HomeMy WebLinkAboutWELL-04-2022-169768.TIF NM l'CkVcrJP C IW tc .1) rif intefnni�
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!,st1a Cotntrnitirr 1ptbrolil)wilt
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81 k WO Drilling It �. ., ��
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WWNteininitiniCOrnfitholar,Sawitie. t 1iiioit''' ...... ..... .... a. .. '.... _ _
i,WIN Ottlltioction Port trill a � l ^ C►_ i....w,..w: �
f sP 1smIMswl sea/,+wu.,,t•.a p;ri r,, I it i 'ygt♦ bttkn_, w .. ��!•Jk�r'°.........,.....:.Mter•
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1771,
Munit.tpitiPubltc. Si. h. _ -^.
of ..-
thot,nal(1tG+hri�t tsuling guOtdYl tmodonnal Wile+Supply(ttrglo ft. ft. ►a
• ln,lutitia►ri'mmmwni,sl limidentisl Water uptil•r Itharrll ,-,.._.•. •...:�..-»,.......,:,. ,--..�.• ..._....---..--.~..~.
• Im jatt„N, .• +t b r srm,1 7 rr . 1'r V�A:44i G ..
M( iflutinu .. �.... w
�f �w
n,_. _ �1k+u„'iv 11, h.
w Aquila Rn.harge Di,roundwiier firmed's:bun _
Aqutf,ytarlps and R.co%rt t"'71frr•i TriI'r , • . , .�tcrt ley._ -
❑ annoy Hamel r .,, t.JRLIAL lM b�
Aquif[I Tot D310
mnwau7l)rrirag, h l IL (• --.----__
EA pen mrntal Technology °Sub►idence Cant+,1 fr i h.T—.. 1
■t:iealthenna!(Closed l.4xgrl Q 1 Data LLL
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•fietshennal Ilium Coolie. HeluiiE 13(kheiacplaih under 42i kau,arts 1 " -,--n. 1 rl. ,
4:Dole µ r11{►)Completed. {j �v _ Well ILa _ _ -- 5 . aIn C'rt f 41R
1
Sao wall Location: .ti- A.LLY 7 5lf"r /r'r�1—i i
5PAEc-iut .)___5-A. Lq rLd'It. • fl.
h.titryrprnrr Narita racti.ty MS litipplkaet.tt ft. 1 Si. 1— _.__�
rny,kal Aalr..asly one tip
Si. ft.
C1..c.\.C. 6a�-i[lam ......______ .
County P.f(41l4amdutwn Ne I PIN 1
Sb.Latitude and ionsltude to d.gt rrarminutrusr.unds or decimal degrees: --
(ttwith.tit.o•r1•00”t;.,00q,,,t N.Crl cbz.
6.Liars)the weUfs)3P+t manent or Ell+mparary tt7"+n•d C.rtifi.J w iI G ,.t•a +
qv
9) •lInrni Ulf farm. I hnrin crag),hot c.sigh,solo f e aaarrae+al Of acereiaac.
7.If this•repair to an existing wall. [Tres nr hn •si I+A.vCAC NC Olsk •o!Li 4C.K OK l l�A wail Cwnrtu+,.ftata,tayrs wed to .
.CO ofrks,.rn.rd hi'.been pr^.Nded to tit‘•err m.,trr
if Ow II a rolru,t,ll!m�iknvrr.air rnn.,rurLw,,glnrtactr,n p'ar.•u rta:r✓r iJ nor
,rp..rr rndrr a.,'I IM n/,11+.1Na vl in,ht but k 4 rh7.furs,
23.Silt diagram or addltloaei well d.talb:
$.For creoprobr/LPT or Cloned-Loop Geothermal With ha*ors;the same You r.�y to use back of Ilt:i page to monde additional*ell silt death of*eh
conamunor.,only 1 OW-1 is needed Indicate TOTAL NU41HF.R of wellsc,,,rstn, is t details. You ma;alto such additional pages if nac.aury.
9. Total++iii depth M land surface:,n C>�rl{ 1 rOrrl _1st.) 2 Fop 411 LYry It;H L Cf it?�S
drilled .__.�. . _ I s ♦ 7
p Sttbrtut din fottrt astthm 30 drys of completion of anti
f.,..tslriplr•,a/h tip ali dr/oh.,/d,/1r.rn,lua p1r 1t. 4 umstrucucm to the tul:.,.u:;,
10.Staticwater loci below top of casing:40 fft) Division of Water Resources.Information►roeatstag loth.
It'Warr if Ili 0 4:61.n,r Ciro.:.,tor • 161T Mail Service Custer,Raleigh„NC 2760.1617
11.Borehole diameter: 6 1/8 {in,) 21h.For Infection .VOA: in additsori to sending the form to Ow address tr Z.44
i41f Rotary 4boi a ahto s ibm,t one i.cy of this form within:if)days of cprnpirestn of wei!
12.Weil construction aurhud: construction to the fotlowiag
it r +uW ,wary.,:ablt direct push w:1
_......._.—.__..___....,.- f)trision of Water Reaovrces.Undcrgraood fa}actteM Coaerai Program,
FOR SVATF,ft SUPPLY WELLS ONLY: 1636 Atli Sondes Collar,Aa4lgfs.NC 2709-1636
13s.Yield(qpm) Method of test: Air f kJ/0 24.for WO;Saco* L Inlcttion delft: Inaddition to arastl:taz the r so
the addraatea) above, also submit sae cop of ibis fora,+ wish= 30 days of
L b.1ylalntectlun Chlor Tabs ...- Anreuor; t'rt-IA __� completion of tsdl coo.tns:oon to the county Weida depiu'laa d of the emery�a " nrberc wrs1("Mtal
Form cos•i ...r.r t'arrr.is t.teP.,trrant of Em,wamm,al Quettry•D'ota.00 of Water Rt.ruca, Pram