HomeMy WebLinkAboutWELL-09-2022-181295.TIF •
WElL CON ION RECORD(( W-1) ForTufo:nalUseOnly:
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NC Well Cotonctoc Ngbsr INC -,15JOVffit•CASIZQG(ffii,fnnitkaiidirah'OR It(ta •Iteible ;:::?:.r, :•p;,.at
Morgan Well &Pump, G MOW TO DSAMS ER TRIEEEESS MATERIAL ..
conip3nY 9 ') 61/8 ZZ PR PVC
2.wencanstradunPemdth W Q 11--Oq�2c a j7I -15 :74•m , TO 1i7HXH(;::(nathamll?ldiensasP�:.,'et�t:,z•.•-::r ......:•i:'_
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Listallamlirablimsgtoragraimpadits 1¢e IIIG s stot4 vets erg) 1t ft. f4
3.WeuUm(cbedtweltase):, • • ft ft. is y
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>•oom ID: •,DWsiKffit- MAT8EiAL
17Agdenlhunl ft. R. J.
1:1Geotheanrl(Heeling/CoolmgSupply) tatsidnatial Water Supply(62gle) f ft m. .
IlituTwett alCommercial CIRcelit4164WabxSWAY( 3) •„
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l7rrr1gation tiWells>1t10,t10p GPI) Favta To .r;MX[Nn1Ab IBart.Ac ei:::: •n aon.n.Liettctr
Ma-Witter Supply Well: 0 A. 20 n, bentonite poured
EJManittaiag oltecove:y R. R.• - •
Injection Weil: • ,
l3AgniferRe:ha r - ttehot edwat,�Remediatino ft. tt.
':smittamis r,PAtsattfiaidi ible)r . :: .'i?.• :i%^Iti: tt-.t :::1%::: :r. •
}:1Agni%Storage zadRetovery' Magnify Buller • room TO aurear,AL UuixCmm>srxnuaaon
13Arpdfca at 13StnrmsReterDhainage ft ft.
ClExpaintintalTedmology CSulutdcoceControl ft ' R. - r
1 Ent:oftenal Posed Loop) DTr ocr :Ill. lrxtorefiitcii nali3ii ifflScieilisW „I
atimth«mnl(Iieatmg1CaoliagRetmii))}} oOther(ez;,lahtunder#2tR,aaado) PROM 2° • -nrst xt(mt'r. ea,mtYm m4gruaatuuw
4.Datewal(s)Completed:� -L�Z�Wc1 DD# ` 5 it 5 it. 1//o.GJ't4Ftiy! 0.014, .
Sa.wegImeotion: b 5 R 2°5 it. 71614/Y•e- C . •
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emmty l PatraL 2m.(PM
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(if °n6 kUlcmg is - 22.CertiSra •
35.60565 N ?/tel rz'11 l/
6.Ts(are)the rag(:): l9Permontnt or I]Temporiny Excised Welt r Date
repair MivtlagrtR3L• t3!(es or CM p1' :Warn Ikambycerothertheadi(r1»Murelmaren+�b:aoao�mtewith
7.Is this:: to on If`Rae 02C.DiOdarJUNa(4'02C.0,240 Well Cdrottuct en Standards mul that a ropy
brcld:is a rosarr,JEtarantranytilreaffnectionhrformaNmasdepfeatli =boaof7ke (Pa mad lax&a»govtdnita thew t11ow= •
pa[rronfertzZrtzra&atC!wnarmtielmetg hsfam
23.3tix diagram.or addtfionatWit- ` .
8.For Go: Ob,j fl'or Qosed-Loop Geothermal Welts having greet You may asatb4 bads of lisle gaga to pzovfdc tdditioual Weltoonshnction info
conthat't•im,only 1 GYM isneeded.TetWmto TOTAL NUMBERofRisIls (tad Own'inRemar shoo).YoumayAsoefts&ediititmatpagesifnecessary.
dtt7led:t ,s 74.8111311frirAL II7STRUCTTONS
9. otalvreIIdeptltbrlasvlend ansfaee: rlf (EL) Submit this G`Yl within 3tfdope:ringcompleaonper the followings
•OrTmlrfiZeveris lbtaAdogioVeb (koxegde-3@z0O'crtd2CUM
XaO.Sta4errateriavetbelatYtopclCasfag 24a.For Ail Wells:Original fame to Melon ofWafer ILaotuces(DWR),
ftwatClCodtsaolos✓ ire°+" �) Xn rarProcessingUIIrt.i617MSC,B•tr+gt,,'LtC27 6'94 I6i7
t1.8orthaiedPamt trt:6 Gy) 2ib.For Infection Welts:Copy w DWR,Uudergcuuud Injection Control(RUC)
Rogan:,
12 WeII mas'tz ietIm meal rotary Me.For Water Susrpfyand Q *.�Ia paa GsofhersoldRetorn Wells:Copy to amnGnostr mey,aaik,dsco/m:mo) county health deportment edam cammty where instsged
FOB.WATERSUPPLY WB.LS ONLY: 211).For Water Weltspmdodng arer•100,000 GPD:Copy to DW;R,CCPCUA
13a.•4feld(gpm) C 0d04tet air pressure Progmon,16f1MSC,IEt> ,r1Cz769P-161t
13b.DLsiufettiontype: Ammrmt C •'G/21(--'
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PomiGWd Heaps ttorenDeputosetofRetvh== d4uelld'^DiskfezterWitaRettmeees Revised64-2018