REPLACE EASTlHG WELL? YES» Ntt T r—WATERLEVELsebwTopoftarlg: !FT SIGNA OF I Wi3.LCONTR/AC70R DATE If an Top of CasMM I/'Y PRINTED NAME O PERSON CONSTRUCIWGIME WELL II Submit the Gr%M i ft the Dbisioo Gf VV W QBW ft wftlft 30 days. Attw hdbmmsffan KVqL. 1617 tO Servke tip— ,NC 2M9-1617 Phone No,(9t9)73a. 15 ext a& Falrn GV&lb Ra lM I