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Home My WebLink AboutNCD003200383_19890101_Koppers Co. Inc._FRBCERCLA RA_Well Inventory Report-OCR'I I I I I _I 1-, I I, I, ' -,: 11 I I I I I. I I WELL INVENTORY REPORT IN THE VICINITY OF KOPPERS COMPANY, INC.'S FORMER MORRISVILLE, NORTH CAROLINA SITE Prepared for: KOPPERS COMPANY, INC. PREVIOUSLY OPERATED PROPERTIES DEPARTMENT PITTSBURGH, PENNSYLVANIA 15219 Prepared by: KEYSTONE ENVIRONMENTAL RESOURCES, INC. 440 COLLEGE PARK DRIVE MONROEVILLE, PENNSYLVANIA 15146 PROJECT NO. 179225-01 JANUARY 1989 I I I I I D n I I I I m I I I! I i Ii ! I, SUMMARY Keystone Environmental Resources, Inc., on behalf of Koppers Co. Inc., at the request of the Wake County Health Department, conducted a well inventory of homes and businesses within a one mile radius of Koppers former Morrisville facility, now known as Unit Structures, Inc. The inventory was conducted through door-to- door canvasing and personal interviews during September -December, 1988. The following report provides names, addresses, telephone number of residents and property owners and provides well information obtained through the interview. Additionally, locations of each residence/business are located on the attached drawing, Keystone drawing number B-512474. The report presents information according to street names. Approximately 145 residences/businesses are located within one mile of Koppers former site. Approximately 90 wells are in use. City water is available along Airport Boulevard and the southern portion of Highway Route 54, although not all residences/business are connected. At other areas, water is obtained through wells. At some locations, one well supplies water to more than one residence. Generally, wells are in the 100-200 ft. range, although a few wells are 300 to 400 ft. Most wells are constructed with casing set into competent bedrock and an open rock hole below the casing. Water quality in the area is universally poor. Many residents do not use the water for consumption due to displeasing tastes caused by naturally occurring calcium and magnesium hardness and rotten-egg smell caused by hydrogen sulfide. Well yields range from very good (20 gpm) to very poor (2 gpm) which may explain excessive well depths. In addition to door-to-door canvasing, the North Carolina Department of Natural Resources & Community Development, Raleigh Regional office was contacted to obtain well permitting information for the area which is contained in Appendix A. I I I I I I I I I I, I, R, I g, I, I I, ' . 1,. ' I •1 TABLE OF CONTENTS Page Church Street Residences and Businesses ............................................................ : ............ I Koppers Road Residences and Businesses .................... , ................................................... 7 Davis Road Residences and Businesses ............................................................................. 8 Barbee Road Residences and Businesses .......................................................................... 9 Weaver Road Residences and Businesses ....................................................................... 10 Highway Route 54 Residences and Businesses ............................................................... 11 Watkins Road Residences and Businesses ....................................................................... 15 Airport Boulevard Residences and Businesses ............................................................... 17 ii I I I CHURCH STREET RESIDENCES AND BUSINESSES I Location Resident Name Property No. of Wells ID No. and Address Owner on Property m N-6 Mark & Pam Jones Same 0 -City Water 44 7 Church Street I 469-3659 I N-5 vacant Mr. Jenkins 1 Plus City Water Route 2 Box B-4 467-3181 0 N-4 Richie Pendergraft Mr. Jenkins 0 -City Water 450 N. Church Route 2 Box B-4 g 460-9883 467-3181 I: N-2 Ms. Podhany Kennedy 0 -supplied by · 581 N. Church Street (see N-1) well at N-1 Ii N-7 Ms. Dillie Upchurch Same 0 -City Water Church Street 2 -Abandoned 467-8246 •• N-1 & NlA Wayne Kennedl Same 1 I 580 N. Church tree! 467-9281 I 2M Mr. & Mrs. Doug Ray W. Herbert Franks 0 -supplied by Route 2Box 1 (see 3M) 3M well 467-9544 I 3M Wm. Herbert Franks Same 1 I, Route 2 Box 2A 467-8602 I, SM Linwood Elmore Same 1 Route 2 (Post Office) '. I I I I I CHURCH STREET RESIDENCES AND BUSINESSES (Continued) I Location Resident Name Property No. of Wells ID No. and Address Owner· on Property I 6M Rickey D. Marshburn Same 0 -supplied by Route 2 Box 4 15M well 467-1590 I SM Doris Mayo Charlie Mayo 1 I Route 2 Box 6 467-3929 m 9M Christine Spivey Same 0 -water from Route 2Box 7 well @ Lonely 467-0791 Hearts Club I 15M Randy & Robin Marshburn Same 1 I: Route 2 Box 5 469-1547 D 16M Mr. D.C. Marshburn Same 0 -water from Route 2 Box 5 well ISM 467-6575 g 17M PBS Pipe Service Martha Brandon I Church St. Bunnlevel, NC 469-8428 I 18M William Harrington Same 1 Route 2Box8 467-8330 I 19M Queen & Otto Lyons Same 1 I. Route 2 Box9 467-9673 I, 13L Linda Hinton Otto Lyons 0 -supplied by Route 2 Box 9 (see 19M) well at 19M 467-4336 I I. 2 I I I CHURCH STREET RESIDENCES AND BUSINESSES (Continued) I I.Aication Resident Name Property No. of Wells ID No . and Address Owner on Property • OS-3 Mack Baker Same l Route 2, Box 11 I 469-8846 I 12L(A) Mr. & Mrs. Edward McCoy Otto Lyons 0 -supplied by Route 2 Box 14 (see 19M) 12L Well 467-7982 R 12L Mr. & Mrs. Maryland Jones Otto Lyons 1 Route 2 Box 14 (see 19M) H 469-8087 I UL Mr. & Mrs. Henry Scott Otto Lyons Not known Route 2 Box 12 (see 19M) by resident No phone I lOL Donnie Herndon Otto Lyons 1 Box68 (see 19M) I: 467-7664 g SL Otis Hinton Same 1 Route 2 Box 42 467-1185 I 7L Roy Pittman Route 2 Box 118 Same 1 m No phone I OS-2 George C. Harding Same 1 & Barbara H. Robinson Route 2 Box 18 •• 467-8445 27L Edna Mitchell Same 1 P.O. Box313 I 467-1158 I, 3 i . ' I I I CHURCH STREET RESIDENCES AND BUSINESSES (Continued) I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I OS-13 Mr./Mrs. John Baker Same 1 Route Box 109 I 481-1290 24L Regina Goodson Information 1 I Route 2 Box 107 not released No phone I 25L H.L. Carrington Same 1 Route 2 Box 108 460-0497 I 2K James Ferrington W.J. Barbee 0 -supplied by .lK m Route 2 Box 104 (see OS-9) well c/o 467-0876 I lK Otis Ferrington W. J. Barbee 0-supplied Route 2 Box 103 (see OS-9) by lK well c/o 467-0876 I, OS-20 Earl Grimsley Same 0 -supplied by I Route 2 Box 102 OS-19 well i. D OS-9 William J. Barbee Same 1 Route 2 Box 141 467-0876 o. 3K Mary Barbee W.J. Barbee 0 -supplied by Route 2, Box 106 (see OS-9) OS-9well I, c/o 467-0876 ! 4K Judy Barley W.J. Barbee 0 -supplied by •I. Route 2 Box 143 (see OS-9) OS-9well I I -~ 4 • i I I I CHURCH STREET RESIDENCES AND BUSINESSES (Continued) I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I 7K Florence Leasing Company Kent Caudle 2 -one . P.O. Box 451 P.O. Box 625 abandoned I 467-0973 Florence, SC 29503 •• SK Shanne Davis/Glenn Rovson Eula Barbee 0 -su6~lied by Route 1 box 106 Route 2 -Box 141 well -0 -new phone number- R OS-0 Lewis Barbee Same 1 Route 2 Box 106 D 467-8920 ', H OS-12 Linda Lyons Route 2 Box 96AA Otto Lyons (see 19M) 1 H OS-24 Katheleen Self Otto Lyons 1 c/o Route 2 Box 96 (see 19M) ' No phone 11 OS-25 Mr. & Mrs. Ralph B. Pennington Same 1 0 Route 2 Box 95 467-4361 I OS-26 Mr. & Mrs. Clemeetine Lyons Otto Lyons 1 Route 2 Box 96 (see 19M) No phone ,g OS-27 Geraldine Griffin Pauline Williams 1 I Route 2 Box 95A Route 2 Box 95 469-1501 I OS-28 · Frank Williams Same 1 ' ' Route 2 Box 95 467-3498 1. ' !I 5 ·~ ! I I I I I I I I I I, I I: I I I! 11 i. I I I I Ii i. CHURCH STREET RESIDENCES AND BUSINESSES (Continued) Location ID No. OS-29 151 141 131 121 101 Resident Name and Address Beverly Holland Route 2 Box 95 481-9647 Sarah Harris Route 2 Box 92 467-8791 Clarence Holland Route 2 Box 90 467-8385 Dorothy Mills Route 2 Box 90 467-3697 Mrs. McClamb Route 2 Morrisville 469-2345 Miss Margaret Paige Route 2 Box 87 941-5895 6 Property Owner Pennington Lacey Rd. Same Same Same Same Fred Weaver (121) Route 2 469-2345 No. of Wells on Property 1 1 1 0 -supplied by well@ 141 1 1 I I I KOPPERS ROAD RESIDENCES AND BUSINESSES I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I OS-1 Mr. & Mrs. John Medlin Same 1 I Route 2 Box 19 467-7621 I SL Walter Shearin Mr. & Mrs. John 0 -supplied Route 2 Box 20 Medlin by well at OS-1 I 467-0993 (see OS-1) 4L Shirley High Mr. & Mrs. John 0 -supplied I c/o Medlins Medlin by well at OS-1 Route 2 Box 19 (see OS-1) I 26L Adams Concrete Products Co. Same abandoned Attn: Mr. Al Sutton I P.O. 189 467-2218 I 20L Sylvester Winston Same 1 Route 2 Box 110 467-8643 I 21L Mr. & Mrs. Alphonso Gary Sylvester Winston 0 -supplied by D Route 2 Box 111 (see 20L) well@23L 467-4855 1 -abandoned n. 22L vacant house Sylvester Winston (see 20L) 0 0 23L Mr. & Mrs. Lassitter Sylvester Winston 1 Route 2 Box 113 (see 20L) I 1· a: 7 I ! I I I DA VIS ROAD RESIDENCES AND BUSINESSES I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I 37M Mr. & Mrs. Terry Allen Bobby Davis 0 -supplied by Route 2 Box 123 (see 36M) well @36M I 467-4943 I 36M Mr. & Mrs. Bobby Davis Same 1 Route 2 Box 119A 467-2836 I 35M Steve Wintermute Same Contact not Route 2 Box 119 made I 34M Mr. & Mrs. James Peptis Bobby Davis 1 I: Route 2 Box 121 (see 36M) 481-4780 30M Dora Davis Bobby Davis 1 I Rt 2 Box 119 (see 36M) Contact Bobby Davis -36M I, 31M No Contact Made 39M/40M · David Quate/Quate Welding Same 1 for all 3 I: 41M P.O.Box 131 locations 469-0291 32M Lawrence W. Giles Same 2; one used I, P.O. Box462 481-9590 I: 33M Maxine White L.W. Giles 0 -supplied by well P.O. Box462 (see 32M) @32M I: No phone ., 42M Natalie Eargle L.W. Giles 0 -supplied by well Route 2 Box 119 (see 32M) @32M 469-5107 • ' ; I, 8 I I I I BARBEE ROAD RESIDENCES AND BUSINESSES I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I OS-8 Shilo Baptist Church Same 1 Reverend Johnny Leak I Route 2 Box 388 I OS-18 Aree Monroe Same 1 Route 2 Box 99 467-9696 I OS-23 Melvin & Emma Bailey Charlie Mayo 1 Route 2 Box 1008 Route 2 Box 99 I 469-1685 782-0625 I OS-22 Isaiah & Jocelyn Thornton Same 1 Route 2 Box 98 467-7304 I OS-17 Thomas Williams Same 1 Route 2 Box 100 • 467-2773 m OS-19 Mrs. Carey Grimsley Same 1 Route 2 Box 100 467-9389 1. 6K Levee Barbee W.J. Barbee 0 -supplied by lK Route 2 (see OS-9) well •• No Phone m .• , I \ I. 1: 9 I I I I I I I I Dr 1•:;· I, I, WEA VER ROAD RESIDENCES AND BUSINESSES Location ID No. 13J 121 llJ lOJ Resident Name and Address Mildred & Earnest Williams Route 2 Box 83E 941-5054 Cleveland Bunne Route 2 Box 83H No Phone Mr. Mrs. Clarance Mayo Route 2 Box AM 941-5809 Zelda (last name undetermined) 10 Property Owner Same AreeMonroe (see OS-18) Same Otto Lyons (see 19M) No. of Wells on Property 1 1 1 1 I I I HIGHWAY ROUTE 54 RESIDENCES AND BUSINESSES I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I 15H Charlie Green, Sr. Same 1 Route 2 Box 39 m I 14H Mr./Mrs. Jesse Chavis Same 1 Route 2 Box 42 unlisted I 12H Research Triangle Glass Blowing V.A. Chiotakis 0 -su,lied by & Tony's Service Tavern Moorehead City, NC well llH I Attention Mr. Tony Zurek Route 2 Highway 54 467-7233 D· llH Tony Chiotakis Contact not I. Route 2 Highway 54 made lH Paul Tony Contact not I, Route 2 made D lOH Walter C. Greene Same 1 Route 2 Box 35 467-2894 D 9H Sylvester Currie Same 3 Route 2 Box 34 g, 467-8659 I SH Emmitt Holloway Clarence Holland 1 Route 2 Box 33 (see 141) i. 467-3517 g, . ' 16H James Harrington Contact not Route 2 Box 33A made u. a, 11 I I I HIGHWAY ROUTE 54 RESIDENCES AND BUSINESSES (Continued) I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I 7H Randy Hester William J. Barbee 1 I Route 2 Box 32 (see OS-9) No phone I 6H Mr. & Mrs. Dewey Green Same 0 -supplied by Route 2 Box 31 well at 5H 467-4664 I 5H James Green/Brisilla Chavas Same 1 I Route 2 Box 31 467-9958 I: OS-11 Mr. & Mrs. Roosevelt Satterwhite Nora Mayo 1 P.O. Box701 (see lJ) Apex, NC 27502 460-0462 1, OS-7 Mr. & Mrs. James Crowe Same 1 Route 2 Box 25 I; 467-8603 1. 15K L & D Rental Inc. Same 0 R. James Layne-Manager P.O. Box 52059 Durham, N.C. 27717 I (919)489-9879 383-7241 469-5838 I OS-10 The Deli Box Scott Beerman 1 I Route 2 Box 24 467-4164 I I I, 12 ' I I I HIGHWAY ROUTE 54 RESIDENCES AND BUSINESSES (Continued) I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I 14K Crowder Construction Co. Same 1 Mr. Don Hancock I Route 2 Box 23 469-5449 I OS-6 Wilkerson Construction Co. Same 1 Mr. Joseph Wilkerson P.O. Box 183 I 467-1829 I OS-4 Mr. & Mrs. Roy Medlin Charles E. Zimmerli 2-one Route 2 Box 124 93 Sunny Reach Dr. abandoned I West Hartford, CT 06117 I I 16K David Strom Gary Boyette 0 -supplied by Route 2 Box 126A 469-1720 well@ 18K 460-9234 I 17K Betty Bennett H.D. Copeland 0 -supplied by Route 2 Box 127 (see 18K) well@l8K I contact 467-4164 18K Mrs. H.D. Copeland Same 1 Route 2 Box 126 I 19K Joey & Candice H. D. Cokeland 0 -su(~ried by I: Route 2 Box 126A (see 18 ) well 18K I OS-5 Triangle Materials, Inc. Carolantic Realty 1 Attn: Mr. Phillip Ritchie Attn: Bob Ritchie P.O. Box330 133 Fayetteville Street Mall I·. 469-2222 Raleigh, NC 27602 I 832-0594 i-. I! I I, 13 I I I HIGHWAY ROUTE 54 RESIDENCES AND BUSINESSES (Continued) I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I 2L Mr. & Mrs. R.W. Thomason Same 0 -City Water Route 2 Box 129 I 467-9634 I 3L Triangle Mini Mart Mr. Ralph Thomasson 1 -abandoned; city Mr. Gary Boyette (see 2L) water Route 2 Box 130 469-1720 I 6L John Crawford Mae Price Realty 1 I Route 2 Box 241 Carey, NC 481-0971 I lM Mrs. Katie Barber Same 1 Route 2 Box 239 467-2291 I 63J Lila S. Jones Richard Jones 0 -cistern Route 2 Box 239 water from I 467-7112 house; brings in water for cooking I 65J Robert Holsclaw Same 1 Route 2 Box 237 467-8064 •· 66J No contact made I 68J Truss Builders Inc. Same 1 54Box 467-.9988 I: 69J William A White, Jr. Same 1 I,. P.O. Box 126 467-9977 i ' 70J Tarheel Wood Treating Co, Inc. Same 1 ,. I. Jim Gallup, VP & Manager 467-9176 I I 14 ' 't . I I I WATKINS ROAD RESIDENCES AND BUSINESSES I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I 1J Nora Mayo Same 0 -supplied by Route 2 Box 30C OS-11 I 467-9780 I 2J Mr. & Mrs. William C. Nora Mayo 0 -su<£plied by Pennington (see lJ) well OS-11 Route 2 Box 30 C I 469-4247 3J Pa trick Rouse Same 0 (buys water) I. Route 2 Box 26 A 467-7015 ' I;. 241 Mr. & Mrs. Ivory Gupton Same 1 Route 2 Box 30A I. 467-4190 ' I Mr. & Mrs. Ozy Blunt i 251 Same 1 I, Route 2 Box 28 467-8277 I . ' I. 261 Mr. & Mrs. Gary Watkins Same 2(1inuse) Route 2 Box 30B I. 467-3163 271 Mr. & Mrs. Glenn Barnhill Same 2 I Route Box27 467-3312 '. 1; 281 Mr. & Mrs. Roland Goodwin Same 2 Route 2 Box 30A \ 467-4561 I ;.· ; I ! ' 1: 15 I I I I I I I I I 11 II 11 I I: I, \' I, I, ! 11 1. [_ WATKINS ROAD RESIDENCES AND BUSINESSES(Continued) Location ID No. 29] 30] 32] Resident Name and Address Niomi Jenkins P.0.143 467-3645 (work) Richard Larry Watkins, Jr. Wanda Culler Route 2 Box 29 467-2949 16 Property Owner Larry Watkins (see 481) Larry Watkins (see 481) Same No. of Wells on Property 1 1 I I I AIRPORT BOULEVARD RESIDENCES AND BUSINESSES I Location Resident Name Property No. of Wells ID No. and Address Owner on Property I 43JA H.M. McGuire 1 Route 2 Box 245A Randy Watkins I 467-1004 (see 43J) I 44J Cathy Routledge Mr. & Mrs. Evangilist 1 Route 2 Box 245B Green Level, NC 460-1828 I 45J C. W. Conkling Same 1 P.O. Box 168 I 469-1233 I: 46J Gloria Moss Ruth Perdue & 1 Route 2 Box 247 Jesse Markum 469-8670 I 48J Mr. & Mrs. Larry Watkins Mrs. Dora Watkins City Water ' Route 2 Box 244 (see 49J) 1 -abandoned I, 469-0825 I, 49J Dora Watkins Same City Water Route 2 Box 244 1 -abandoned 467-1875 I 501 Leon Riley Gary Watkins City Water Route 2 Box 243A (see 26J) I No phone I I DeHaven Transfer & Storage Inc. I 51J Same 1 David E. Long P.O. Box 163 I, 467-0777 I. 1: 18 i I I I I I I I D, D H I I I, I 1· AIRPORT BOULEVARD RESIDENCES AND BUSINESSES (Continued) Location ID No. 52J 53J 54J lL Resident Name and Address Triangle Fountain, Inc. Doug Carroll P.O. Box 192 467-4830 Air & Land Transport Phil Sparrow 469-3960 American Legion B. J. Abbott P.O. Box28 467-3700 Mrs. Corice Potter Route 2 Box 242 481-4707 19 Property Owner Same Thomas Fanelli Carey, NC Same Marvin Watkins Route 1 Morrisville, NC No. of Wells on Property City Water 1 City Water 1 -disconnected 0 -disconnected I I m I I I R D H I g, I D u. I I, I APPENDIX ( . ·. - ..._ ..._ I I I I I I I I I I I I I I 1 ,.01 ..._ ..._:'.,\'f< _.I / ..;; ..._ ..._ os-29- ) . os-20- os-21- QS-26 - os-2!! - 3 ' . ... ----( ----------. ...... ' ...... ' 7H ... ... -- 4 5 I I It MILE ...... j_ RADIUS I ...... ...... ... -...... ' \. ,. --40J -◄1.J .C3J / / / I I I I I , .............. ~ ,---------- J SC,4LE-(FEET} 0 JOOO 2000 STONE ENVIRONMENTAL RESOURCES, INC. \ NOTE: ALL LOCATIONS ARE APPROXIMATE. ----&.ii -&.ii -liiil 6 I I I ,UJ I I.. I ..._ __ ) I ... ·-·-·-- 7 'f-. r.Y' 1/ LOCATION MAP j I / · DOMESTIC IYELT-SURVEY KOPPERS COMPANY, INC. FORNER MORRISVILLE SITE H I J L M N 0 I-I .. ,. ll/l1!/1111 '"'• 85J2474 - I I I I I I I I I, I I, I I I I Ii I " I OFFICE OF WATER ANO AIR RESOURCES GROUND WATER DIVISION P. 0. BOX 27687 -RALEIGH, N. C. 27611 • J-. / h~ · ,, u<dii!>r,_; •,a. ,. 3. sc:?E55 / ~rt!,;r,; f -r!n-1 ('~,t~/ Ye:., -yL.,G' / 4. TOPOGR:..PHY: drow.,/Jo!lry, ~ hilltop, flat·:---. , use oFwcLL: ClfA('k:Cko•rr.: ;> -?(' 71/: 6. OvES TSIS WELL [~t:/e· EXISTING WELL? ~ 7. TOTAL 9EPTH: RIG TYPE OR METiiOD: //iw/:i, 8. FORMATION SAMPLES OLLEC'fEO: [=:) YES No. of Bogs __ _ o. CASING: Inside Woll tl'd~. " Depth -~ •ei~fl. ~ From Q ,o :;i~ ''· ,g* 10. GROUT: Depth Mo;~ MtlhOd From CZ. lo --J...0 t, flµ,i• ~ II. SCREEN: Otplh .Qi2m_ Tili!I an~ QQsning From Jo "· ' 12. GRAVEL: 0,01h ~ Mot,ri;:,I i From Jo ti. 3.5.-,b It{;# "· WATER ZONES{dtplh); I 14. STATIC WATER LEVEL: / !),_ ft. aJ:M,,9' top of ca1ln9. ; i / 7 D.=<l LUNG LCG i . y ' (0,7 31 ~/ /0 ' / below CosinQ is_~ __ tt. obou 1ond. 1urfoc1. ELEV·-----lc------,r------1r-------------- OATE MEASURED: c;.. 8 .,..,pt . I • .., _ I 5. YI ELD!gpm, 3:3 METHOD OF TESTING: ~L7i~;,Jh,.;-:::_~--1\----'---+---U 1'l_µV~---=2..=--o __ -__ ..,_.j_--::;--:c-;--r-/ 16. PUMPING WATER LEVEL'. J.I D fl. oflor i • '3 i> hour, < _ , 1 -, '9r ') 1 I lf-,') '2 or .:,_27 qpm. ../ -\ , J ' J 7. CHLORINATION: Typo H, i, If'. Am.,.nl 1(l (,{,i.1} ~ / 1 I ~ 18. WATER OU~UTY: _________ TEMP~ATUREIC_ t----+----+-------------- I9. PERM.l.NENT PUMP:(Show o si.ttch of wtll head on bock of form) Dote instol1td _____ T)'pl ______ Mokt _____ .----+----+--------------- C opociry __________ (r;ipml HF-_______ ~~ '""7.--.. 1---1---./--..<;::::,:.::C~:.::;::=,--~-- l n to'<, Otpll'I ________ Air lint D1plh !\([-c-.:,·-... :_:·; ·•~ ~ •. _\ .. · .\~) 20. HAY! YOU INFORMED THE WELL OWNER Oi' THE -'#:--~ · !·} OEPARTM£:NTS REOUIREMENiS ANO RECOMMENDATIONS? 11----lf----le-------::------'-,.,.:,.-- M/,'( 21 1974 21. REMARKS: -------------------·lf----l----1--------------- ! do h~ret,y :ertify 1h01 ll'lis well record i, !rut ond uocl. SIGNATURE OF CONTRACTOR OR AGENT DATE Form GW-1 White Cco·1 • Offi:e of Water and Ai1 Resources; Bl~ -Drillers Capy; Green-Owners Copy I 1 ''.'.,'. ~::·.~~: I ~ccess ?.:,7': ':·?. :_ ved ~l:::,• .. ; I su.:tion !..i::e :hlori~ation .;:-ipe "'emoori!ry /,.band. I -. - Gate Well constructed I )e.te Puma 7r,stal.led I I I -cness ~ n / ! ! . , ;_yr-~---::, Signature .·l.·_-;:;-::;;:;:;-___ ~~------;Typ~e-- Address N=e Address 'Type I ••• . . I ··•·y . .. .. ·. -, !-i 11,-3.,- \;: I I . _:,__;. r'Jo?..9, s·1-~·-L':: -i .• I _¥• I ' ' -1 -' I I I I I I I I I I I I I I I I I ' I I I i. i :. ' --.--.,.,.r~-i 1~·-=-·--· .,,,,-:·_,, i 2 3 5 -s P. 0. < I /I 1-: / : .. _.~ ( ! ,,_,......, hi I l:::p, flat -o,rc ';i-;J-73 r,::-:,-n.; ~.=!'."'.'~ I TO /J ,::;-(""/1.,.t • I J ,•,.-A c'. /"'\ r 7. 7C7.li.... OC:?TH: ,;_)(-.'.);"') /~ "1-:::: I/ /) /\ / /' ID. II. 12. 13. 14. 15. I 7. IS. 19. zc. "· C.'~·J:..:T: ~ Inside Diam. Fy Material Wal! t,'lidl. o, wei5!it /fl. r F'ro~ ("1 lo -~ " C:l:-e:•ar ~ ./\;,;..,..-..P r V s:n::::N: Oe,:h ~ Typ~ and Openit19 rro."7': lo ti. G:=!t..','C:L: C.?Clh ~ Material ~ro,.-, lo fl. WJ.T.:::.~ ZO,"iES(d,~th): So_,;_ 3Tt.TiC '//~TER LEVEL: fl. a~ova top of casing. ii 7 ft. belo .. Co sin; ObO'lle land surloce. ELEV. a.:.70::: MEASURED: .. 'T'I !=:LJr .. ;,_r.,}: lf' METHOD OF TESTING: ,:?,t.,, r :")~ -~{) -:-z /; ---c::'r) .C:(..1 c;-~ 1,5 ")-' -, '7_,;' q;_t::; ., ' ti/_,,,,_ . ,, 15 ,;.10 ii (1, "''',;,,_::z, /J /,.rJ . I 1-n /'J,;7 lt/o /ti;) 1 o ... ~ ' :)...Or., ::i.. 7.::; --, -r< __ , ., '?l" ::).~O ::v, ,') -• :.·-/ W.!.T':::=! •JlJA'_JT)':·--_ •. . ... ~ ~: _. .:E.~?E'(_ATU;E\•F)___ ·. ~/ ...... '/ /! __ 7__ _;-1 ?:'.?:.Y:..~:~:•H PUMP:(St'!<Jw a sk1t!.:h of w,lf he~d on·bccLof form) 1-.:._..:...-+----'-,--'-!---"-----"--'------------ :>:1~ in s:c: ltd _____ "i)'~•------Mok, ------1 ~------1,--""--'--·--I--'-; _ _;·~--~· _-____ -________ _ C :; :.:; 17 -------'-------(,;,m) HP _______ _ !:-:::(,1 Depr,, ________ _ Airli.i? D.1:;ilh _____ _ !-----+----+-------------- OR AGENT 'o'ihiie Copy-Office cf Water and Ai1 Reso~rces; 8!ue-Q;ille1s C0py; Gi,en-Owneis Cop,· I I I I I I I I I I I I J.:l . r I \' . ·l I I I I I I WSLL LOCATION: ~·:::.._ __ :-.-:::.:. -=~--=;~.--::; ·:2_si.:.~., ;:..:.::-::., ~;:--~1...:.::., a..:.::. ::>:-'.'"'I..-.~:-::,.. Draw a l~tio~ch showing the direction and distance of the· well to at ·1e ,st wot · nearby reference points such as ro3.ds, intersection~ . stre . • :identify roads ;rtth .state High11ay road identificati~-=...___,, · · ··. ~ .. . -----~~-·-----·-~ .. d -:r' \ .)9 / ' ~:=,o\C.-.i.,s-...,,v...~. ·--•-..: ....:....:._·_ .. \ \ \ I I I I 2. I 5. I I I I I I I I I 7. 8. 9. 10. I I. 12. 13. 14. 16. I 7. I ,a. I I I I 19. 20. 21. GROU:ID WATER DIVIS!Orl P. 0. 60X 2iS37 RALEIGH, N. C. 27611 9EG. NO. -',"'::·_:... _:,c:.TlC'N: ts:-.:-~ sV"ch,:lf ~• '..:c.::!::il" c11 occ~ • .•..,.,;:r~stT~n; t·.·:lr::1sv 1 1 1 e cf form) \<ake Ccunty: --'=----------- --'L'L'L·"::.....c':::'.i:01.rr;_:~:.-:.,· c:5icYCi_1~1.;~;,_ . .,:0::, d.L,'-c~~~~----------0L:OCl r: n QI e No. ~ .-!-:,cj, &mmur=it-, or Su~-:::ms1c., cno LCI No.) -~;'--~"'-'-"':2,,.__.,:._,· J,&_ ..._ -:-....... E?: n:----.""" T :•,....,--, ~ -DR:1 : CG ti. C. 27560 I l,"~G :...:C-.C.E$ 5: "~ l , ~·~·:J"'-!""; svi l le, -er • -qCfi L 3 3, -•oTS hifl1co, ""' rRn·M rn i::"1"',::;1,1 ,,..,..,,., i ~ ':::l'"PIP.,.....,u T ~-X-R ... ~r. ra., vci.91, 11Cp.t, i..:SE c-= -,.,s_i_L; 'nnmo C.rrE: 5-2 73 n 2S rl~" .:::.;"lrl cr=in i te CCES i:-.1S '-N'EL.L REP!....:.::E AN EXJSTING W~LL? 25 50 oranite T07 :..L SE.?'TH: " n .~!G TY~ 0~ MITr!OD: a j :c ro;:: __ ...,,i.::--:oN SA"""-ES COLLC::CTED: LJYES No. of Bo9s c.,:.s1.-..G; ln1ice Woll ll'lic:k. Test t:iJn.e: or ~ Cic.~. weiohl / It. g Ty\''I[_ l • 7 n C'\. m. ?/l ~~'." Fr:m n ,, 25 tr. 6½' l ' 1:20 o.m. -20 qpm 1-,n~m -?/l rmm GM.OUT: ~ ~ ~ Fr:m 0 " 20 Ii cement eurne -r" ? - SCREEN: . Oeplh ~ .. ··-· T:t:Q! end Qraning "'3sso/7s;, c::~ From IO 11. 0 I / I ,..--t::, J -jRt.VE!..: O'!plh !!.:.!. ~oterlol Fr,m " II. W.1TER ZONES(d•pth): ·:p; f' +- ~Q It. XllQlltK STATIC WATER LEVEL: to_P ot ea1,ln9. 1 b1iaw Cosinq ;, ft. ot,o.,. land surface. ELEV. DATE MEASURED: YIELD(go,nr. 20 METHOD OF TESTING'. blowing: .PUMPING WATER LEVEL: fl. alter hours of gpm.. CHLOF.:NATlON: Typt HTH Afflount] Q tab) eta. W.1TER QUALITY: TEMPERATURE('rl ___ ?E~Mt.~ENT PUMP,-Show a 1ktteh of well htad on back al form) Ocie inslo!ltd Typ1 ~Aoki Cc-;;oc:ily {i;ipm) HP ln!c~, O,,ih Airline D1ptl'I -·-· ,-.-·_· ··-. ..,/i .! - . --. 1-4'-'IE '!"OU l~i'O?.MED THE WELL OWNEFf .OF THE . ,., :)£.::::4.;;."":"V£NT$ :1EOUl~~MENT5 ~NO RECOMMENDATIONS? J. " ,_; rl:'.~A~:..-:S'. . ~--; -. .. -·--. ... - 'J 6-1-73 OR AGENT DATE· wnit11 f"nnu. nHir-o nf W:,to, ::inti 4.ir R:11tn1rrr:p~• RI~. nrillp,r~ r.oov: f.r11:e,n • Owners Co□v I I I I I I I I I I I I I I sie ::ct: o C t..f:.e -v-s,::::..::i, access ·,:ell r.ea:.. sho,,..-ing ';:)art, grcut, a!ld WELL LOCATION: Dra'-l a location sketch showing the direction and distance of the '-lell to· at least two (2) neELrby reference·points such as roads, intersections and strea.m.s. ·rdentify·roads ,dth State Higbve.y road identification =bers. \ I \ -- ' I I I I I I I I I I I I I I I I I I I. I . '. I '· i I I''.-, ' ::;c-,~r,::;,~,1 _,:-•_;_ . ....,._,.,__,. OFFICE OF WATER A/ID AIR Ri:SOURCES GROUND 'I/ATER OIViSIOtJ <:: T:JP~Grl.!PHY'. draw., vollPf, slope, ~i!ltcp, flat FROM I T"' 5. USE : c WcLL: ff(--n__e;= DATE: .z-~')./ • 7 ? ; ".R 7 8. FOr1.",1A7!0,~ SAMPt.ES COLLECTC::D: C:J YES No, of Bogs __ _ o. C.:..StNG: I nsid• Wal I lhidt. o, Depth Ciom. •t1~M/fl. l:Jt: km~fo "1..b ,,. ee?qt 9# •i:'.. .. ' 10. GRCUT: Otplh Moltr1ol ~ From -1.q. lo 'LC fl f trJ.w,,,1--:;./LU,~ ,-44&( , ,,. r= ,_,, I II. SCR:EE,'J: Oeplh ~ . T;i:1a gng Q21ning 1'"---1----1--------------- Fr::im !O 11. 12.. GPAV:::L: De::,th Siu Moteri~t From lo ti, 13, WATER ZONES(d,pthl: 4 g: a,-,.id-:, 111:s- J4. STATIC WATER LEVEL: ':l. 'z-ft. obo-,t . lop of co1in9. Cosing is / fl. above 1ond ,::: ELEV. _____ '""----,----~-------------- CATE MEASURED: q~ 'J.. /-J 1 15. YIELDl,om; '1-"2,. "'[THOO OF T[STING' l7('~f't,..-L- 16, ?UMPING WATER LEVEL.: LJ. D tt. oltor __ ,_/::.,, fc.-V.=. __ hours ot :'1-q__ gplft. r7. CHLORINATION: Typ1 H,W • I.. WATrn QUALITY,: __________ TE"'P~RATURE("r) __ _ 19. P::RMANENT PUMP:{Show ·o sketch ot w•II head on bock of form) Octa in1lalltd _____ Tyc,1, ______ Moi.1 _____ ,lf----+-----+--------------- C:~ociry (Q~ml HP ________ l~-----1-----L--------------- lr:l~'k• Otpl~ Airlin1 □•?fl'I -----11 20. HAVE YOU INFOR,.EO THE WELL OWNER OF THE '1" DE:P.lG;T!-JE:NTS RE:OUIR::'.ME:NTS A."iU RE(:OMMENOATIQNS;:>~:f.. ' :/ ~i::.'-1~.=l:i'<S: ---------------------1 ~ ___ _,___ ___ _.,_ ______________ _ I de ~ertoy ::1rl1ly 1no1 1h11 ,.,u record ,s 1,u, and uoct. G~GU~I:) 'd,\1:-:: ,_.,., .. ,,.,. SIGNATUP.£ OF CONTRACTOR OR AGENT CATE_ P.A'_O: G... .' 1 ... I I I I I I I I I I I I I I I I. I I ,·;-7 ---,· -----·. 1o/ELL LOCdTION: Draw a location sketch showing the direction and distance·of the well to at l9ast two (2) nearby reference points such as roads, .. intersections·and etre8J!IB •. Identify roads with State Highway road identification llUlllbers. · ... ::--.. ·--·.·., ... -·--··--····--·-·-·· ___ ., ___ _ I I I I I I I I I Ir I l1 •1 I: ·, I( !- DIVISIOH OF GiOUND WAT~R y/,k...;J_ g 8 J 3~2.-u. \foll Ho.: Field _____ _ ,• ' R cco rd ed Cl Y-;·~/"-_!.'-/'-/1"'.'c-'.:..·: --'·(_· --------~ U S'3 .·, Ci.:iun ty ',,-) ~I ·/,,1 c/_,.,._,/, .;J! -....... ' .. ,,.., ,; ,,. . ". ,.,.c~ .. ,. I ·.'' 1'J. I :i-i~, ,'....·;.• .. :;,,, . .,.-,.. r,1. --or.. 2, C,ner /j(,__t'J /<./:.J.1,',,1 .' I fr fi Ci i,' ..;> Addr_e»-:-'-6~/j-'------'-/-''./.:..•~·''.:..'c./_,_,,"c...::V:...·.:..•c.···'_1__.:..-e_:::.... ___ _ / 3, EievatYc ~-----ft. above t'iS._ ______ _ Reference poin._ _______________ _ ~-Tcpography:~1,,, ,; 11, ,,,,,,~ '''."~'>"' ''''--,-;,-----,--,-----,.,.------ 5, Ty;,e: :ug, ~ bored, c r i ·,en, jet ~•d Oc.,,---7 ..) 19.2....'.... Use,~~A/"-'6'-Y-'1 __ _,,{/,,,__,S-J!.,::<..:-=..=,!,L=:_ _____ _ 6, Depth: P.ept._~ _____ ft.: M,._s __ __,,(o"'-q-...,_ ___ ft. 110+ C4-'C./ 7. Casing: Oept,~ ______ ft. Oiam. __ _,_2,._ ____ in. a. Screen: fro111-ft. to ___ ft. frorn..__ft. to ___ ,,. ___ ft. to ___ ft. fro"'---ft. to ___ ft. Typ•~------------------------- 9. Water-bear i ng form at ion: ...,.../;_'f.,;.r_i_w_tl_-__ .s::....:lc., _,c,-'I_"'-___ _ 10.Waterlevol: P-D, ft.:4:!r,oc.J"2., 1qM -r~ • I ~~s.,.. _, .. i -.....,_' b. low , ___ ..c,, / r.,,.+1:'.-....c.".;..c·-.. '-<E=="'--"--'"-''-·~ , _____ _ which i~•--.Jfoi.,.." ___ /t. (above,......,. !urfaca 11, Yield tgpml Pu,,,p: __ .::if;,.... ____ -1F1ow ________ _ 12, Drawdow,, _____ ft. after _______ _,,rs. pumping· ., ____ _gpm. Spec, cap. _______ _gpmtft. of dd I 3. Pu~p: typ cap. ____ ,gpm. Hp.:_· ____ _ I~-Hours pumped dai I y 15, Qua I i ty: Ve.tZ 11 16, Analysis: By ( ____ ;.__ _____ ...,,at.,_ _____ _ pp• . pp• pp• Siu K NO.,__ ____ _ Fe HCO co,,_ ____ _ Ca so~ Mg Cl Na 'F Total hardness pH ______ _ Di~solved So I i do Temp. _____ °F s::i~c. Cond. __________ Mirr-omhos at 2S°C __ _ ,- 17, R!!'Darks: :>r,1r · ,_. :.' :: • , . C, •hit• co~y -Department of Water Re,ources QI'""' -nr-i 11 ,., " CODY. Gre!n ... o-,_ner 1 s CODY 18, LOG: Formation Depth ( ft. J. N Form G\>1-1 . ' i ' ' ., ·1 ::> ! ! ''/ .:1" ' : I ; I I I ' I I I I ! I ' ! j. I '. ;· .. I I ! I I ! I I I I .. ~ . I I. I i I I ,. - . ' I I I I I. I I ! i I ' l. ' r----, . __ ; ___ . __ j I I I I ' i ; i· I I I- : ;,_, I 7J· :;·: I' " , _,_,,It/ I ' --- - - - - - - --· -·-·· ------ - - --· - - I I I I I I I I I I I I I I I I r. I. ·,r~r l _q:co.~0 -.:.---. ·~c:.i:1 ::.;;:,:·_;"i!..- ·,:·:,;;_,/DEPARTl<EKT O, '//ATE., .,ESOURCES DIVISION OF GROUhD WATER 3ox 9392 -Raleigh, K, C. 0ri11~~1 5 ;egistration ~a. ____ _ \ve I I Ko, ,.. (-',') , "1 j 7 ' · ~ · · ;'': R, ecorded by· __ i.:../_'-".;.T_l_· ·:_,~_· ,_:_·'. ____ / ______ _ -·~ ·:.-.--. -.•; ·.' -11,,.., ..J '""'.'.:... I t Fi old-_____ ""-__ 0 ff ice __ ,~=.,.-~/ _____ _ ~~ ~e•..:... __ .,£,s.......:=....~=--L---~ I~ ... :➔:-.,,•: _ USG"---------- ====~=~===_.;.~=====-=';""':'======-=~=~,- County• (.r,i ' i-l~c~t'.on: ToWTic_ _________ ..:_ __ __: _______ _ Na F Total hardness ptt· ------- Dissolved Sol ids, _________ _ Temp: _____ °F Soec, Cond._. __________ · Micromhos at 25°C __ _ 17, Reaarko: ____________________ _ '11h i to copy -.Oepartilent of Water· _Resourcu-· .. · Slue Dr i 11 er• s:: copy .. : Green: _,-Own·er•·~--Copy, :·/ :...;:...:.-;~,~-·,~:..~:~:;.:_·.~-:··,.;.' ' .:lJJ:f.f :;·'· .. ~ . .-........ . • •.!.;:..:'"'°-•.:•;.-A•,:,.:.:•:· .. --~--. ·--- I I ··--.-·-· ·•--•-··--..... -~. ·-- I -;__:.· I ·.·_;);..,... __ ·_,., ...... _· .. -, . ·-· I I I I I I .-. -,.::.-. I , . .,-.,'. .. ~_;;:.: __ .. ·- ·.:..... ......... ,. ... ·.•.c·~-:,-~ ~=:~~ .· --... '----·----· ,· I I I I I I OFFICE OF WATER AND AIR RESOURCES G~DL!:'•W l'l.i\TER DIVISION P. '.J. BOX 27S37 RP..LEIGH, N. C. 27511 REG. L I 1--,._:::___ :__::.;-:,:.:-y_.'-j; ;s:--::w c :;,l.,l'f::, cf ~! 1::::1:."' ,;:, :::►~ ol for~) -'.~er~~: 7::...n: '-!:;~-; svi l ''=, :-;qr tr-, Carolina I I 2. 3 4. 5. 6. I 7. I I I I I a. o. 10. II. ,2. I 3. 14. 15. 16. ,e. 19. :-,,.'-Ii:._....: ,_, '--.. .. --.. :.:::-:1:::;3: ;\~x 42. ~~-:i:-:--:.s·:ille, N. c. 27 560 f'\f:PT".. 1-:):,,;:,G?. A~'. dr~, vol Ir,,, 1lc~, /'lilttoo, / let l="Rn~ T~ -0 22 CS'.:: C: ',i,E:LL'. ho:ne c~ 10-25-72 GC='.S n-1;s \lor£LL REPLACE: A~ '.::XlSTif-tG w-£.LL? 22 150 TOT.!.L CEPTl-i: I SQ' ~=v TY?£ c~ ~ETuoo: air FOrf~ATIQ:'-1 SAMPl.ES COLLE:-':"C:D: QYES No. of Boqs CASl!-iG: lnsidt Woll lhidt. o, Dep!h Oiom -..ei~nt / ft. I.!2!. From n lo 2ft fl. 71-11 i:'1lll GROUT: Deptl'I ~ ~ From 0 lo 20 " cement oume SCREEN: Oeptb ~ T:il2:s ond Q12ening From lo "· GRAVEL: ~ ~ Mor1riol From 10 "· WATER ZONES(d1pthl'. 1351 -STATIC WATER LE'(EL'. 25 "· top of easing. b1lo• Cosing ;, l fl. ObOYI land surfoc1. ELEV. DATE "4EASURED: YIELO(qpm): ; METHOD OF TESTING: blow Test Time: PUMPING WATER LEVEL'. ft. ofltr hour1 0I qpm. CHLORINATION: T.YP• ara A"'°"'"' 14 tablets WATER QUALITY: TEMPERATURE("F) ___ PERMANENT PUM?:{Sho• o· 1l11teh of •• II h1ad on boeJ. ot form) 001, in1toll1d Tr,t :ii.4ake C::pceity (gom) HP Ir.IOI.• Cepth Air lint O•plh HAVE YOU INFORMED THE we:-•' __ , OWNER OF THE ~EPA~TMENTS REOUIRl::MENTS .l.NC P.:'.CCMMENOATIONS? yes R£MA?.K3'. I do r-.~r,oy :trlify 11'\ol 1!"1i1 -.,;1 r!.c-or~ is :r:.it ood ••oet. SIGNATURE OF CONTrfACTOR OP. AGENT DATE ~ -ORI' Li~!G LOG :r.ou.~T,n~, r,,:-~--,,,o...,,..., clay shale :, "".- ')') ~~ C--0 7"'Y"<"°l"l~ <=:, /-+-I ~ (' "f= 11 .. ' ,:00 -7 gpm •:10 --7 gpm ,:20 -7 gpm :30 -7 gpm H'P~~-~~20 9 ~ lmn - ., r, n -~--"<fll!T -··· I I I I I I I I: I Ii \ :-:-9..·,.-2. s':.:.e:c::. o[ t.be , .. .-~u t~s.d shc·..:::.r:5 •:2..si.:c~, :c'...:..=::i seL.s, ·;2=: 3, access p-:irt, g:-·:::r~~, a.=".: e22..:.::3·.:.:-e. -~----.--:;--··5,• WELL LOCATION: Draw a location sketch sho'Wi.cg the direction and distance of the well to at least tvo (2) nearby reference points such as roads, intersections and streams. Identify roads with State Highway road identification =bars. I I I I I I I I I: I, I: I:. I_. I, I ,1 --' ' ·-· , .. _._,,1.-, 1- 2 :-,...1'-.'EP .~vr-:"-• ,w ' /' ' :..c;:?.:::s.s:?. (,' . 3-:J::.:: 3. '.-!c:--:-isville, ~L c. 4, TDP0G?..l.~':'-dr:J""&, vc!l"Y, sic P•, /'Ii 1 :100, /:31 - 5. 'J SE ,J,,: ·,i,::1_:_: ? L cnt o;.,2 9-21-72 S, D OES THIS Yr'E 1_L ~EPLt.C~ ON EXIS;"!NG WELL? 7. 1CT.!.L JC?TH -425' R'G 7y;:~ Cr!: METriGO: air 8. F Oi=:MAT!O,"i SlMPLES CCLLEC-:-EO: LJYES No. of Bcqs o. CASING: F ,om ROUT: 10. G F ccm 0 0 ~ 42 " ~ to 20 I nsi<:e W':l i I \hi QI.. o, ~6:\; weisht / fl. I3 "· Motuicl ~ ft cement pump 27 56 ~l II. SCREEN: Depth ~ Typf gnd Ootning F ,om to ft. 12. GRAVEL: ~ ~ Moleriol From to ft. 13. W ATER ZONES(d1p1t1); so• 14. 15. s C D y TATIC WATER LEVEL: osinq ; . l ft. ATE MEASURED: IELO(gpml: 2 2l fl. lllrdUI: below lop of ea1in9. ODOVI lend surfoe1. ELEV. METHOD OF TESTING: b· blow 16, P UMPING WATER LEVEL'. . '1. afl•r hours 17. I 8. ot CHLORINATION: WATER OU).LITY: Type ~pm. HTH --mCNnt 14 tablets TEMPERATURE(°FI ___ 19. P ERMANENT PUMP:{Sl'low a 1k1teh of well head on bacll of f~rm) Oat, insroll1d Type "'4akt Co~acity (Qpm) HP \nto'o Oep1 h Airlint Dt;ith 20. HAIIE YOU INFCP.MEO THE W2:LL OWNER OF THE DEPAiHMEN"':"S R::aut~EMENTS .:.N ') RECCM~ENOATIONS? yes 21. REM.lR~S'. . 1 do heret:y cerldy !Ml ll'IIS •!11 r~rd IS .rut ~rd UOCI. SIGNATURE OF ::::ONTRlCTOR OR AGE:NT OATE ~ r.,'ake County: ----,=~--~-----~ .-, i I c:,;; ii Llt!G LOS i'l~;)TI-1 I FROM ,n I Fi""'''lil.7:;'" nc-,_,...,.,.,Tun, 0 40 I clay 40 425 red rock 3 -:, ,::-C.:-ri ,,,_,.._ .__, ·, . .,/ 7 '.5'"0 c-<i ~!-' /...t CFU. -Test :i'ime: 0:00 -2 gpm 0: 10 -2 gpm 0:20 -2 gpm 0:30 -2 gpm -~ - R,t,Lti V tu ~ i~ ti,(,s. r. n .• -. .... u,.~ .... ' . ; . :: ._ ~fl• I·. • .. . .. ~.3l~i1<·"! • 1'I (' . .. ~·, Whit• rnnv. Office of wa:er and Air Resources: 61ue • Drillers Coov: Green• Owners Copy I I I I I I I I I I I I I I I I ! . I, i I ,.;.,:_ _ __, .--,.,-;::--;----~·. ~-------.1, WELL LOCATION: Draw a location sketch shoving the direction aod distance of the well to at least tllo (2)·nearby·reference points such as roads, intersections and streams, Identify roads vith State Highway road identification mimbers. . --' . ,, ", ·~ ~ --~ '..\ I I 11\i::Ci I y,,_,__ I Eeate.r GROUWJ WATER DIViSIO:l C.27511 l I County: _l·l_a_k_e ___ ---,-,.------ -----,......C:;...:5:.,~--~----~---=~-~----------Ouodronqlt No. -~~~-'~• _:...~•~U..~: ~·--' ,·-::-:::: '.....::mm..nr, ;J s.~:ll'YIS•0"1 :Jlid Lot ,-,.o.l 2. r,.,:,.,£~ Ko,....-;::,r-rQ..,.,-a.-v 1 ,.,c ' a. -,_, -, ~ ~-. -'· I 4, 5. 6. I 7. I I I 8. 10, II. 12. I 3. , •. 15. 16. IB. 19. 20. 21. .::;:~E3s: ? .o. cox a' ~or:-isv:.Li..e., N. C. 27560 TO?CGRA~ drcr.. 'to:IPf, slco.e, Millloo, t_:rt t.:SE CF WELL: Plent c~ 9-25-72 DCC S THIS \lr'EI_L ?.EPLt.CE A,'-4 EX!STIMj 'HELL? 450' air TOT~L DE?TH: RIG TY?:: c.=: METHCO: FORMATIO,'-' SAMPl.ES COLLE:":EW: LJYcS No. of Boqs CA.SING; lrisidt Wal I !hide.. o, 0 Depth 22 ~ wci5r.v:3r. ~-Frcm " ''· GROUT~ Depth Material Method o, 20 =t !7=P" Frcm lo ,, SCREEN: . Qu!Jl .Q.i.Qm.. Typf gnd Opening From lo fl. GP.-1VE:..: Oep1t, 1L!! Mcteriol From lo t I. WATER ZONES(dtplh): 55 1 20 -STATIC WATER LEVEL: "· lop of cosin9. 1 b.110• Casing is ft. ObOVI lond surtoc1. ELEV. OATE MEASURED: YJELO(qpm>: ~ METHOD OF TESTING: blow PUMPING WATER LEVEL: fl. ofllf hours Of ;om. CHLORINATION: Type 11TH Amount 14 tablets WAT~R QUALITY: TE"'PERATURE(°F) ___ PERMANENT PUMP:{Show o ·~ketch of ••II htod on bock of form l Oort in1tolltd Typt Moh Coneity (;pm) HP lnt011.1 Otpth Air lint Otpth HAVE YOU INFO~~EO THE WELL OWNC:~ OF THE OE0ARTMENTS RECUIR~~ENT.S :.~O P.E:O,vH.4ENOATIONS? yes RC:M.l.RKS: I ~o !':rrtby c:1rtily 1h01 this ••II rr.:r:! is I t'JI co< uoc:t. SIGN~ OF CONTRACTOR OR AGENT OATE -DP16U~G LOG n,o~ l='Rn."4 T•' ;:"f"ls:JL\AT1no.J r'l!='cro,oTl"'"' 0 20 clay 20 450 red rock 3 :', 5"5" 0 0--0 75"5'°0 o-0 R 'SHLE r r:--1; .. Test T me'!' ; ,JU -'! gpm ' :40 -\ gpm :SO -\ gpm 11 ;00 -\ gpm - -,-..,.,....,'Y-< 'TT""-r,,. . J.. .L\..,, .L, .l V L LJ ·-·-\.A,I .... ~ N. C. Ot,J~ of Ihm-& Air Res~""'"' ""'"Ii"-<>-,,;, I I I I I I I I I I I I I, Ii. Ii I WELL LOCATION: Dra"' a 1-:.cation sketch showing the direction and distance of the · "1811 to at least two (2) nearby reference points such as roads, intersectiotlS and strea.ms.,. Identify roads "1ith State High"1ay road identification numbers •. I I I I I I I I· I I: I, I, I, ' i [,. ,,c~ ' " I OFFiCE QF 'N.i\TER MID .i\lR RESOURCES r,o,~,1,11 n "1•1 -1 FR 01'VISIO'I -.,,1V ... ,L •. II,'"\ -\ 1· ,iell ;) J p O f10X ·z-··-R'I F1GH " C ?Yl' . ,·;..) ,u:J/ \t',--1 1,r1. .... ,J 1 :::::.'-ir->.lC":"C.~ t"!eater Well Co., l:::c.. .:::Er.. no. L WELL CONSTPUCi!ON ;i€?l.llT NQ. Wake Coo..11ty; -----,,-~~~----- Le: .~o.) ____ C:i.:.::dronqle No. .J '-f-r c..l,, 2. 3 4 5. 6. 7. B. 0. 10. II. 12. I 3. I 5. 16. I 7. 18. 19. 20. 21. :'HNC.?: ' '--V--' _: J' • ' ,, .:.:::OREss:? • n Svx 0 ~'.:::r:-is·:i l. le, N. c. 27 56 ~. ~. TCPOGR A~-rr: draw., vol!~. ,lo;•, r-.i!lfOCI, l!ct L.'SE OF 'nE~L: plant - CATE: 9-28-72 DOES Th!S i'w'ELL REPL~CE A,S ~XI STI ~G W~LL? TOTAL DEPTH: 300 1 RIG iY?t.:: OR METHOO: air FORMAT JON SAMPLES COLL~CTE~: c::::J YES No. of 809.s CASING: !Mide Wol \ lhidl. o, ~ Oio&t w11i9~t / It. rw-From 0 10 22 Ir. (3 ga • GROUT~ Depth ~ ~ From 0 to 20 fl cement eume ... SCREEN: Oeptb ~ T112! gnd 02tnir,g From lo f '· GRAVEL: Depth ~ Material From lo rt. WATER ZONESldopthl: 30 ,45 • & 75' STATIC WATER LEVEL?O -f I. rap of cosing. l below Cosing ; . It. obo"e land 11.1rloc:e, ELEV. ' DATE MEASURED: YIELO{qpm}: 10 t.lETHOD OF TEST1Nd?low PUMPING WATER LEVEL: fl. Cflff· hours OI gaTH 24 tablets CHLORINATION: Type A"'Ol,N\I WATEP. OUALITY: TEMPERATURE("Fl __ PERMANENT PUMP:tShow o ·s,etch of •tll head on bock of form) Colt installed Type Molt Copocity l;oml HP lntak, o ,pn, Airline 01pth HAVE YOU INFORMED THE WELL OWNER OF THE OE?ARTMENTS REQUIREMENTS .!.NC RECOMMENO.l.TIONS? yes R~MARKS: SIGNATURf: OF CONTRACTOR OR AGENT DATE CH<. /'1/:"P"'' ,ROM T-~ 0 20 20 JOO - Test ~ime: ORI' L','IG LOG ~--. ·-·-·· "l~"'".RIPTinN clay red rock ) ,._ ","j"a 0-0 7 ~so a-,'J <, l+LI=: c_ Ft 1 1 :00 -10 gpm 1: 20 -10 gp• :30 -10 onm n T'I , ' • , ' ' ,--,-, ~ .a.~ •,-,.;I, .l V L, LJ -~ ~= ~~ ,., -',.,, ... ... • ' . ,~. : ... Cf~t. of W.ater ~ Ait Re5n~<'~ ?..11!11:,:.'1, N. l., I I I I I I I I I •·i· 1 .. I! I I 7e.::ts, access po:-t, grcc.t, a~,.:: e2clos1.J.:e. WELL LOCATION: DraY a location sketch sho1ol'iog the direction and distance of the. Yell to at least two (2) nearby reference points .such as roade, intersections and streams. Identify roads \<lth State HighYay road ldentification munbers. ' - ':· I I I I I I I I I I I, I I I Ii 1.- 1 i ' 1: I ! ' OFrlCE OF WATER AND AIR RESOURCES GROU:1ID \'/ATER DIVISION P. D. BOX 27687 RALEIGH, N. C. 27611 ,i,.--=:'_·_ :__:::.,o;: {S,--.:-: s~~ of 1~, ioc::_~::in :i/\.OCi;l, of fqrm\ :-.~cust T~ · ~'J::-r:..svt 1e .10:-tn .... aro11tla ;;:;:3.:-:<.-:-:i:-e~ Co. l , I j/1/ ,Z WELL CONSTRUCTION .:i£R.1,,11T .'lQ. Count,: ---'-'',i-"a"k"· ·'-~~----- • Qucdrongl,e No. ,--:-!....!.... ·=-( ·j ;_ .-.x~, ,_..:mr....nit7 or S·.:oa1v,11ai :ind Loi No.) 2. E~ ... 11 A •·;,--i:1~-0--':'i'r'N ' '' :_;,:-;:i r.~ .• . ;:. .... .. '. 4. s. 7. a. 9. 10. 11. 12. 13. 15. IS. 17. I a. 19. 20. 21. ~R£ss:?. -2 ~ Sex ,-oO, ~-:n:·7:.s•1i:!.. l~, N. c. TC P0G?. APHY. dra-a, vcllco,, 110~. lliltloo, flat - USE -')F '"'E!...L...: howe D.rE: 8-11•72 c•:E S T!"i! S '..-€LL RE?!._ACE ON ::xJSTING 'tlf'Elli' no TQT:..L O~PTH: ?SQ RIG TYPE OR MET'r-100'. air FORMATiON SAMPLES COC.U:CTED: LJYC:S No. of Bo~s c.:..sr,-.;G: lnsidt Woll thidi. o, Deoth ~ 6\ •tiSJhl / ft. Ill! F,:m 0 --;;-21 If. [3 sa GROUT: Dep11'1 "4o!eriol Mtlhod From 0 20 ti ~men t 7'urop lo SCREEN: ~ . ~ -'-•· Ti1a on~ QRl!!ing From to fl. G?..l.VEL: Oeolh ii!!. Material From lo fl. WATER ZONESldtp"l: 2001 35 -STATIC WATER L.EVEL: ft. tap of c01in9- 1 below Cosine; is ft. obo.,. land sudoct. ELEV. DATE MEASURf:O: YIELD(gpmr, 3 METHOD OF TESTING: blow PU"4?1NG WATER LEVEL: ft. ofler hours 01 gpm. CHLORINATION: Type HTB Amount 24 tabl WATER QUALITY: TEMPERAT\JREl"Fl ___ P!Alr,IANENT PUMl>:(Sr"tow O .sk-'r:h of •ti! htad an back of form l D019 inlfolltd Type Molt C:pcr:ity lgoml HP lntol.1 OtQlh Alrlint o,p1r, HAVE Y'J'J lNFC~MEO THE WELL OWNER OF THE DE:PJ.AT"-IOITS R£0\.JIAE."4ENTS ANO RECOMMENDATIONS? yes REMARK:>: . . , I do !'l.r.or _,,11!y thcrl 11'111 ••ii rtccrd 1s lrut and ooct. S;GNATUR!: OF CONTRACTOR OR AGENT DATE c;<,11. DRii LING LOG -- ""-· •R"" "" /'\l:'.",.."''DTlr"ILI 0 19 cLay 19 250 shell rock LJ.- -::,_ T <<o c---., / .cr~o () 0 . <: (-ff_!::. (J FI 1 Tes • tune: '+:W • j gpw I 4: 10 -3 gpm 4:20 . 3 2pm 4:10 -3 nnm - f '-'{" .-.,__r .; . ::--<_ , ,1 ..,. , ~ . -'1 ::if;.? -~ 1972 \ ri! r, "'.'e.·~•; ~ ' :;1 •. 1 .... , - I I I I I I ., I I: •r Ii I ! 11 I: I, . ,· 11 ' ' Ii ' (. 1. \· I, I I, I l - ske:.2~ o[ th8 w-~i._:_ C.ec.j 3:.ic•·•·~;_n.g casj.:::g, ?L.-:-.~ 7e::.:s, access po::-t, g:--ou.tt a..sd es:losu.T~. WELL LOCATION: Drav a location sketch shoving the direction and distance of the· veil to at least tvo ·(2) ·nearby reference _points such as :roads, intersections and streams.·· Identify roads vith State Highway road idantification Ill.llll~rs. · · · · · · ./:z. v Ll.l- -----------I I I I 2 I , S. OFriCE ,JF WATER AND AIR RESOlJ:;CES GROUND 'I/ATER DIVISION P. 0. BOX 27687 RALEIGH, N. C. 2i611 Eeatet Well Co. REG. ,'lO. ":'.'-'-L0CAi~: (Shew,? s~~t, cl m, 1oco1ton on bock of form) .~ottsl To-wn: :'10 ,, V · l i occ -•ee Rd ,4 a Cc C • 1," l l. , F'.C-Od_1 C~:mur11JfloJ}ubd1v1s1cn and Lot No.) :",-,:',"E.=?: ,~1. ie :..ar :-'!_r:i • ' ~ t. 2, Cox 102 ~~rrisvil le, fl. C. .:....:c:F-Ess: "'"OT).. T:~AP,-,)': drc-., vol 1"1, s!c o • hitl!OD, flat <RnM r,o ·s~ '::F WELL: Hocie DATE: 8-13-75 100 200 WES i~IS WELL REPLACE AN EXISTING WELL? .. T0T ~ L DEPTH: 200 RIG TYPE OR METI-100: Air I 3. F ')R\ol,HION SAMPLES COLLECTED: LJYES No, of 809, C.!.S!.'-IG: Inside Wol t lhidt. I or ~ Diam. weight/ ff. ill! . F~::;r:-. lo fl. ~ ~,,. ,-. ,,J.'''1..,.·.,1, Depth ~ ~ r"rom lo fl s :.::.:: c:~: Depth .2i.2.m... Type and Ooening ?'rom 10 f I. ·---- ~~t..',EL: Depth Size Maltrial f°'.-::rr. 10 ". ·HATE.~ ZONES(d1pth)'. above 5Tt..TIC WATER LEVEL: ''-top of co1in9. below I CJSin~ ; . II. abovt land surface. ELEV. ':.lTE .'-tEASUREO: ' YIEL:>(q0m}: . METHOD OF TESTING: Blowing _., ::•.;MPING WATER LEVEL: ft. ofter hours " •tr.rn 42 Tabs. -:l-iLCRINATION: Type ... mount -,lt".l.TErl: QUALITY: TEMPERATURE("Fl ___ 13. P:'.R!-,1.ANENT PUMP:{Sho• 0 1klfch uf ••II htod on bock of form) Dc:t instatltd -Typt Mokt C :, : ::i :7 (9pm) HP i. L,r:: it Otpth Airllnt Depth HJ.VE YOU INFORMED THE WELL OWNER OF THE ::,:: ;..l:: C1-'ENTS R~QU!REMENTS ANO RECOMMENDATIONS 7 =::v.:.?~S: \/ell was Drilled Deeper " .. ; • J • ~ /· ,, I ( c I, /, .. ~· ->.) < SIGNATURE OF CONTRACTOR .OR AGENT DATE .,,.ELL CONSTPUCi!O."J PU!!,ffi NO. County: :.Ja,ke " cdrAnQI l'io ,c " ' DRILLING LOG ~-~1,4 ·-1f"I•• ,...~ ... ,.. ... ,,.,-,,.,. .. Red Shale ...:p_ 4 . -:;, cc,..., 7J?C,.., \II) -;- , ,· .. . -··-· . -... -., .. ,·_.,.., .. " . '-~ '. :r ' . ': ..... : : .: ,... J, Whito rnnv.nffirP nf ~tPr ::uvl Air RP~nurces: Rlue-nrillers Coov: Green-Owners Coov >-I-z :::> 0 u 0 w • ~ ·, i ~ ::x l'' u R H A . , ,,,. - - -- -- --- --- -- - I I I I I I I I Ir I I I 1: I GFWUiW \'/ATER DIVISIO'I P. 0. SOX 27587 RALEIGH, N. C. 27511 \).J ~ .9~G. llO. WELL CONSTRUCTION P~qu1T NO. 2 '..lake 1: County: __ __:c..:,:::.,:__ ______ _ flOrr1sv1.Lle, t~.t...., nwy-.. .)4 -r4 ~ -----=-~~----~~--c=-=-.-=--..,.,c---r----------Quooronqlt No. ..J .,__ l Rood, Corr.muf"lly or $ubd1,o~•cn and LO! No.} '::"-WNER'. Bnsbr,3 □ger Eoterpri ses -"JDREss: Box 157, Cary, N. c. 27 511 DRII LING LOG ' T OPOC,,P.A?H'r: drc-w,, 'f'Oll4'y, 1!op•, hil llop, flat i:;-Qr M Tn - ~. u SE OF WELL: home DATE: 7-7-76 0 18 elev 6. DO ES THIS 'w'ELL REPLACE AN EXISTING WELL? DO 18 180 shale 7 T OTAL DEPTH: 180 RIG TYPE OR METHOD: oS~ 8. F ORMATION SAMPLES COLLECTED: LJYES No, of BoQs o. C ASING: Inside WO 11 lhidt. or -· OtpH\ F ,om 0 lo 22 ft, 6~ wti:r /11. * . r -m. ga v. -.. 10. G ROUT: Oep!h ~ ~ F ,om n lo 20 f I cem.eot blowi-ow; II. s CREEN: Oeplh ~ T:i::a and 025nin~ F ,om 10 fr. 12. GRAVEL: Depth Moteriol Frorn ____ ro ____ fr. I,. WATER ZONES (dtplhl'. __ ,1,.~,_·u,•rc_ ____________ _ ~--+---+-------------- 14. STATIC WATER LEVEL: JQ ft. obo...e _...,..~-below lop of cosin,;. Cosin9 is ____ rt. obo-ve tond surfoct. ELEV. _____ 1----+----1--------------- DATE MEASURED: _________________ _ lf----4----4-------------- 1 ~-YIELD(qpm~ l 5 METHOD oF TEST1NG· hlowini 16. PUMPING WATER LEVEL: ____ ft. ofltr ______ ,hours 01 -------~9P"'• I 7. CHLORINATION: Type_-=b,.,ta,hc:._ __ _,Amount 29 tabs. I 8. WATER OUALITY: _________ TEMPERATURE("Fl __ _ 19. PERMANENT PUWP:{Sf'Htw o 1Hlch of well head on bocll of form} i Oat, installed _____ Typ1 ______ Mok, _____ .._ __ ....,.._ ___ ...._ ____ i.;.··_:._·.·_,, ~-_,_·_-_,_·_-_--_-_· _· ----''- Copoci1y ____________ (9pm) HP________ L_.. lf----+----+-------~,-''-'·'---'''---- ln10kt 01pth _________ Airline Otplh \. . -.J . , .. 20. HAVE YOU INFORMED THE WELL OWNER OF THE DEPART'-'lENTS REQUIREMENTS ANO RECOMMENOATIOMS? yes \J' ',.: ,.J •• .··, \, 11 :\; i_:1:-:· .. ; : l \ 21. REMARKS: ----------------------11----1-----l--------1-'"".:....:C'-"-'-'-'--~---- ctrt1fy lhol ltus •tlt record 11 ltut and tiocl. C'? /2 _ _;u c'L'z::vv .C.c:; R.B. Heater, Pres, t 11-5-76 SIGNATURE OF CONTRACTOR OR AGENT DATE Form GW-4 White Copy· Office of Wate, aoo Air Resoutces; Blue· Orille1s Copy; Green· Owners Copy I I I I I I I I I: I I, i I ! _\ ~ •. ' l.: / o' . j l~ ,, ,,. . :: .,.,,. ~ ' ~ \ · .. '"" . - rt~-:-._ . ;, ' = ' ~ i . -l •. ~ "' _;.:.. . .. ( --. . ,. .. :. ·.!-, . I I . ). }.: 0 o,.- c ,. X , I / I COUNTY I I I I I I I I I: I I, I I. I jwELL RECOROj DRILLING CONIBACTOR 1-WELL L0CATOf OFFICE OF WATER AND AIR RESOURCES GROUND WATER DIVISION P. 0. BOX 27687 RALEIGH, N. C. 27611 REG. NO, lorm) WELL CONSTRUCTION PERM!T NO, .~orut Town: -~'l!;~~~~~-----------------Co,nry: ~4,,L<~~=------- ---:::c---;-;r=,d-~~,:S,.----;;-;-..-;;i;-;;;;;;-;;;;;-;;--;;;,rot""W.-i _________ Ouod ra nQlt No. _____ -_;,:::fe_'f-,_'_-;,"-= 2. ' OWNER: AOOREss: ,,.., • ., r, - gc;__ y I, ~v'.~ /7, C. , 4 T OPOGR APHY: dn,-., vollry, 1lop1,~ flat SE OF WELL: 6 f◄ &i:( -DATE: /-{_~ -7 z_ 6. D OES THIS WELL REPLACE AN EXISTING WELLi' itft:_ 7. T QT.AL DEPTH: (_':;J-t/ RIG TYPE OR METHOD: 8. F ORMATlQN SAi.iPL ES COLLECTED: LJYES No. of BOQS CASING: !nsidt Woll lhidl. o• F D,p1ri Diam •tift /fl. ll.a, D " :2.1 ,, ~ ,om 2 • 10. G F ROUT: •om t> Depth lo le> Md:::.t'-Melhod SL_. ,, -~ , ". ,2. 14. 16. 17. I 8. 19, 20. 21. SCREEN: Qi2l!!. ~ Type gnd Opening F •om lo I<. ---- GRAVEL: ~ Size Moltrial From ro Ir. WATER ZONES(d1p1h)'. ~,/'~ ftp' I~-ObO'l't STATIC WATER LEVEL: fl. ~ lop of co1in9. Co1in9 is I II. obovt land ELEV. su oct. DATE "'EASUREO: 7 l' -zz YIELD{gpm}: :2 METHOD OF TESTING: ~ PUMPING WATER LEVEL: fl. after hours of 9pm. CHLORINATION: Type tit#, Amount ·tz;, WATER QUALITY: TEMPERATURE('FI ___ PERMANENT PUMP:{Sho• o 1lle1ch of ••II head an bacll of farm) Dolt [nstalltd Type Makt Col,'lacily (;pml HP 1ntolle Depth Airline Depth HAVE YOU INFORMED THE WELL OWNER OF THE DEPARTMENTS REQUIREMENTS AND RECOMMENDATIONS? ~ REMARKS: ~ I do he••·• crrldy lhot :his ••II r1cor~ IS true Ql'\d e1oc:t. SIGNATURE OF CONTRACTOR OR AGENT DATE OR\L LING LOG "' "" FROM TO C:-1"\0U ~Tll"'l~I !"'\,:'<.",-~iOTlr'H,J f') ,-(l(} •. A _,..,-J.:,-o IP~ Y v•; /. P;? I'? • 11, .. . I I I I I I I I I I I I I I I I I i I i I wELL HEAD COMPLETION: Draw a sketch of the well head showing casi:ig, punp ;~~ing, seals, vents, access port, grout, and enclosure-. WELL LOCATION: Dra~ a location sketch shoving the direction and distance of the ~ell to at least wo (2) nearby reference points such as roads, intersections 8.Jlli stream.a. Identify roads 'Jith State Highway road identification mimbers. I I I I I I I I I I I I I I ' I --. ---I :.:. ,_ -,-,~-I -: :. . :: -•.•;:-. --\.. -' ... ' G i '/ [:; i Yl 1JF ::i'/f RC·!U1Et'H c\L ·".::.,·;,;;JC.i'''.E:'i I G~W~:·i~;.:ATE~ SC.Cl :·:,ti P.·~1• :ox 27~ .. ~7 -;J.LEl:~~, :'!,(, .·:o. 1 2 _,, l iOL ____ 1_6_3_6 _______________________ 1,)ucld r ,:ing le .'lo. ____ :::S::,_ _ __,'t--''Z-'--------- 2. e:-,,.~:ER: Bern Bullard i. AcoREss, ,601 Lambshire DR. Raleigh NC DRILLIN(; LOG TOPOGRAPHY: d r~-~, valley, slope, hi 11 tO!), flat (J 7c9.~~ne l DEPTH fROM TO FORMAT IO~l '.:i2SC?,!?7:Cl;'I s. use of '"'ELL: -~HLo=m~e~---DATE: _ _,_7.c-__,2s..5.c-c.lc.7,_ __ _ n 1 <; c·nd clav 6. DOES T!-1!.S ',.;EL:. REPLACE AN EXISTING WELL? !:lo -70Tr1L ;)E?T!-1: 200 RIG iYPE OR METHOD: {lj,i;: ' C ?CIC\ n.a el ,e o 8. FOR.MAT ION SA/".PLES COLLECTED: YES rlO 9. CI\S!NG: Depth !nsirle Wa 11 thick. type Di". o, 0 __n_ _ft_ weight/ft, F'C'Om ,o f, B st eel 10. GROUT: Depth M"terial Method rrom_J)__ to-2.Q_ ft Granite Blowing 11. SCREEN: Depth Dia. Type & Opening From---to---fc (Sh diltanca to ar up reference points 12. GRAVEL: Depth Size Material From ___ to ___ ft 0 13. Wi\TER ZONES {dC!pthl: 60ft. 14 S oro, f above f . , TATIC WATER LEVEL:~ t.belowtop O casing Casing is _l __ ft. above land surface ELEV: . 1 S. YIELD(q?ml: .'4ETHOD OF TESTING: 16. PUMPING WATER LEVF:L: ft after hours at gpm. 17. CIILORINATION: Tyj:,e s:Ili Amount l 8 . WATER QUALITY: TF'.MPERATURE (of) --- l~. PE~'1ANENT PUMP; Date Installed ________ _ Tyi=,e ______ Capacity ______ (gpml HP __ Make Intar.e Depth~--- Airline Depth ______ _ 20. HAS THE OWNER BEEN PROVIDEU A COPY Of.THIS RECORD AND INFORMF.D OF THE DEPARTMENTS REQUIREMENTS A.ND RECOMMENDATIONS? yes 21. RE:1/\RKS -------------------------------------------- 1 do hereby certify that this well was constructed in accordance with N.C. Well Construction Regulations and Standards and that this well record is true and ~xact. r_1>;J; ,1._ C:-, I I I I I I I I I I I I I I I I I I l I __,,, :;!·1IsI0.•J OF EMV[R,:.•1. ... .::~n:.L .'\.:.,•I:.~E~E.'<T, .:.~.ou~◄L.i ... ATE.;;. P.O. :lGt 27fd/ • :i.ALE!GH, ,•LC. 2/S:: lJRILLD!G cc::-:'?.AC:'OR Heater WE 11 CO . :'.5::G. :;o. 1 Co. He.;)-" 5 4' ~-~"'c..;..J-.,...-'?--.-,----:-~...,...,.,.---------,--,----,--,-------'('udd r.:. :1Cj ! 2 ~IC. (?.oad,Cc:':'r.,unit'j.Or' s&bdivision and :..at No.) Wilker~on. Contractor 1 , , oo RE s s ,'-':i.""1._· =--9--"Wc,,__,~..,_1,aa.Ly..,_i1,.,ae..r.__,,d__,_R"'d=-.!... • .,_, -"C'-'a'-'r,_vLL, .::N'-'C'----2::..:7 5 11 c sern · ft\,~H---00 4. ':'OPOGRAPHY: draw,valleyrs.lope,hilltop, flat(circle ana) 5 , L SE OF WELL , _ _iO.u.f_..f_1,1.' ,_c..,e._ ___ DATE ' 6 -2 3 -7 8 ~o~--~l'-=8'--------'s""'a,n d cl a~y __ 6. DOES THIS WELL REPLACE AN EXISTING WELL? _ _,n.,_,,oc_ __ _ 18 400 shale 7. TOTAL DEPTH: 400 I RIG TYPE OR METHOD:_~a~i~r~-- 8, FORMATION SA.XPLES COLLECTED: YES NO ______ _ 9. CASING: Depth Inside Wall thick. type Dia. or weight/ft. From __Q__ to-1.l..Et 6¼ 13 1 b s . b 1 ack s t:.:ecceccl::_.. _________ . _____ _ 10. GROUT: Depth Method -------------·------ From _Q__ tol.lJ_:t ~l)l)Ut blow -------------·------ If add1tl.onal space 1s needeo, u;;-!0,lc<O.:"'?'o"rin 11, SCREEN: nepth Dia. Type, Opening From ___ to ___ H ___ _ LOCATION SKETCH (Show dhunc.e to numb•red roads, or other ai..:;: re·~enc.t· potnLs) 12. GRAVEL: Depth SiH Material From ___ to ___ ft ___ -'- 13, WATER ZONES(depthl :_U.L....----------- · c r: above 14, STATIC WATER LEVEL:--Jl.JL ft.belm,top of casing Casing is_l_tt, abo~e land ■urface ELEV: 15. YIELD(qpml' 3/4 METHOD or TESTING,..J?low. 16. PUMPING WATER L!VEL:. _______ Et. 17. CHLORINATION: Typo-HTH Amowit ____ _ 18. WATER QUA.LITY: ______ __,Tuu>EnATURE(oFl __ 19. PERM.ANENT PUMP: Date Installed, ________ _ Type ______ Capacity _____ (gpm) tlP ___ _ Hake ___________ Intake Oepth'------ Airline Depth _____ _ 20. HAS THE 0\-oNER BEEN PROVIDED A COPY OF THIS RECORD A.HD lNFORKED OF THE DEPARTMENTS r~L:O,UI .:ME. T:; A:/0 RECOMM.ENOATIONS? __ Yue~S:,_ ___ _ r,''. 21. REHAlSJ<S _________________________________ _;,_;_ I do hereby certify that thia well waa con1truct•d in accordance ...,ith N.C. Well Con!::' C'U,~! io,1· Requhtion• and Stand•:::::?3/.this ,w•ll recort·i•-,.~u•~andfoct. •~ ~~R OF AGEHT<l;AT? AJ.Nf lUJ / I / . ·•' ,, ,o I 1, '~ I I I I I •• •• I I I • I I <I I I I I I I I I I I I G?.OLJ1'-lD :,,.',.\TC:r\ D I;i IS:C~i Office· of Wa:er & Air Resou=ces ·0 We L l ~ :.ic a ti on --'\-'--, .:.\ ._,,,-"---'o'-. "'' se...s· L':.sL,.i..:;>-".__ ______________ _ (Town, Corrrn., Subdivision and Lot i;o,) Address WELL CONSTRUCTION !--\uG~oN 1_\.)fl'w ('.__<) County { \ Cl.• '= Road/Street I Drilling Contractor Name Address Meets Min. Standards I I Measure. ill Permit Location Distance f rem I Pollution source Other location standards I I I I Total Depth Casing Depth D iarne te r Weight/thickness Height Drive shoe Exception approved by owner Grau t.: I Type Thickness I Depth Sc re ens Deve lo omen t I. D. Plate s1~ ;i,o ),0 I : Abandonment ( eere~H• ry/ permanent) Water level I l I Well test Ch lor ina tion Cutti"n:c:s Reper ts Hater sa:-:i.ple (appearance) ------- IC v---- 1/ \,-"" NA v" v NA 7 7 7 1. v-- Remarks 7 Reg. Ir I I I· Enclosure Encl0sure floor I :::asinz hei.:ht Access port Valved flow Na:1:.e Water tight oipe entrv Well entrv Vent Hose bib Tee (jet) Sucticn line Chlorination Temporary Aband. ~easure Address Meets ~in. Standards Yes No NP. V NA V I I I I I I I D a te we 11 Cons t ru C t ed _ _.O......,c~.1-.,,,.::cc.:a,fl..,, s~· '"'R~ ... ' ....;7+, -'-' 'i.J......;7.::3=----, Date Pump Installed _______________ _ Witness I . : Name Address I Name Address I \ I I r \_!~~ / \ I I I \ ,o-r-' '/ ' ' ti:>,'l.Q. .... \,)!\ . .', .. C: '-lQ;),.__ ___ , \ \J r ,'-' <;::. c,. ,.:- ii I I I Reg. ii Rer..arks Signature Type Type \ \ I \ I I ,\ I I Gl\Olf•;~ :,.;';..T~? D£'.,r:[S~i):,: O~f~ce ~f Wate::-& Ai::-Reso~~ces 1 · )•,,,T,'2 ::-____ ,_, ~··~~-e-· ·-',-c,~'e-·'-'----'-\'_._,. C..:_·_' ----~---•-'--'-'cc-'e-~~--------- \:idrE S S ---------------------------- I WELL CONSTRUCTION Road/S:reet_~l-~_O~b'-~-~/~0"-'-~'--- Well No,.).;,\?...--tz. 3s ::, 1 io I 7 S So .3 t I Jri 11 i ng Contra c to r __ V"'',.,'-'"'-'-: ·-::_! -"-,"::--=o.:...' --~-~--' ..:-0-'-'·,~·;-"I .;..' .c"-:c.·c,_~''--'-'---.,-,--,----------------7:_:f __ _ i'Jame Address '· Reg, .'f -, W -: l L I , L '" Penni t I .,ocation Distance from I Pollution source )ther location Standards I :otal ,Depth Casing I ;eptlT I. , .)iarneter I '·/eight/thickness ! !eight . I ·Urive shoe : :xception approved I lly owner rrout: i . . 'fype I_ -::hickness Measure I 7 !,- t,o I 1/. ... / ·:. , I ·Z C:- ,z_, 0 · Jepth -z. () I S~reens ! .:)eve J occ-.,,n ~ I T.D. Plate i: _.tian,:,;ome:: t ( ·t,P.moo ra ry/re :maner.t) I':!,, 11 t,c· s c, \ :l1lo1·ir.a~.i.or. Meets Nin. Standards· Yes No Remarks / ~ ,/ ,.,/ v ---.__..,, v '' I I I ·.-;~ter t-i g:-1-::. pipe entry ·:ent I '"'""., Bi':l 'c;ee (Jet) I S1..:.ctio~ Li:-1e .:'hlori:1ation .'\band. I IJ5.te W-11 Constructed ~; I ..). Ot-;,I I C, .' , ""-r 0?.te Punp :nstalled I I .. 'tness I I Na'!le I , Narne 1· / .. I j ' i / I ', I •• '---I - ' ;·,-_::5" i_ = i \ f -, --,. r✓=o~q,s•J '.--~-= - I I :· I -. -1 -' - I -' I; no -;--,. ··1'1('\ .:.__,,,';~~<'"".~-; Signature Address Type Address Type I I 0•~::.-:::: ----~,,.. ''. ('. ~ - G~C~'.D :•'.~I~?~~-~~~~~: Office cf \iater & ~ir ~esources ~ ---; . .:.... .. _;::_;:_ : ~ -:.. Area ------------ I dd:-ess _________________________ _ Road/Street i b : 7 --''----"--'------- 1--====================================~r,J~:~-' ~~~~' :::' :::::;,=~~e 1~;~:~o~~=·,)::/.:,~7'1=:=c-~c,v-..~3~~==== WELL CONSTRUCTION ~ v ,~ e ~ ~ I Drilling Contractor_-1.[~0A..:....:.-~s~-f1~~~:Z~-0.'~~~EC~-~L=L=-------,-,-,-----------~' l~:J°<--_-,,----,,,- Name Address Reg, # I ermi t I Location : ,istance from Pollution source I · ther location . tandards I Total clepth asing I Deotl:r · iameter I .•. Weight/thickness : eight i 'uri vec shoe 1,-xception approved J. y owner 1,Grout: · ! :,1pe l_!hickness , epth I S,:,reens . i._ ?ve J ocrr.:n t Measure t Y:t ./ 'i'~ J.u Meets Min. Standards· Yes No 1:s}A .....- ,__.- ---- Rema:rks -P\..L"'? ,-.!cv f-:c'~-._ ·c::.n'), r\~ u~ 1'.:o\d 0 1.-\\·:.r,, -..:::-.sN b I I fes :"Io Remarks I :::ic los,_:re ;'.nc lsoure ?loor ~ _,,,,--- I Casin.s Hei:Sht ~ccess Port I. D ~ ✓ I Valved Flow ·,1ater tight oioe entry , \IA i ,..,.,---- Vent I -~o~-~ Bib ,c::: ·ree (Jet} /\le:, I Suction Line 2hlorination ,-..j, p, NA I Temporary 1\band. ✓ I Date Well Constructed Date Pump Installed I Signature Name Address Type Name Address Type 1 I D r--LJ .... ,.. I I I c:.::_~:=,. ...... _~:..=-. ::·.-:::,3:c:-: Office of ~ia~e~ & ~i~ ~esau~~es --:, ' Ji.-..'";,!.: :-___ ___c· ·.:.."'-''"--•cc:=:.;:"o..-~· _ _,_,,-re.'.:..·-.:..· _,,~·-c'-i =-' -",._,•~--------------- • ddress ___________________________ _ Date __ 5,f---/~R'-l-/_'7~, _,_✓_· ___ _ A::ea ___ 7'------------ Roc..d/Street /1~ 2 7 -~-'--'---------,,:-We 11 No . -Z --, '-i '--•__i__, -Z... I WELL CONSTRUCTION 3 S-'.,u '-r \' / 71 ,o 3 (" .Drilling Contractor_---'(.:..0--'.p.---'-' S.=c!~C__;_f<:..=__1~~.:..~~-,-~~=-~-=:::=-;:_, __ ~•-I.:..'~✓'-"'"'-.,.-,--,--------------'-' '~s~----- Name Address Reg. if Si.-.)'·- J o I ermit .Location istance from t'ollution source 1-ther location tandards 1Tot2.: Depth , as1.ng ' Depth" I ·iameter ' 'weight/thickness I eight 1 urive:, shoe l~xception approved \ y owner .Grout: ( '· ype • Thickness epth i . . ' . '5,creens I evelocment 'i .D. Plate Measure \.o -· b,,nc:oment ( ~?.moorary/p.oP!!tat!'.:!.!rt 1 .. -,ll t,·s•, l1·11 lo r·ina :-. i :::-: l II L:.. i ~;;-·~ Meets ~!in. Standards· Yes No Remarks I::: le,, ..,,.,..--- v '7 ' J I I I ;:-.lori:ia tion 1 ':'<:::1oore.ry A band. · 1 J2.te l )::.t~ Wel 1 Const1--1cted ?'· ·= :':nstalled I I I I I i I I ,. l I I 't-ness t )'\I I \ N21I1e :io \/ A 4 r I Signature Address Type Address Type 0 I I I '.-.;~ l l ~-:.: :: ::::..-:.~ _ _;·_._,n~""'''-'.''-'. ,c,·'·-""'c'''-'\'-'\"c:..=-~\-J'°""_,,l-=--~--~..,.--c--:----,----1 :, .:.o·,.:., C'.o:.":":1., SubC.i•.-is:..-on c:--.-:i ~ot ~-:c. _)·:::•::~--~_; ,:1.---. ~.:...., ,· ., ,...._, \_,.,, I !,dd res c_U~. ''-.\_· ~'-=-~-12.,"""''-"-"----~-'~~('---<--'\ 1_,\..c..c:~; '-'-' ''-''-' ,_\_\.o.e~~G:'-' '--.c....c·------ \.lELL CONSTRUCTION Da. te \<:\ l\>> · i::,, 1 ..=..rea 7 Road/Street \..., ~ -~~~------ We 11 No. ._\:i '\'L ·\;:.. \ I I . Drilli:-1g Contractor )llv;,\c..y,J ~ \;\),\\ic,,-.5 \.)J-.\\ <::',. -'-\Lis;· S \-\\~\.ere \\:, 'l.77u7 Is; Reg. # I Penni t Location I Distance from Pollution source I Other location :Otandards Total Depth I Casing Depth I. Diameter \ '.,eight/thickness I I f!eiiht D.ri ·,c shoe ~xception approved by oi.-mer Grout: · 1 Type Thiclrness I Dept:~ I N a'lle Adcire s s Meets Min. Standards. Measure Yes No Remarks J .I ✓ .11 1 j .j '7 ., ? NIA 7 / ,j I I I \·later tight :;1i;:,e entry I Vent !-los' Bib I Tee (Jet) Suction Li:ie I Chlorina tiun Temoorary i-.band. I Date Well ~onst!'ucteci I · Date f',Jmo Installec; I I i I ' I ' I, I I: '. \ I ' ' I 1:~. ,:,ness ' Na'i'.e \ \ \ \ \ \ .. =-~ LJ 10/s-/·13 Address Address N ' r ;---------------- / _Signature ___, ... } ' . V' tt:r'-''> < Type N I I I I I I I I I I I I ' I I I I I \ ' I I ' 2. o "NE R :_D_L._ .,,T ·1 :n e s E , c, l l P J r .. _. i. Aoc,REss,___i;o,, Hampton Val le,· [0_ .. Carv ~ . u ; E OF ;.; £ [. .L : -~h=oe<mu.>ec ___ _ 6. OJES THIS WELL !U:'.Pt.ACE: AH EX:STINC Wf.L!..? __ ...llil ___ _ 7. TOTAL OC<TH, 1 Q Q ' RIG T'il'E C·R M:::·;:·oL : __ __a_i_r __ C. FlF-"1.ATIC~ SAf!P!.tS COLLECTED: YES NO 9, CASING: Ir.side Di,i. ~all thick. tJ~e or -,.1~1.;:-.t/fc.. ....,C// ,;R~L .. [~I".'; :..~G -------·-- 1) ___ -~.6 __________ sand clav ~ __ L_r~, n~-_______________ _ ----------------- :'J' _Ll_l]2_;;~_ ...l.l..LI..;~ t cc 1 _________________ _ 10. GJOUT: Dept:; Me.t~r ia '. ."le thrJd From _o_ tc__]_Q__ Et g rQu t --1'.Q ll •--· i.l d2d1.t1.:,n1l s.:,a.ce l!l n,:,P.ded, use .:,ack of form 11. S :REEN: Depth Dia. Ty;")c ' Opecinq F'rom ___ to !t L'.:'CATlON SKF.TCH (Shav di.1tan..:e to ;iwr.h,1rnJ ro.ids, or other n.ip re'.er•nce potnts) 12. GRAVEL: Deptn Size. From ___ tc ft ___ _ 50 ' 10 13. ,.,·rEI< ZO?ISS{dc,th) '--"-"------''--"--0isl20 __ _ - 6 ()' 30 ~pm -::: f"I above 14. ErM.'IC WA~ER LEVEL:......u.z._ ft.b~lowtO? o( Cd.~ing Ca."Jir,g is_l__ft. a.bovf! land •urfi..,ce J-:U:.,/: 1s. YrnWlgP"I ,_.,4c.,0,_ __ !<ETHOD or TESTI>iG,_ll.l!lliing 16. FUl-t.PING WATER LEVEL: ft. a.f-:.er _____ ~'Jura at ______ gpn. 17. CHLOHINA.':'ION: 1 ype HTH Nnount ------- 19. fERMANJ:::HT PUMP: Date Install'!'d ________ _ 1ype _____ Capacit~ _____ 1~wml nr ___ _ l.i:-lii-.c Cleptn _______ . 20. I.AS '":.'Hf. r,.-u~ER BEEN PP.OVIDED r. COf"( f')!" ':!11.3 RECO~D /\ND [:,_rQtt.'1EV f'.ECO~'-'.ENJAT IONS? _...Y.e_s_ ______ _ 21. !.EMA:i:.i<S ______________ _ do hece'::>1/ ct-rti!:y that this P.,qulatL•Jn3 and ·st"ndard~ , ,. / / D, U ' 8 \ \ \ -- - - - -- --- - - -- - 0 ' H A >-..... z ::::, 0 u :11: ~-I, . i, . ~ "~~~:-l. , { ~_ .. :t·~ .. . l\J ... ""--/1'°'--·r-1 . . .. . ....._ :✓.:;) . ·-" '\ -, . ) _:• II . ~"-\; ,/V= I l '.,._J --- I I I I I I I I I I I I I, 1. •: :- II ' 11 I I ... ---, . ,. ' ~ ·-' ,,-, 2 5. '.; 5 7. 5. ' 7 ' i ~=-e:rt:J : T JPc:-:;2 AP-rr: dro•. valle')', ~ hi/ltoo, flar ;:::i_'JI..,( I T' I 5£ 8 F '•"•r':'.LL: -; )07:.11.£.. DATE: /D-!J--Z3 0 I ! ' I I JCES T~i3 \YELL R:'.PLACE AN EXIST!~G WELL? .--.JY' i _!,- , :)TAL 0E?TH: /_1CR RIG TYPE OR METuOD: C-2,!.& I ..;--;-1 ! 7 i /1... J.1,,.,-I CR)T':.TtO.'i SAMPl..£S C:)LLECTEO: LJYES No. of Sa~s ' i ~ t,"n c:..s1 ~;G: l nside Wal I !hick " ! {,,(). I:;·;, Deor."I Diam weJI /fl. ~-Fr~m 6 -;-.. it( le. ''· "' :{1 I t:f;. ' I b-1} , I Vt.ti:r · i /11\ i i I lQ. -.,RC"JI: ~ Mo1er1')I Me!t"iod l ram C lo 2£ t ,, ~ fl;,tPI/ i I ' II. F SC?.E:i::N: Oep!h Diam T:,:pe ond 0'2~ning i ,om to ,,. ,I 1· i '.'.;RAVEL: £!£.!! Size • Moleri::i! I I F rorr. 10 ''· I I 3. WATE?. ZONES{depth): dJr +-/tt7P. rt!-above STA71C WATER LEVEL: ". lop cf casing. I -(:a sin; ,, II. Cb'Jvt I on;j surfaee. ELEV. l)ATE ~EASURED: Le. -!;_--7 ::,. {1&'-~ YtELD~g?mt .~3 METHOD OF TESTING; 16 ''lln 16. ?UM?:>lG WATER LEVEL: '2 t;, ft. ofter /,Db hours " -~] gprn. CHLC?.!N,HION: Type Hy.H. Amoun,:Ji/,1,:.Jdfi 10. WAT~R QUALITY: TEMPERATURE("Fi ___ 19. PERMAN~NT PUMP:(Sho'N.a 1lu1teh of well head on back of form l Oar, installed Type Make Cap:;:;17 {Qpm) HP 20. l:,ro·u Dt>dh Airline Otplh ii H.'..\/£ YOU JNFOR.1.,iEO THC: WELL OWNER OF THE RECOMMENOATICNS? *A, i :~?A~Tlv'::.'HS REOUIAE~H:.NTS ANO ! 21. ?::~.~!~~s: :1 ., • I • -.D ·' /J -1 -/) I~ )U:.Lu--Cc...., .... .<t:--t: [., t.t't::{fr..--e1/" ' SIGNATUF!£ OF CONTrlACTCA OR AG~flT CATE prp1,1-"Ti:Ji'i .'1~-::.r~10.,..v,~ ..,P,, _·JI, L--/ c2 th'-£.,,-;'-lr2<A. ViL,{ 17 i!/211_ ,1/ -,P,-.,,f ,(vt;Jt...., ,¼,,4; u A 1 ,; /) [/, . IV)-{,//. "1J! r.,/2 ;P.··. (f ,{.. ;0;1. /I J -· /;i,C}::.... _J...l/1, 11 /!_,,.,f ,/ ,_ l-,1_,-,.,.{, , :2-"3 o A R I< ':> 7 0 ~.::;--5' I I LJ.. '7 Q Co ll5I. -= I - ~ .,,,, <:;".,A./ /) <: ~ r/7\ P J-:{1 0 ~ ~-So.~ r°" ~ 3.2l I I I I ;.':.J~ ?:.:.. ••' .-• ~ .. ~ ' . .J WE0!.. HEAD COHP!..ETION: Drav a sketch of the veil head shoving casing, pu;np piping, Geals, vents, access poft, grout, and enclosure. Draw a location sketch shoving the direction and distance of the veil to at least tvo (2) nearby reference points such as roads, intersections and streams. Identify roads vith State Highway road identification numbers. I ' ·' 'I •• I I I I I I I I I I I I I I I I I I I I I I I ', I. I, Ii i I, ·- I ,, , ·-,.....c O '." i : l ~ .-' J -~ :'! -~ i -5 ;: (at i on ,Ii o. ·· _,__. / ~ ':l<?i 1 Ho.: Fieia __ ~""~---- ,',1m ,.::'<_;-.·>,~-----~--~.:~--., l_):-''1.,!._l._££ o~:c ·-:,,_. .·,..,-'7 :,:/ .19~/ ?.ecorC~c // -.,,,,/;.-//:. --,L.,iuice ______ _ z-:'/---:, f,,.-c, ~:1/'.1/ ~¼,f --tlSG .,_ _____ _ co ___ ,. ___ f-:.. co ___ lt, ,o ___ ft. T~?e _________________________ _ g, Water-bearing for~at ion: /b',?10"}(2,A,A.cp ,4 TC 1' __ 11. Yield 19.0"'I Pu111p: _______ _ 12, Orawdown / "7..;' It. _, • t /;2. 1 .0 fP'I. Sp• e. CI p • ' ________ gp~lft. of dd 13, Pump: 't 'j p I e '-p • ____ ,gp~. Hp,: _____ _ I~. Hour5 pumped dai 1 y ______ _,.ate, _______ _;9p111 ·s. Qua Ii ty: 16, Analy1is: 8y -----------~•te ______ _ PP• ppm SiO K HO,,_ ____ _ Fe HCO co~------ Ca SOq Mg Cl ~. F Tota I hc!.rdnes, pH Dissolved So I id, Temp. _____ •F Spec. Ccn-:i, ___________ Hicromhos at 25°C __ _ I 7. Remar'.<s: 18, LOG: Forution Depth (ft.) £~ .£ £-L ~~-fQEL.!1//N c}.() I I I I I I I ( I I I \,. _J -. ' . -. ~ j l ~ : ~ :J.:. I 1),1 ~-·.:~ :~ ..::n = ~-cc··:,c:.,_' __ . ~-"'~-="·,::,7~..::_,.,;,c-<.:··"-''~''-'.:_·~'.·-!..,:'-·, -=.2:""'/_,,e,_-:;,t,,, '..., Ref e r<,?:nC<,?: poi n '-------------------- 7. C:!.sing: a. Scr~en: to ___ ft. f ro."Tl.....-_f:. to ___ f:, ___ •t. :1?~---------------------------- 1/J ' ,i ;';;~ g , W a t e r-b e a r i n g fo rm at i on : _1,'..="-<'....A.,:::::,,:::,,,,L_::~"-<""~""--------- 10. '.:later ]eve1 : __ _,/_V..,. ____ ft. r~ot. 19 __ r.i e i s • (ab O ., t I b ~ ! o·.,, )-----------=========------- .. :ii ch is _______ ft. (above, ?o-,.J _surf::0 I I, Yield (Jp,.,l ?ul"lp: ________ ~i:10,. ____ __,_~---- 12, Drawdown ______ ft. after _________ hrs. pumping H g pm. Sp,c. Cap. ---------~Pl'l/ft. of dd 13. Pump: tJ?• cap. ----'i?rn. Hp,: _____ _ ---~••te ________ ,gpm I q, Hours pumped d2:;J fs. Qua Ii ty: 16, Analysis: By -----------~•te, ______ _ PP• . p P"' PP• SiO K NO,._ ____ _ F• HCO co,__ ____ _ Ca so~ ~g Cl Ha F Total l-:c.rc:!1,eB pH Ois:101•,ej Sol i d5 Temp. _____ °F S.=>ec. C-;.i-:, ----------Nicromhos at 25°C __ _ i 7, ~~:nar:..s: 18. ;z: For;nation -«'f Deota (ft,) /J I I I I I I I I I. ' \ 1, ! I, i ' I I. / ' ', ' I. I. 1: 1· I / 1· '. \. I I ! I ·~ t 3, ~1.e·,ati·J", ______ ft. ~Oove HS.___ _______ _ Reference ooin,· __________________ _ ,4. T:Jo:;,J.:;r=;:,ily: Jri.-, ~1 1:. _.,i!1. 5. T;;Jt'. C•J•:;, ~ :-:t1'J, ~f'i,,,n, L_'J-a 6. Dept:\: .Cl.eo:. _______ _ ~ t • : ... '!! j 1 • ft ' 7, c~sing: a. Screen: i rom____f ~. ft. Di 1m. /, Y;,f i,i. from ___ ft. :o ___ f':. ___ f:. t, ___ fi.. ry,:,~---------------,----,------,--------- --1/. -~-~-9. Water-bearing formation: __ '--'~'-=--'-'=-=-....c."'-=c....:;..... ______ _ (!'lo,, e, :i :! Io·.-J------------::::===:::~----- which i s, ________ f~. { a. :i o v e 1 -~--_-_,:_._,_._._._~_··=·~· ! I . Y i el d ( g Fm I Pump : _________ i:: I o _., ____ ,,._£.,__~1/'"-"--,__.....-=-- l 2, Orawdown, ______ ft.. aft,r _________ hrs. pumping ,t. ______ gpm. S?!C. cap. _________ gpm/ft.. of dd 13. Pump: :p,, ________ cap. _____ ;?111. ~?-:, _____ _ 14, 15, Hours pumped dai I y,_, ______ Rate, ________ gpm Quality:~ 16. An a I y • i •: By ___________ __,,a te ______ _ SiOz------K ------~o.,_ ____ _ ,e ______ HCO'.l---------CO.,_ _____ _ Ca Mg Ha Tot:i.l narc!•1e,, so~ ____ _ Cl F Disjo\vec 3ol id,, __________ _ pH----'---- Temp, ____ _ Spe~. Cc~c. ___________ _ !~icrcmho, at 25°C __ _ Dept;-\ I-,___ I I I I I I I I I I 1:· I • I-I, I . !. ;; :-: .i ;{ ::!.7, ~"-------''---'------'-::...:C~c'c.c· 'C·-------- I~ r. _:;,, .,:~.:,_( \ (.' r'1,/j .' .• .:::,...::: .::. .__ 2 .. o· .. n = r _______ ~c_o·c·~---'------~...:.r-_c.-c--'s'--''--'"-~=------ ·~ J .-E i ':'I a: i_;:,1,_ ____ _;__f:. .· ... _ Ca Mg Na h:?.rdness:. 2.'oOV,? HS~_·c··_-:....· _______ _ .,·,_. ·.: pH T2mp. ____ _ OF Micrc~aoo at 25°C __ _ 17. ?.e.-, =.<< s : __________________________ _ ~ 0 ff i C ~ ____ C_: ____ _ ._0 7_:'.;·0-;.;·.~:7.~~-:;-;_.~~~~i:;....: .;:~:::·-..:~~ ~"'f-;: ;:· ~ ?,•?,=~~ I I I I D a:, __________ _ -;; 0 ff re·"----'----- I 2- I I I I I I I To tc. l ------··.pH -I_, . ' IJ i .Vi·:> i ·, ~ d Sol id, ____________ _ '::r.d. ------------/ ~icromho! at 25°C __ _ 17-·': :--: ~: '·· '3: __ ~1=-'~'-----"----'---·---'-~----------- I I I I I I I I I I I I I, I \ I, '.-le 11 Co. J. ,\DCRESS: 3 O 4 Ca ,--1 ' st. ' 1. use o, wccc, -----'O_f_f_i_c::....::e __ O.\TE, __ 8_-_2.c.._9_-_;__7_;__7 __ 5. ~CES TP.:s WEL:.. ?.E?!..AC::: A:-1 ::::,:rs,r:;G :-:ELL? _Ncc..=oc__ __ 1. TOTAL DEPTH: _...:2e...,,Oc,O=-_Rrc :·:·PE o~ .'-1.ETHoo: ....cA'-'-i..,r __ ~r.s ___ 110 ___ _ B-Steel 10. GROUT: Depth ~~ce=ial :-lcthod rrom_Q__ to..2..Q_r, cement Blaw 11. SCRc.EN: De;:ith Type & Opening rrom---to---ft (5h01 12. GR.!\VEL: Depth Si:e Material from __ to ___ ft ll. WATER !ONES(depth), -=2..::3:...-_3::_:0_f:....:.t.:• _____ _ 14. ST"TIC 3n •bove . WATER LEVEL: ......::!.,jJ_ ft.belowtop of casing Casing is __ l_ft. above land surface f.LEV: 15. YIELO(gpm) :_l~Q ____ !'1ETIIOD OF TESTING: Blow 16. PU:-1PING WATER. LEVf.L: ft after hours at gpm. 17. Cl!LOR.IN,\TION: Type ~I~ Amount 18 . ....,ATt::R QUALITY: Tf.MPERATURE (of') l 9. PERMANH:T PU/'IP: Date Ins ta 11 cd Type Caracity ______ (gpm) HP __ Hak.e ____________ Intar.e Depthc_ __ _ Airline Depth ______ _ O:)!LL!.'U; :..oc DC?Tr! :"RC,'1 TO FOR.'1.A7: O~l ~ESCRIPT:S~ f) 20 s._:i.nci cLav 20 2(H) shale .. If add1t1onal space 1s needed.~se ~dck of form / I 0 .U R H A M I :0 '-~ ,. 20. HAS THE Oh;..:En. BEEN PR.OV!DEiJ RECOI-I.MENDATIONS? y E 5 COPY Of 7!1IS RECORD AND INFORMED OF THE OEPAil.TM.ENTS REQUlREM.ENTS ,\.'-lD 21. R.CMR.KS -------------------------------------------- r do hcrchy certi!y that t~Ls. ~ell w,ls co:,str~cted in accorddnce with s.c. ~ell Construction Rc<Jul.'\tions .1nd St;,1ncl.1rds .rn,i Lh.11; tltis wrll rr.r.orc! is true· ,1nd cxllct. , • I ;1 ,/ /, • 1 , -. ; l / . t-1 ,. .: ,._ '--, ·1.._ ::i ~-:.;;1,Tt.:RC OF CONTRA~7on. OR. AGENT DATE form GW-1 Rr.vised 10/1/76 Submit one copy to Groundwater Sec~ion··a~d one t,o,_ownec I I I I I I :1 -1-. ·.· I :,c;:;i c.~.:C:CU,'i.i; DEPA,~T!.'ENT OF i/ATURAL Ai'iD ECONOMIC R_ESOURCES OFFICE OF WATER AND AIR RESOURCES GROUND WATER DIVISION P. 0. BOX 27687 -RALEIGH, N. C. 27611 Heater Well Co. P:E:G. NO. 1 1. 1o°€LL LOCATK)'-4: {S~ o s~cl'I of r,i1 1oc,o~QJ' on bod of form} ~o,ur Towr,: ~10rrl5Vl-b.le . ,. 3 4. 6. 7. B. 10. 14. 16. 17. 1B. 2 I. ?.t. 2 Box 2 -Morrisville NC ~E?" \ r-,:,0 i--1,. r';':munol7 or ubd1YISICl'1 ond Loi ~lo. D0"'-u BUCK ' :., ..... l..: Rt. 2 r Box 255, Morrisville, ,~ ., .., ... ,.. ,.., ADDRESS'. -----"·-TOPOGRAPHY. dra-., 't'Oli.y, aloe:,•, hilllOP, flat FOnl,< TO USE OF WELL'. borne DATE: l 0-29-:Z6 0 15 DOES THIS WELL REPLACE AN EXISTING WELL? no 15 160 TOT AL DEPTH: 160 R!G TYPE OR METl·tOO: air FORMATION SA"4P\.ES COLLECTED: LJYES No. of Boos CASING: Inside Wot I lhidt. " 0tpt2 Oiom. wtignr /ft . . ~? r,om 0 IO l Ii. Q~ I3 Hi ,.;i ---- GROUT: Otp!h ~ ~ From 0 lo 20 It cement blQwing SCREEN: Depth ~ I:r:121 gn~ QIH:ning From IO fl. ' GRAVEL: Oeplh ~ Moteriol From lo 11. WATER ZONES{d1p11'1}: 70 I STATIC WATER LEVEL: fl. obovo ·top of casino. below Casino is fl. obo•• land surface. ELEV. DATE MEASURED: YIELD(opmt 2 i,1ETHOO OF TESTING: blowing PUMPING WATER LEVEL'. rt. ofter hours 01 . ..... CHLORINATION: Type HTH Mount WATER QUALITY: TEl,IPERATURE('Fl __ PER,-.ANENT PUWP;(Sho,t0 tllltdl of ••II hnd on bocll of form) Cote installed Typ1 Molli Coooci1y (;pm) HP Intake Ot"th Alrlln1 Depth HAVE YOU INFOR"4EO THE WELL OWNER OF THE DEPARTMENTS REOUIRE"4ENTS ANO RECOM"4EN0ATIONS? yes REM.\RKS'. I do htrtt>r c,,1111 ll'lat uu, ••II record 1s true and uoct. _r ............ ~'->"--'---'--'--=-"~-''-r.,..;=-----'-4~26-77 SICsATUAE OF COHT~R ·oR AGENT DATE WELL CONSTRUCT!ON PE:RMrT NQ. County: __ W=a~e~"'~----=------ Ovod,00,1, No. ___ -:S--c:..._4-_.__.,_I __ _ DRILLING LOG e'r,o,tATlf"\N clay shale . - 1"-~•r.:-,,:-,,m -1.,·: .. ,_. (-·~.71·! ,~.~n.?---1),,. u ... : ;..:~~ . ._,_.__ 1,eJ ;,.1 i• ·' 1; / ~: ·, -<;..;. ;~,,~-,I ,. =•I GROUilD 1-'slATER OIVISIJ,~ RALEIGH, N. C, I I I I I I I I I I I. I, I I I. ; '. I I ,. :r ► I I I ; __. 01-:...--;;;;~~~.;-,.=., -:· WAKE I TOPOGRAPHY: draw, ,looe. hili, ¥ailay,-}ht, riago_. RIG TY?£ OR ME~OD: A it: · ·,,,,.), use 11::aile.r:piWk TOTAL DE?TH: ;:!i!!!!!!!1~1ft.° Date Af'ti \) 7 / CASING: Depth _L.2.ft.; Diam. _ _6 _ __i'n,; Typo _f;,._e._ ____ _ .... ---~ ~:--r.;=,.·.t_·_-.. . ___ ·_·~·.:Method · · ,:•.•~··"·'•"· .. ,. Grout: Depth SCREEN: from (ft.) to (ft.) s 1 ct .. s\.,i~\:·i .. · :: . -~ .:,..:.·._·_:--.· .. .. .. . ' :::-. _. ·-:. type .• I v WK I 281 4/ 1 -8 ,t.H (;,v 9. . ~ . -'4,--:P CO UHY _.:.,l),:.,.)<-=e,::..IC-~--'e.=--_-'-j --'!-t--'1-'/_·:.;c..• ---- Q U ~OR AM G LE ~. ,\ -_±}_ M I I I I I I I I I ;· I I I I I \ I \ I I I I!.· i .. I I I I Location l mile vest of Source Drilled well . - .. DEPARTM~~'iF ~~;', 5 NrtR10R REC E J\(E 7/1 GEOLOGICAL SURVEY WATER RESOURCES DIVISION WATER ANALYSIS JUN 7 197! N. cl'~. Jrlt?itcr ~0t, fS "ces f'.,,.,.,..,4 \' I•• /"\: .. ,_:_'_v • HJl!!~h. li. C. Morrisville //,/,, ✓.L... c✓-; --'C:, ./"? "-'' ,z. n,,,,A: . , IJJioOO .J 4/v-8 I Dote or collcct1on S-13-71 ,£}'-? --6.-P ,,u'bV1y I / . r.ogc hdg.'lt(ft_) Otochorgc(eec,ft.) Temp. (•c) 6t°F ( in milligrams per liter) Sillc11 (510~) •••..•••.••.• Carbonate ( C03 ) • , •• • •••••• 0 =-.( I Alwru.num (Al), • , , . , . , , , .. , llic11rbonatc (nr,03) ........ 254 Iron (Fe) ....• , •.•• , , , • , • , I .159 Sulfate (so.) ••••••••••.••. ' (Hn) •••••••••••• I K'\llC,111\C O C Chloride (Cl), •••••••.•.• ,1 82 • I I ' C11!cium (Cn) .•••••• ••••••·•I 19 fluoride (F) •••• ,.~·······I i ' V.o.i;ne e1 w:i ,~fg) ...•...•.••. 6.8 Nitr11te (NO:,).,, .• .; .••••. , I Sodium (Na) ..••• , • , .•• , , , • Phoaphate (PO,.), •• j.,, .. ,. ' . )i'otaosium (K) •• • • • • • • • • • ·• • I I • e • e e e I • e e e • e I e • • I I I e I I I -L1 thi'.Un ( u) I I I I I I e • e e e •• e I • t • • • t I I • I I I I I e I I I I I I I I I I (in milligrams per liter) lJl~ ~0.1.V~<l SOH<la :(.a!lc,,O~ s\J,;ll ••••••••••••••••••••• 4-~ ABS, , •• , • , ••••••••.•• , •••• Residue Upon cvapo- r11t100@ 1eo•c ......... Color ..• ~ ..•.•.•.•.•••••.. Hiu-dzless 118 C~C03,,, •••••. 'JC .......................... Nonco.rbonatc, , • •., • ·•,. , , • 0 ::::-.( I • ••••••••••••••••••••••••• Specitic conductance pH .••• • • • • • • • • • • • • • • • • • • • • 7.5 (11icrombo1 ·at zs•c) .. ~···· 690 . U .. pubUohr.d r•·~~ub r.•.1!,j~ct to revlalon · . . . -~c;-__ I _; ........ ;},!_.--. I I __ ,.:,:"':..'.:.e (Ci..) :.C:-~:e..c-.aae U,tr,) I I .kl~!"', ini fy as CaC07 , ,:edfic_· Conc.ucta.".lc~ i :•,!:i,c:-omhors at 25'C) I, :~lo!" : ::: · . ~ •.e:=::;,era-rure . '.\.J -:k T:"roe · I ,e::_l De9th · . a si::.g Cepth ) .-:--~ ~3-· 11 Ii, ! •1 11 I. --::\~=2-;:: •..n:,,_ ~-..:~f :·, .... I • '. I ":..; .2. .:.~-.:.7"?'::::::'3 ~:~ '.:}i~: 0~;;::e-::3 ;,E:: .0 ----- 5.0 .00 o!, 2,3 l. Ii ". 2 .00 6.9 2 5.5 l.l 0 .12 0 I, ~ , 90 5 6.4 75 ) ---' -:,._-, . .:-:-·;,· -- 0 3.0 .OG O"- 3.2 9.8 . 5 .l .4 i+l 170 "-3 .oo 15 52 1.9 .2 .c I.ill. ci< 306 .0- .. 7 .. ·;c :· .. '.· . 37";~'>i: >' · · 212-r: ·o 59T.:\>; 2- :,7; 4::s:,,. Tria,ssic· .. 200' ., . : -- .01 37 .. ; ':.. ·-:-:·:r· ... - I GELL ,,ECORD! H0RTs CAR0LIHA DEPARD<EHT OF WATER lES0URCES DIVISI0H OF GR0UH0 WATEl e ~ )-ko I LJ(( i c7'f BOX 9392 • RALEIGH, M. C. l''ILLER: ? ~ REG. HO, LOCATIO~: TO'N"H Jt)le'y\~,...) ( ·2 ~IC, HO. ADDRESS: I T0?OGRAPHY: draw, ,lope, hill, valley, flat, ridge RIG TYPE OR METHOD: /~ r-\Jse .....1..P__,'S,.__ ___ _ I. TOTAL DEPTH: 'J,OQ ft, Date / (}-(3-.:;3 OSIHG: Depth .2Q f.t.; Diam. ~in.; Ty,e T~ (QA• 7 I I I Grout; • Method SCREEH: from (ft.) to (ft.) slot size typo '.)UAL I TY: --------------"--'------TEMP~----- STATIC WATER LEVEL:• 2.11= ft. bel~,. top of cuing which is --ft. (above, belo•) land surface. Oah•-Il -1;3--c:3 YIELD: (gpm) ¾ MJ Flow," Pu ■p, Ball, Est. Y 4-_t y-I COUHTY _ _,1,,,'-'..!....:.i...:.c/::. . ...:._ ________ _ (place thia aheet OT~~~correct ,qu ■re on map, matc:b. cornors..and circl"c, dot at well _loca~ioa.) •·· PUMP I HG WATER LEVEL:. __ ft. after. __ hrt, p11■pi ng at _ gp11. Spec. cap. ______ gp111/ ft. of dd. ... PUMP: type, ________ ~ Intake depth ____ _ Cap. ____ 9PCI, Hp. ----~ _i, REMARKS: ....:!."------------------------------=---------- S;:'o c... -/ 11 ,; DRILL LOG' I, 15 . I Soil and Rock Fo1'111ation Depth Fr011 To ~ I' ,4-0 I I .. -------------------4---4----1 I: I • 't '1-?i •• ~ ..., ... :._ ---·· I I I I I GELL RECORD I HO.i;r. CAROLiHA OEPhRTl-EHT OF ·,HTER RESOURCES DIVIS!OH OF GROUND iATER BOX 9392 -R•LEIGH, H. C. 'r /2 r a-.l,! l\J k I Z...7 s-' D.<i LLE.,: E ·11 ~ ·) I ~ LI C. HO. T ;-!al/ ? '-....I...,-V-- ! . L0CH I DH: TO 'IIH : ,l·'. ~ ' ' .-_,._ ;• HAP; 2. OWHER: jj_.J ' COUNTY --~l}j~O~:._;~~=------- -.-'J ) ------------,-----.,----,-,-----------QUADRA~GLE HO. J -:-, --'-.W...--'-'f------.L'"-' .. !..;.'-'/-", ·-<'-'/ c"--'-f'-'-,'---'1-;.·-'-'-·,'--. '---'·_;;_c_-.c..:' .,,-',..'-'-I ,_~:..;'✓'--'k_ N ( ADDRESS: J. T0.0 0GRA?~Y; d r ~-.. , l o;,e, hi 11, val I ey,. fl at, r1age 4. RIG TYPE OR 1-!EIHOD: Use ,. TOTAL DEPTH; 'IQ ft. Date fl..J.,,., ' 1/-11-(.-(, ., -' 6. CASI HG: Depth ' C: ft.; Di arn. 0 ~in.; Type Grout: Depth --~· Method _____________ _ I 7. SCREEH: from (ft.) to (ft.) slot size typa I I I I, ' 3. WATER ZO HES (depth) : ~q'l''"-•-'-0::'--'<-"&--t:i"'-"'"'$,.We:."----------- QUALITY: _______________ TEMP: ____ _ I<). STATIC WA~ER LEVEL: __ ft. below top of casing which is __ ft. (above, below) land surface. Date ______ _ I, YIELD: (gpm) ____________ Flow, Pump, Bail, Est. r.iY -1- (place this sheet OTer correct ,quire on map, match corners and circle• dot at well location.) PUMPIHG WATER LEVEL: __ ft. after __ hrs. pu■ping at __ gP■, Spec. cap. ----gpai, Hp, _______ gpm/ft. of d, PUMP: type. ________ ~ Intake depth _____ Cap. REMARKS: DR!LL LOG: Depth Soi I and Rock Formation F ro11 To ,~ u.. - ) S'JD 6 ~ )_ ~O "5 !+LE" A,I~ I I [wELL RECORD I CJR:;_ .. i DE.'!R~ENT OF WATER RESOURCES DIVISION OF 3ROUND WATER BOX 9392 RALEIGH, N. C. I )RILLER: rV\0011 J I I • LO CAT I O ~ : TO wit . ___ 1'-"·~c.!j.-''.l:;'~\,,_;)~H=' .c-' '-''.,'-'/)-'-' -'J'=='"------ REG. NO. LI C. NO. I I I HAP: ow,ER: ADDRESS: TOPOGRAPHY: draw. ,lope, •· RIG TYPE OR METHOD: TOTAL DEPTH: / b z=;' ft. CASI NG: Depth ...J..J,., ft.; hiil._valley, flat, r1e1g;._ , , Use t-1~,c-v Date /C)-,3-~3 ____ _ Diam.(, J1L..;n.; Type ______ _ Grout: Depth ___ • Method _____________ _ SCREEN: from (ft.) to (ft.) slot size · type I - - / • WATER ZONES (depth) : _::b,~U.-'-.ci_3...,_,,U"'-/--------- 1 .. QUALi TY: ---------------TE'MP: ____ _ iv, STATIC WATER LEVEL: '2...0 ft. below top of casing which is 1 1 , --ft. (above, below) land surface. Cate /0 -14--~'.) l : YIELD: (gpm) __ .,.._ _________ Flow, Pu11p, Bail,Q ,-l'. I (place this sheet oYer correct square on map, match corners and circle a dot at well locatioo.) l't PUMPING WATER LEVEL: __ ft. after __ hrs. puaping at __ gp ■, Spec. cap, _______ gp11/ft. of dd , PUMP: type. ________ ~ Intake depth -----~ Cap. ____ gpa, Hp,----~ i . · i u REMARKS: 11.•.------------ r· .' DRILL LOG: Ii ~ /1 Soil and Rock Formation I: - Depth Fro11 To c... -I ) -=; fo o 5' ")._ ":) 0 'S [fLE A,)/L,; I : .;.;_-r:,-·_ . . ·. :· '· ·-' --·· MORTh CAROLINA DEPARTl'E~T OF WATER RESOURCES OIVISION Of GROUND WATER BOX 9392 -RALEIGH, N. C •. -7;~~:[{(fi~~~ • \Jk . GELL RECORD I I )RILLER: ,==-v,oci id REG. NO. ½ LIC. NO. r 4-1 y-Lf- ---'-'c.;;..;;_---..:...c_.;;;..,...~ ,=.:---;-,-:-' /,,_..;:_; .....;_;_-c....=;;___;:_:.;:.;_;;.:_;_ _____ .....,,,..;;;;..,,,,,---.c.....!....;l:'...-~-- L oc AT ION: T OW"M -i~-"'-'='--''-'&-=''-'''-"-'_v:..,_=· C.•------cc UNTY ____ l~Y~"-' ~l'~•<-R-________ _ MAP: ,--,----------,----,;c-::=---::-:~-r----:--,-------QUAORUGLE NO. ✓ t-{: / OW"MER: /-1:;, 'o bv /,! o /:.;I~ C, 'Ti/ T~ i,~o-J'._ N I .---,----,----,---,,--~ ADDRESS: TOPOGRAPHY: draw, ,lope, hill, valley, flat.,r1cge I I. 2. I 1 ·: 5. I RIG TYPE OR MffiOO: _________ Use ___ _ TOTAL DEPTH: f Q 5' ft. Oate h, f,._,,a //-/_.J..1."'---"b"'J..,_ __ _ CASING: Depth _l;S:. ft.; Oiam,b ,~ ~n.; Typo ______ _ SCREEN: from (ft.) tc (ft.)· I 8, I It I I, I:. .. PUMP: typo ... l, i . I REMARKS: -•------.....,.---·-••_•_•·_. _~_~_· _· ________ .. _·_:::_.'_:r_:_._,-_______ =--·-·-_-_·_. ---,---·'_· ·_-_':'' . --" -;;?8 ci..: ;. / Ii s. ' DRILL LOG: ' I: I ' 11 I! I (. Ii ' I. 11 I ' ' Ii I ., I ~r ~n · .. :.· GELL RECORD KORTH CAROLIKA DEPARTl<EHT OF'WATER DIVISIOH OF GROUHO WATER· BOX 9392 -RALEIGH, N. C • lESOURCES ·~ ({eftfti e iY k~ wKt-i:71 . • >RILLER: REG. HO. J" 1--fl v--S- I 1. LOCHIO!: TO'~ ~AP'. ---,----------:-rc--=--;--/~c:::-:=---r,, L -"------,-----------QUADRANGLE KO. OWllE,: >h bbv /0~; CJ;. ~ ,0 ~=-< H couNn ----=-/.u~~~i--'. =------- 74--/ I I I .o. I· I I ADDRESS: V hill, valley, fl•t, r1age TOPOGRAPHY: draw, ~. RIG TYPE OR METHOD: -~,;J~i'-'i-_· ____ Use-· __ -~f-':)=--- TOTAL DEPTH: ----,-,-ft. CASI HG: Depth ~ft.: Date ; ~-; 4-63 ____ _ D. :/1/ .. IUI ... ~ In,; Type _______ _ · Grout: Deoth _---~· Method--· _____ ·_·:.-_,._:_-~_• ______ _ SCREEH: from (~\l,_t<> (ft.) ··slot siz~:-::_,:<\\\: type: .. _~·:: \-':A :_ff ~li~i:-;---· ____ .:.;;it/;. . . .;,_-::·· ,;;;; ,;;;-,,::J,~~.!)~it~!;;!.½ ~0l.. . .}; ~fc•il "' f~~ iJ :::::~;::'.a,~;1~~/:4,~~i!!Y:;i~·.i?::.;~:;~~:!c~;::::'.:~~i YIELD: (gpm) c~••:se~,<. {' 1 /9 :'!i,;~;~ ''J~Jci~;:;P,u■p, Bail~@·: · dot at welLl~~-~~t'.'.;;>: -,:;"~c/ ·•• · PUMP.ING· WATER LEYH!_,_. ___ ft..:..af_tel".·,~hra-½,puapint at·:::L;.;_ 11pa, Spec.-e•P•----~-gp■/ft.<ot· dd PUMP:· type DRILL LOG: :.:;--j.:'.~•.::::·_: .. . . ,-" .. ,•:-···'•---:· .. :::·::···-·{":-:i:~:•:.::·· ~-. . ..\/\·-_; . .::..:-·:. · ·· -.. -, Intake depth:-.. . . -'-'.'C~p; :-----9P■, Hp. ----~ . _ ,~,:: ·.·•· ., ..... :{~,;_~:~:::·i;·- . ----.. ~~~7_":;,:~-.:-~: .• ~. ~8 :.;:>~'-I _. ~-5""5"9?i.%~0y.!:_: l i 4'tt~:~( _: ,-ii/d};gfi i...£: ~/i){~,.: - . "< ~·~ ·. ::}:-t:'.~, I RECORD I DRILLER: MORTh CAROLI !A OE?ARD<EH OF WHER RESOURCES OlilSIOH OF GROUHO WATER BOX 9392 • RALEIGH, H. C. REG. HO. LI C. HO. , . LO CAT I OH : TO Wll --,,/c.~.,.1 ,.::;•>~,,:....' -=·'-.c' ':....~:..·'-"/."-'.(,,,:=:. '._' ,.,, _____ _ ' IJ) , Ir, • COUNTY --~·-"'---"'c.,_y'--=l..L;;;._ ______ _ I I MAP: OW!IER: I /.I.-I --,,,:-J":•----------------------------Q~ADRANGLE HO. ~_,......,__ ADDRESS: TOPOGRAPHY: draw, slope, hill, valley, flat, rioge •. RIG TYPE OR METHOD: _________ Use ______ _ TOTAL DEPTH: ___ ft. Date ____ _ CASI HG: Depth __ ft.: Diam, __ in.; Type ______ _ Grout: Depth--~· Method ____________ _ SCREEH: from (ft.) to (ft.) slot size type . , .. ·•, . WATER QUALITY: ______________ ._._.TOO:·-----· STATIC WATER LEVEL:._ ft. below top of casing .. wllich is. (';'\. __ ft. (above, below) land surface. Date_. __ ...,;._____ (place tbia sheet oTe~ correct square on map, match corners and circle a YIELD: (gpm) I · · ... . . · .. dot at .. 11 loca.tioo.) --------~--F ow, Pu ■p, Bal I. Est •. · 1:,,2 .. PUMP ING WATER LE~E,~;-. __ ft. after-__ hrs •. pu■p i ng at _· _ gp■, Spec. cap. ______ gp11/ ft, of· dd PU1'1P: type ________ ~ Intake depth _____ Cap. ____ gp■, Hp, ----~ ,\ REMARKS: ...,, ______________ __,,c.C:...----,'l=.1-----"c..::,_ _ _.?-,=-3..L..;;O=---..::S:...;H-'--'--=L..:.ct;=---,-- i 1·: · ______________ _,(~3;;._,_o_e:::.,L,,____3 ..... $' ......... 5"-=oc...o=•~ .... _-. · ..... J ..... ['""'+ ..... 9----=18=--- ,\ DRILL LOG: Depth . . ~ c.. ~ / . ·• Soil and Rock Fonution· Fr011 To · ~ _ / ·-~~ j y ... ·11 ~. ~ I I i y-7 )5)007 I\ ·(3~ce) 11 ! I, I. 1 . . •1 1'. I I ll A/vU [!ELL RECORD I CAROLI MA DEPAR°™EHT Of WATER R':SOURCES /\Jc ' . /~~'-, ,l.'---,._°.4.. -· Di'/ISIOM Of GROUND WATER , / ';( .v"r_ · 1 ~ BOX 9392 -RALEIGH, H. C.,_~<l,.:.6-',c_,Gi.J../,J f:0 /::J<-af:~.J" :;__::j:;;,:1';-"r,. .:,ILLER: REG. MO . LI C. MO. I , .• 1. LO(;AIIO~: TO'..r,,1 ;t,~ .v'-': .16<1_,-~.,,~~ I Oi<HE.,: I ADDRESS: TOPOUA?~Y: dr", sio,e, hill, valley, flat, rioge ,, RIG TYPE OR HETnOD: i;..,' Use I I :12- IL I ', 1, I I I I I I I I: i I. I. i I L ------- T07.IL DE?TH: ___ ft. Date ____ _ CASING: Depth __ ft.: Di am, r./;✓ in,; Type ______ _ Grout: Depth · Method _____________ _ SCREEN: from (ft.) to (ft.) slot size type WATER ZONES (de,th): ________________ _ QUALITY: ________________ TEMP: ____ _ STATIC WA,ER LEVEL: __ ft. below top of casing which is __ ft. (above, below) land surface. Date ______ _ YIELD: (gpm) ____________ Flow, Pu11p, Bail, Est. (place this sheet over correct square on map, match corners and circle a dot at well loc,tion.) PUMP I MG WATER LEVEL: __ ft. after __ hrs. pu■ping at __ gp■, Spec. cap. ----gpt1, Hp. ______ gp11/ft, of dd. PUMP: type, _________ , Intake depth-----~ Cap. RE)-•.RXS: -~'------------------------------------------- DRILL LOG: Soi I and Rock Fa rmat ion -JJnVn G-. LJ~.i;Jo r~ - Depth Fr011 To n h, ~ , ?~.Jw-4clr-/4yd 0,J LLLR-/zo-,,...a.. /),l<J _,;:,lo ,,. .230 DLRT JS'Sa r J -r r+? IS 'S' e o::.--I