ED-1982-001-00_lithologic_log

•/���i- N0RTr; CAFGL;;'vA DEPARTMENT OF NATURAL AND ECO"i13M;':, FcES
OFFICE OF WATER AND AIR RESOURCES
WELL RECORD GROUND WATER DIVISION
_ P. 0. BOX 27687 — RALEIGH, N. C. 27611 _
DRILLING CONTRACTOR ✓ _ �; r ;/ ,/� ! „�QEG. 140. WELL CONSTRUCT,ON PERMIT NO
I - WELL LOCATION: (Stow o shetch -61 the 9.gc on boeJt of form)
Nearest Town: �- County:
'Ir
4 & ' i< ti Quadrangle No.
oo m rut or u tvtst9q an¢�ot No.
2. OWNER: ! •�_�!c c �� +: C_
3. ADDRESS'
24 - - lGs =, ,: i 1(
4. TOPOGRAPHY:
drag, volley, slope, hilltop, flat
S. USE OF WELL:
!_.i r, :j DATE:
6. DOES THIS WELL
REPLACE AN EXISTING WELL? A-k
7 TOTAL DEPTH:
R!G TYPE OR METHOD:��—_
8- FORMATION SAMPLES COLLECTED: =YES No. of Bags
9. CASING:
Inside Walt thick
or
Death :,,am weight /ft. ype
From:
to ft.
10. GROUT
:,epth Material Method
From
to It
11. SCREEN:
Depth Diom. Type and Ooenina
From
to It
12. GRAVE!
Dept,, S1ze Material
From
to ft.
13. WATER ZONES(depth):
14.
STATIC WATER LEVEL: ft.
above top of cosing.
below
Casing is fl. obove ;and
surface. ELEV.
DATE MEASURED:
15.
YiELD(gpm) METHODOF
TESIiNC.
t6.
PUMPING WATER LEVEL:
ft. after hours
at gpm.
17.
CHLORINATION: Type
Amount
IS.
WATER QUALITY:
TEMPERATURE(`F)
19.
PERMANENT PUMP:(Show c sketch of
well head on back of form)
Dote installed Type
Make
Capacity
(gpm) HP
Intake Depth
Airline Depth
20.
HAVE YOU INFORMED THE WELL
OWNER OF THE
DEPARTMENTS REQ. j!REMENTS AND
RECOMMENDATIONS?
21.
REMARKS'
I do hereby certify that this wed record is true and exact
DRILLING LOG
DEPTH
FORMATION T'
FROM
TO
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31 7)r.'RACT0R OR AGENT DATE

HEAD COMPLEiIGN:
:`raw a sketch of the well Head showing casing, pump piping,
seals, vents, access port, grout, and enclosure.
WELL LOCATION: Draw a location sketch showing the direction and distance of the
well to at least two (2) nearby reference points such as roads,
intersections and streams. Identify roads with State Highway road
identification numbers.
Jv

MEMO
DATE:
TO: 1.4 SUBJECT: �1 1iA4QtJW
F64-
Geological Survey Section
North Carolina Department of Natural
Resources &Community Development

i
i
iWWI
MN
GN
T
121 MILS 1-MILS
MIIS
AND 1980 MAGNETIC NORTH
T1ON AT CENTER OF SHEET
IrUUNIA NJI
5455 // NW
SCALE 1:24 000
258
5 0 KILOMETERS 1
10w 0
METERS 1000 0_ Zip
1 5
1
MILES
1000 0 1000 2000
6000 7000 eppp 9000 10 000
FEET
CONTOUR INTERVAL 2 METERS / v
NATIONAL GEODETIC VERTICAL DATUM OF 1929 / K G
CONTROL ELEVATIONS SHOWN TO THE NEAREST 0.1 METER
OTHER ELEVATIONS SHOWN TO THE NEAREST 0.5 METER - S
THIS MAP COMPLIES WrFH NATIONAL MAP ACCURACY STANDARDS
FOR SALE BY U. S. GEOLOGICAL SURVEY, RESTON, VIRGINIA 22092
A FOLDER DESCRIBING TOPOGRAPHIC MAPS AND SYMBOLS IS AVAILABLE ON REQUEST
159