GW1--02951_Well Construction - GW1_20240513

SVE1 L CON$TRVC` ION RECORD(GW1 For Initxuni'°se Only. T
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1,!Veil Contractor laformafian;
t •�1,5re'ay " i, "- t1.14h17
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"FA C'aenactesOwe 20' '''— h ay,"?
oL c zi.R Tntcia e.SS E MATERiIA.
.tWC Wd Corsaetoreerlfk uloeNamber )c Otif1R A$N Uer Matt-imsw<us) H.LEVER tt a rAbte)•
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_ 1&INNER ASINO OR TLiliNr)eestLera t ciiud-too¢) ,
"►oast• arttcrr xetc ores MATERIAL
2,Well Consiraetla6 Permslt ft: !Q(f zT ia-
°4uvllo zakla..ellt nantriiea ure/u fl a Or,County Star,Stoma,eatj
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'• :3,°WellUsc(eke&%yelluselt ! f it la
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ta .VNerSupFlyWettt iRahs ' TO, bUhlETER ant 1irfS4 M
• ■Agricultural ' ©Muntcipal/Public lid tt. ,(0 n, r ti
is yp /fir
II Geo:hemtai(Ileatinp/Gool,n8 Supply) tifitz tdcat)nl Wxzr l eta a tn. ,
, z .„ /nV..1,..e,f,,, tt:al rv� t4� z t[ titt Was kY stotvd!5 atc.L.Gk 3 fF rat 7 N-4t ,+�., v."... is�..k- 4,j• rL it ,t r_
fmaztian raoui .:-m MA'ri rat." ehrrr.tt'.LM!ITMETRODa AhfatN4.
Non-Water Supply Well; 0 n` Z�' ff. LAB/Lit`✓.) faW el 4f .
`I Monitoring 0Reous`oy r. to t
Injection Well, L. , ,
la Aquifer Rerhwga; a ,'"CielloitodaLltzt Rcrt tat6prt
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11t MuiferStange end Recovery Sat tg.SA,*ATtGItT I rAC[t Ks Orel ,
QY Barrier raou TO att`raaxts TM rfAtfatati:tr asczxoo
1g Aquifer Test' rj5sormwater Drainage, ;a' f 4P ft. frr+ .4,'I f'tt,f' 4,.t
. 6iperitrre::tal'1`eehnQlogy OB*sidcncc Coasnol Ice f. ,1',.~.
(ttoredLnap),' L f • Sa tDAlt1kVit:ttxitaKae4sdd"+EimW uennatta$. r
jIGeothermal(HeaaingiCoalingR.enaa) nether(explahlundee1r21RrmMks) seaSr riS oescwrrioxt ea.�..riv mw deaac?
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4 1ta to R eiks)Comp)tted: 1 /.1'29 Weil IDN g'S O,�y r
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t/eM,L,ocailaa.
„ 3yr . n rr Ai t'= ,,,,jet/16 Apse'/ rr {�it' te. ft. ` ' {
,F Slcal.Aridf»sslAy.swd?sts h" t s / ir.`a
of R&MAttl�5.
K 7c ty` -Parcel ldataficadonNO OnN) t.
5itn,itifttde and lo ifuilt,int} recstsalaii(estsredadaordceti l degrees - ' "'
` `(1f ief field.one laelOna ix 4dficiam)L. ' .$ 22.Cct-tt ' oU; ' -t 'to
L. • s.a '1''44 -N. —Ix6-311 el - ,x' '"- ��.� t/ ' ,',
6,"ls(1,,f0(he weilfaj .t!'aeuzaaent.. or tiaporuY s Card talllrell Data „! :
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'' By srgrra!tq t7ur Forar,!hrrebq rar^,t,�y clear do watt fs}was tkLZr)creamed tb acters3cricc
?,fs this arepairtonraautfo iretj: QYes arEallo wtd,ll,INC o?C.DIMar13.;ACACOK O2COY'ejlCor6trq,anS{q ,rtrars-lriw(a
""' lstsaroarir-fitlotchiecrviriii aWi hon6�6i ia,da"'piaGi ii xitofJte.`:copyrfihur�s6Rikiireedpro'>te4 atkeuilonner -, 'L.,
weir Pry,
23.Site dlavaaa or additional ei'ell detailii • ,
You fun use;the,b*ek of this`
$.tot:s'scopratxlUPT o"r,�aosed-E.oep Ctolhei`uat!'Vctlrhavwg tizt Same � �`, p io psu;'szlc adabti'°�uxti seta�tetEs '`=�ei1 �`f'
cotutiuctioa,only 1 GIY.11s needed, lndiaae Tt7fAL NUMBER nisei's construettoo.details,You try aisa attach adtboonai pasts if necessary. ,, .
dolled • SUBMITTAla INSTRUCi1()i `
9 Tatai well depth below;land aurfatx � • 00 24)6 Doc° !)IA ttiill Submit 11tig facto within 30.44'1 of campteuoti of wctl ,,,
' i l ar 0.4t'a fs-ettr lrrI911rkprPrz"t/'duicrvu(exast#s•,30,z i`nrsd J0100 Sonstaneliett to the folloNmg ;L'L -
Q 14.Stack water level below ton of cuing , (R,) , -Division of Water Resources,Information t'ractsstag Unit,
ff"'rtrr.{,,,t0 abort ca{ky use l 1617 Mail Secs lee Center,Raleigh,NC 2 699.1617 u
u, tI Bdrrchole dtameters•.-; Jf ') ` 24b.ftt Tp15cfton%itellLi:'''Ii;itidelliton In sending the foan'to the addresswIn 24a •L:
/ .above,also submit one copy of this forth within 30"days of completion o(':wetl
t2.Weil room aerion method r7 U i con,„,,, t the fopowing: , ". r
(f a eager,ratii5 cable direct-push,etc,) "".0
Division.4Water Resoitr cos,Vnder round Injectiion Contra)P i °tt°
.OR,)LL.t T'ER'SUPPI'i'iNV`1LLSONLY ii ,+,' . ' '.'1636MailServ4etftnter,Ralel h,i3C276991636 t if
13a Cleld(gpm) :Method of tear. ►rr r l+"Yri- 24c.For WViler Supniti Fz,,(plectlon We11q, In add'itinn to'sendiag the f i to
the addtess(es) above also submit one copy of this form within 31i days of
13b,1)lt fectioo type Amcunt; Z JI2 L.. comptedon•of Well consult' Opp to the county heailft,department of ibc eaunty .,�,
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�, a ra where onni nietr,d: L'` t, `
Fond GW-i Nato C=toliaa tkpartmca°t of£ntdmnmental Quality..DiLiblw+of Wee;Rn oiutos Rarsrasl2-)2 20
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