HomeMy WebLinkAboutGW1-2023-01112_Well Construction - GW1_20230126 jl
Thle tblm tap be teed thr single or malttpk we Far Taumei Use ONLY:
i.Wdl Coahlteyr Infaf'inatlon: f
Josh Plemmons
wenc"Ju,aftN,me- ft. ro
IL
4137-A 0. fL
NC WanConrt+IvlorS�tiiflnaettpttNPmbvr
ClOWWWer Well Drilling Int~. ff. 1 fb
Cmt*eey Nerve
2.wdlc _221u)1-014- S "
W►aU �'RtlMtlf'17'fBk�: AA. hr.
�+�wid/awemr�r Pip na Cou>r�,Wat4 Ymlomoa,elcJ --•.-.
3.WeN tUae fL
(dMdttal�tltek
-
o�la�llatttt OL ff,
[X3eethetmel{Hetfi> ±aoHng�PPIY) {tetittmuial Wits Suppler(stogie) fir. R fw
hd Bum
riauConrts�l [1Rtx�ertdel vYtaef testy(ehtfed) f.
Wen: 1 fL
t7Moniton}og � � h, m
oAgWf Retlhtrge
LlOrmlfidapta'Remedietion
OAgWf*Sttyegt:end Remvmy OSeHntty Sorter
11A Wtfta Test
Q3mimwater lkairuge
OExpainteatal Technology f]SubtWtatce Coaht►1 IL R.
CMONWMnal(Claud LoW) MUMm Skiftim R�dlda
t� ne:nn 17l]dw minumdor#xlRAW I ft, ff:
wWII)C%N*tw. 1 Z�►en as 'L IL l
sn.Well L.mNett _ fL
i1�11"4�MOugrrQWee Paenlry]ptil giplfoe)
R...-
Ad6ay r end 2* n 7
i l
Cnvrry PenxlTdmtifiadiarl[a(PIN} r Um,
Lt�4de ae d Vf�Ehtde fn deg vwWm of &%w@tdt or tdeemal
(it.ran fiekk ma IWMW 1,=Motetq tte�txa: 23.
Oda DSO_ w �� I' /® M a ll
tN cee;WGBCIWFM pW
6.tt(nre)thene>rtk � ' B Mo f ► 00)um ffmw ewaww lr a7.is i t ti rep*to tin � ark 1SA A' .0100 or ISAIWCAC DZC,M WW7 C�Iha SiEratanlf a1d*&a
1Jrlao aysyn�*Mtar+srndbtede�►prot�darrodkbeAaetr�,
�P�'4Au+rRRwant+�pevaprnWanlr�l�rmar/nn d a(nt�rtanmen�7hr.
PV*fp wrdrr#21 r4"hJftAm a•an*rA ckof*bjtwft b.gate iit�eol�f'arliflaYl R111 tlWRle
Noteberofwefl; �; Vim my use the h ek *p rD0�&Wm or 1ie11
Pkf+dFn+lonar twttittucft-danils. Yost MW ry•
+ndlwJrrnaa a°w"� sPl '+rel�ONLYu�thtArrme+Mtaons<rnd,0nl.Pnrmv vr» SUR61MAL INBTUCi'IONB
9 TtilNlrytq�Ueiafrfatidtmtiiecc: �05^ �
ForeniMlp#Imb list aft dqxkrl(d(.mu(mo�n�le`j�lf)f►'ma2�1oo7 riL) anu►>he� tinsf�mwithm30dgsof of well
Ili.Sgfle wafer kcal
{lknxr Lf trTantr bc1�r f!P ofcartog: ��,) Divfdon of wow Qtallfy,leQ�rAla"
use +i 1617 Md SI�tD![�AI*,Rift NC 2�76W 77
24L ti it InIwOmWeds 1n mWithm tlb*Wag the form to the addmu in 24a
1Z Well conoruetlaft mod:_ m-�-� .�.� obtwe,ateo submit n copy of this tbtni within 30 drys of cm*ieft of melt
mw.Cobb%dheetpmh.eta} `mot conetturifmt rt►thc fbgotiving:
FOR WATESR SUPPLY WRI.L$ONLY: lmwhbn of Weer Qeuf "Uaftw m jipif Raj
eeflnl E Pt Ogtsm,
16"NO ft vice C49kri ftNdg%NC 27M106
131t.Yteld gym) ( Mettmd*Reel: 24M ft WSW smob?dE 1 t dltn W�.►'in addition tosmdifigthe f m fo
13r>Dfttefecy}� Amennte calnpigion of Well coneSttCtion to the of tMs faen wlThin 30 dQyA of
witeve anon ofa+d. hegib&PMU N Of the=W. .
ften G ,t
NmA CaroNna P4penmentof t:nvhomnant and NntamF Resoorcea-Diviabn of wets qui
- Revleedlen.2Gt3