HomeMy WebLinkAboutGW1--05452_Well Construction - GW1_20230821 WELL CONSTRUCTION RECORD)(GW-!Z roe itreotsiUieilt(jr.
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Landon Phillips li,WATER ROMA I
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tai we*Cram oramamer<lrwftopea%at m IS.OVTZR CARING(R,rtnslsrad walk OR Lt!([R r l
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NW Poole Well and Pump Company VIM' T i ° im K 7 su7
Cowry N N.4wa[R CAMPO OR TVIOSG f poderr—+ ri,,,Dfl+�,_
2.Wen C1aslnitrrr Permit Ill 3 s-3olG 4 PROW
r—"R TO k °`A"`T R } mamma
tas'r atdrveurtii.witrawrftrTtreat At VIC Crays aim Ynrwra.er) ,__.. R r I.
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IT.SCAFFN { )taTOut
%Me Sem*Wtt! snow rt) "10.4112701 tain
-SLOT t TmCtotas
C3A ieitltsal ONWIREWRiToRk It. R. -.
C. -4i pialisrllssliq ) ,111016410--s Wirer Supply(singk) ft. ' R
C,. C� Oes it WefSlp ilpIy(shared) ~Is.(R()tr a
(;L-. OIIs> 100.000 GPO FROM TO MAaLtL OtMACINT McR0°t ALM)I
'Non\\:etcr Sul•ply\\ellr — U R t o • / Tt l' petAr- _ _ .
`\, ... ❑R es:overy ft. R.
)nje.:,,.n\bill:
ft. h.
❑Gcuund.vater Rcmcdtanon 19.SA NDIGRAVE I.PACK Of applirn►lel
Q@mn!:r`:".r,:J(1.1 I4:wce) ❑Shctttity Ramer FROM lT TO %t TCwMI t7rlf.ACC1rT.YT MUM
DStunnwater Drainage ft. fL t{if
al Technolop ❑Subsidence Control ft. ft.
1titli:et;u41(L:!O1id 1.oopI ❑Tracer la.DR G lI.LIN LOC;(attach adaihnwai,keen if necritar.)
ttRONl TO DESCH fYTTON t..,Jur,h..ene..,Iminet type.grams pm.mu
DGmdheren1tHeatnlatCuohng Reutm) ❑Other(explain under a21 Remarks) • OM R. Z h.
4.Dale\Vcll(s)Completed: ;'1GI'-23 WellIDN - Z ft. ail ft <Aw
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54.\%ell Location: 0. h. risk 6IewT """ ^((( (
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.. ,,A.1.Iw ner Name Faahty IOU or applicablel R R AUG
�� nL 15a1 n. h. 2 ,} 2023
iS'C�. /«el� Levu/Cel ye 1Ocrlraycn ?r;-.
A.1 4as..l'Ilv,5nd tap f1 �Ma7r�Uri
/ 21.REMARKS ��i VJ 31' i
Ceaut �^ �`3A Parcel Identification No(PIN) Used hdfder Ad s e&drive irCZ --
Si Latitude and longitude in degrees/minutes/seconds or Aecimal degrees:
literal Sidd,OM Ur/lour u salewnt) 22.Ccrtificali .
35. ci 038-5- N 1 ?0---7� C \\'
R.Wawa We viaU-t f]Yermaneut or I7 hemporary Stratum of Certr5rd Well Contactor Oat
l)v'wiling this form.Ihetesrretetle Idtnttiewrlyyy wr/errsO otr!=Wtraarw+tsat_.:,.
7.Ila Pas a amp*Was ousting well: ❑ves or ONu I5.4Nc_tit'rJ2C WW1*. i4IICIC INC AM/1f11Canut.va Moira maAm....
NAO a r MINIM Pit rrtbrvN vnil Cuu.nuCuun uliern.m.ou and eapl.u.0 the tannins of d.. of Ma reCor.!hni hedlePatWfasMrwlMOW
rs},ae wnb►=.lit rrrnwA%w.non,.r Oil fi.n Muck„/thin tern.
23.Site diagram KatMmoI well JeYie
k I'rr f;cupwbti UCC tar Cluaed-L omp Geothermal Wells having the sameyou may use the boa Ott pare ID provide addstorwi*al COi�):1wei L.
car;._ mot;.r..011* l GW-I ttneeded Indicate TOrAI.NUNII1l/R tii.vells (add'See Over'in RetnathBail Yoe owo eli's&616Ymrlpagesifnec^t_..
et) ,_ 24.SUBMITTAL INSTRUCTION
L Total vial depth Wow Rod turfrct: I L S (Raw) Subunit Phi,GW-1 within3Q tiny,of well enmpietis°per slot isimis_
Fen swim&weihrIntrlrlleptis y,bfl.,rvue 4tuttaphr-3(ie?1UO'iota 24 tar)
24a. For All Weill: magma! licit to Dotson of Waft' Ream =(DF.1.
Il5ugtriMerlrretleMppefeyeiw;; 2'� (fe) Information Pracesung Oat 1617>rl9G,Rakish.NC276944617
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6 24b. F'ur Injection Well*Copy Is D'W11,Urderptotsd Igeatoa Cantroi Ill•
IL rrteM tR itaaeser (in) Program,In3n MSC,Raleigh,NC276199-1636
Rotary
ILWdmirmsnamitt°tmatkwl: Ne.low Water Supply Utterer t talc Cop}.,a._
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tsa jn motoor.aYYbisat peak an i county ens u.rnu d bk l:nt. ea O C white vwwalfed
tVR WATER SInLY WELLS OWE: 21a1 F'or W r�rr Well rear 1M�M�. Copy to D1t R.C. .-
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