HomeMy WebLinkAboutGW1--05935_Well Construction - GW1_20241009 . . , •
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WELL CONSTRUCTION RECORD(GW-1) Foliate:mai Use il=Only: 1 ;
1.W6 alsbilderbanliadoic .1 i 111117111
Ridcy Comber . •
VidiCantrasortimat • /Lit-L ‘5 it' M
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2 t,464-A • 0 -32)-
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NC WeiCashadotCatifssbOnliamber .
Frank A._Cober&Sons Wel Offing,Inc. - - - -
hill M iiiiifiliiiill
0.....y.... 39. /3C .
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io swam, itISIS libaiatAL - ,--
2.Wit Censftnersen Peewit th 47 ft• rk'ft- • :os• SDR-21 we ,
/ace arclicable wen aeitemetimpentits 6.e.WC CommlY.Stift Vorigare•ere-) •
3.Wei Use(cheek yea am?) . . ilete- ‘ ,e, it-• 5-1* /5-.r
Water Supply Welk . • • MOW Ili SUM=. SLOITIZE THICENISS 1111f11
. ft. is..
. • c-,:---,Gladiser.00rtog Supply) .".;1'--,:--— Wster6uPPV(single) n. ta.
, . Oileakindhil Water Supply(shmed) III. ,.:. .... - • .
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TO MAMMAL ENIRAFIDMITMIZIND&AMMINT
ft. IL. ; IF ..--
Noe-Water Supply Weft
. - ClbwvaY • • e. ft.
NW*Wdb • ft. ft. 0C-I 0 & 2024
_ A ,=n-- ludurse.
• •,7,- Stsage and Eterovely - Oformiry Battier
ft. C4-v-i:e2i.L.,'
• -Tea Ditterawattr Duistge .
011utssidloce Cotdfol ft.
... ._. ._ . . . . -.. .
n c •••-- (Clamed Loop) Clicilr •iMose TO mesmarnme fesisallaidlamseateadttaleitar-ode.)- "
MeigulatiC1:-/Y....j7111 erven(estpiaitimo =hes tat itetalike) ft .rz2 it- X...ed
11, it 5 ft- - -5 `1"4, /),-)
W -- -
4.Dale'Waft)Campleted:
) 12:3.
5o. eil Loons=
aticr kt
:et 0.- - ‘,e) 11'. „,. c/..cir . le-•-
ts. ft.
Nome FaasTay ID*(ifirpheabfe) • .
raTF•itier// ale5.(Dr' ka,M4P.I'Z LC
, ft. • n. I - .
. ft.PigeicetAdebes.aty.letirifi VV9i / I/9 -. __ _ • . • _____ _ ______
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ck-city .
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5b.Lailinde and imestandels theneetilininsteriseconds or dedosal&peek'
22:r ,
dtvenseidase tallo ottn:koO )404A'‘.. -•i-
• 35*L-7_3 /3 V 80 6 701' °
N •• W . tZi --4? 97
• • Stagnate ot,atl Well Canto,* .
• 6.Is(amil the well(s)14enent or r3Temparary
By sigateg this forst,I/mei,aatify that the waft)was(mere)easstrairsed be aceorciaxe
With 15.A MAC 02C.0100 or I.S.4 liCAC 02C.0200 Well Convict=Stastiattla mad tkata
Mathis*repair ts em esisthsgwelk ClYes or ESC
kI0Iadlcausatathas tesimmatiat awl=plata the atatore of the caPY cfads mord has bees, poll g Fr!te the well owner.
rrqttbs•k7s:givildrairks seetkaar on shahs:heti:biota= 23.Site flagrant sr additibosl well detathn
Yon may use the back of ads Pagel°peovide additional well.site details or welt
8.Far GespeebsiDiPT or Closed-Loop Geothermal Wens baying the sante
coostraction.. details.You mayidso ailed:wittiest!pages ifrecessay.
consImetion,may low-1 is needed. Intimate TOTAL NUNIDElt ofwens
thank SUBMITTAL_INSIDUCTIONS
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--5-..TsIni wall depth bambini anafiem g-- - - ---- 1 -
(24 .'24s For MI Weft S221:mit this form-within 30 days Of tirwoplytion
Far asmitipkwat tist ail alleptkt giffeleat(example-344200'and 20100) coostmetien to the followinw
IL Iltdiewaftr keel heinriap dug - a.5 • (ft-) Division afWaterlitemerces,lathamstist Eantenniag link, "
Yuma levelit above ark*ate"-I...6 1617 blag Seri/ice Center,Raleigh,NC FROMM
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1L Dardisla diameter: (In.) ' 24h.lambkin:les Welts: in addition to seadin' g the fora:to the address in 24a
above,also submit cete copi of this form within 30 days of completion of well
12.wia anstrnetisn meths& Air Drill constxuction to the folkasine
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, (Le.sox lofty.able,tfoutpesk cfc4 i
Division of Witter Resairees,Unakegroand Injection Oantni Programa,
FORMATE&SIMPLY WFLIS ONLY: • . 1636 Piteft Seryiee Center,Releigli,NC 274104636
Lls.Ilitllgyag Ci Wand al tesU Air 24e.'Fee Water Savoie likliniection Well= In othiltion to genaimg the fcela to
the addi (es)above,she.submit one copy of this faun within 30 days of
13b.Didadecilest type:Wilugle , Amoset. 2 cgs' cempletion of well amstMetton: to the county health depanoseat of the coomy
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Form CAV4 . North OnOraIst Depalsogat of Etneharaneatal Quality-Diektiottorarater Rertitces Revbedz.22.2016
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