GW1--06706_Well Construction - GW1_20231024

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'Well Contractor I f0rnlation: a .•rj�ry
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4.Data Well(s)Completed: V
58 Well L ��
�/ Facility ID#(r{opplicable) '
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tilde in��e�nl(nntegjBBCunds Or decimal degrees: ��.� dew.Owen oil,o and longitude f
Owen Roll,one iav3aa$ W
N g a of Certified wall Contractor ` a with
this forma re,rlfy Mai the aell(a)was(were)anomie;ed in occorn'
Fetrmanent or OTemporar7 ton Standards and thpt a copy
6.lis(are)the aveIl(s)s NCAC 07C.0100 or 19A NCe1C WC.OZ00 Well Commotion (
ClY n or o o t isracmrihas ka0Fre to thawail owner #
t0 an etfls�8'�p0 loan the nature of the f !
T.Is sibs a repair nb{jbrntallonandexp additional wr411t7et tat
svoi la¢erytrtr•,,ittt o 11soff nett a Onate bg Jhis 23 to diagram or a amp r nngt±r�rfi- iltf0
MP.in n*ryV}ftP.AAt1tR1A �r�•
pndar#.3.r r::Jr-,narent...zr. k a • • ,,-.. elsaattacrioratYior*rrrs rtl
uxr.ins rta.ix ni init.:r?
�.,�.'tiny Soot):?pussy_ —__ «:;o$u:uay Cu:..aiuuG (add'See Over'in latndCtS9
..;OTAazt' ER of wells '' i
_ � .�•:�g:on!"iGW-lisnoeded. IndicateTOTALNt7� �4.SLJTdMITTN'��UCTIONS
construction, Y
dallied: (ft.) dwell e0mgle�i®ApOI'�tata�
beddep land ferfaee: Submit thisGWI within se
9.Tote1well depth s: Dtigiuel form to Division of Water Resources Wig,
For St multiple watts last el below
ifd(�ergrt{examP�-3�, 0� 1��� 2Qe. or
7.statte water level below top of casing: __ f ') Information Promising Unifl 161? AVOW W
;/water iavet is above ecstng use"+" ?Ab.RnrTj n� { AV�e�IIBt '(Apr 7 I Ij i
(�� �+dez�round� ie�ulon Cm>iroi(NO
11,Borehole diameter: �'�``f� �•�??�M�r,u�tan» Nr••,„ ...�:,.:
12.Well construction methods � - - t�� 1, r�.�,, I�.
(i.e.attm rotary,able,direct push.etc.) , i t '1"1✓! t 1 J
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FORWAWA.SOPPLY WELLS ONLY: r �'�