HomeMy WebLinkAboutGW1-2023-02439_Well Construction - GW1_20230404 .gym...
ij J r E:M'1Zi r WELL CONS RU. CTION RECORD
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iderQualy
1.. WELL CONTRAGTORCERTIFICATION# 6 12-
1.WELL CONTRAC OR d.TOP OF CASING IS /1 FT./lbws[mu e .
Jh r. f . /1 i �� ;i' ' 'Top dossing allot beim tend srfacemay req e
a in accordance w 15ANCAC2C 0118.
n (burividual) - e.VlED(gpm): 5 METHOD OF TESTA rAdo ra
;#, Ph:f/P Sr-ae.A LJ f l Co. aG. £ DISINFECTION:Type tiV/ e p)
Vtiett Contra Name
SIREETADDRESS 44 3 iria-R.ttz.I deA !;. WATER ZONES(depth):
From 34-D To 3 5/ From - To
c-y 0 Ia.., n L o 7 pA.7 FroM To From To
my br Town State Tip Cede From To From To
•
Awe ode- Phone number
7. CASING: Depth Diameter liticknossAVeight Materiet
2.1NEL. ORMATION: From 0 To ('o, Ft. CAI -Si)47 21 04-.5AL
SITE WELL®S+Cf ie) - - From To FL
WELL CONSTRUCTION p epq ie)S/JlrJ`'230 i-o a 1 From lTo
assoc9A['[EDFERiVI(TIRi'rs ? . 8. GM: C 1 Method
8.WELL USE t heck � n E f) 6'O r f i .� '`�Q/11
IndustdaVCornmerciatl Ag� Reo�eryD Mier i1 From„ To _
Inigatioa1I Otheil ((Est use) b es >t,c From To Ft, C c...1�.,Js
DATE DRILLED -/�/ a--3 -
- From_____To. FL
TUNE COUPLETS) 4 .3 Q' AMI3 ppar s.SCREEN: Depth Diameter StotSze Material
- 9.WELL LOCATION: I From To in. in.
City_ ' ' �-d i S vw COMY Re clk:nsfhAos From To in. in-
.1 q8 .SAeilo0 _Ad a7p2 S From To FL in. in.
(Street I'taiDQ.rdeemetrs.Carareur y.Subdivisita.LotM.RiMek TM Cale) 10.SANE/GRAVEL PACK:
/LAND SEYT NM _ Depth ir_____ Matte
El Smote Q Valley LI Rat D Ridge El .Other ERFu To
peek bpi Maybe in dues, From To
LA'[I'iUDE /� I 0 . Z 6 or From To
LONGITuoE GPI Oki a V i a 7 0 mad l 11.From 4RG LOta
Latitude/longitude source GPS 0 Topographic map /�
(location oft veil must shown o+r a USES tope ramp and From- ® /l e 7C �r
DescliPilQn
• to fhb for n fnot using.GPS) (✓_' (y-3 1 �a /1 0 g.✓ k-el de?
d .5 4 /�
5.FACRLiilr-inmsramearrti5mskiessateaeavellesiocoaea 15- yoo' 6., r<n ; tG -
FACILITY ID9(ifapple) , ,x
NAME OF FACILITY -
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fi- -
SIRES'S"I R ;► 4 70T3
• CilyorTown State - 2spCode 1S1i_ 4V'^d 'tx.r'.s7'1� 'li.i
•
comae PERSON I2 t'i v'/ A 4 a kern / !�/ �
MAIUNGADDRR S I I� 6P A,h c r0./ �p f;"SS F - • -
f Ci Gl i s i.et 11 C.- .Z i70 a.5" 12.REMARKS:
City or Town State Tip Code
(33& )- 6bf - .6-705_ _
Area code- Phone number
&WELL DEMOS: 1 oo HEREBY CEMF Tt AT'rtoswEILvvascontsMUMEDeti ACCORDANCE Mimi
a.TOTAL DEP'ttt 1 1 a ' • = 1u2C. ANDTHATACOPYOFTRIS
b. DOES WELL REPLACE t;xis-Rd$a view YESIi NO - 2-/3Z 3
SIGMA OF WELL CONTRACTOR DATE
c.WATER LEVEL Wow Tap ofcasinT /0 , FT_ �
(Use+IfAbove Top ofc fug) (PA,/// -<;r1 •-.1it -
PRINTED NAME OF PERSON CONSTRUCTINGTHEWELL
Solna the original teIt*Division of WB1 r Quality ttti t 30 days. Attic Rem Gi i-lb
1617 Ma Semite —ugh,NC 278 9 9-1 61 7 Phone No.[9i9)733-7015 reset968. R?e3r_128I7
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