WI0100489_Well Construction Record (GW1)_20180122

WELL CONN7-RUyr]1014 RECORD
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1. Well Conhathr Infvrmaevu: l
RobertL Wells
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NC WdIConeamrCmdficaav Number �
AWD Services Inc.
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1 1.25 m SDR11
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WatersupplyRon:
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Geofhensil (Heming/Coding Suppty)
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OReeidentid Wafer Supply(dngle)
❑Revdencal WaterSuppty(dored)
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❑Aquifer Rahmge
OAquifer Stomp and Recuvmy
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❑Stormwstm Oreinage
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❑Oilier Iain under 421 Rammku
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d. Dab Well(s) Completed: 1/08/18
Se. WeULoeatiom
Robert & Nick! India
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18 Busbee Rd Biltmome Forest,
Well RIO
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NC 28803
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6h Latitude andLongitude in degroedrvutes/ueovde or decimal degrees:
6fwd1feldnmkdaagkeoadest) Elev. 2252
35 32' 29" N 82 32' 15"
6.h(ue)Me well(-): ernuvent or ❑Tenrporery
7.Isthissroptrtoaoeautio,mll: ❑Yes or -10
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rcpv/r until pol remwb eaml=n or on Mvboek ^lrM1lrf=mr.
B. Numbar ofweEs mnalrueted: 7
FwmvlBp)e rn/active ornon-Miervipp(Y we((nahYLPwla IAeavmeemrbYOY=II, yWmn
evbmlr one�m.
2A Cards de
w 1/22/18
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wllb lyA NCAC C.0/Oa ar IA9 A•G9C 0aC.adaa. wafl mmauelkn Smrldoldamrdrgala
o=ry=fMY recoMMa beenpovlhEM rlx wMlown=n
23. 81M dhgram or addjtlonel well debik:
You may sup fhb hick of npegs fopmvide additional wxll bile details or well
wnsWotiandelaile. You v:oyg•esoatheh sdtlitimeipegea ifseceaary.
SURAMITALINSTUCTIONS
9.Ts1davd1dapW belowhadsu f : 2@250' 2@275' 30325'(D,) Ma. For All Wee,; Submit this fare within 30 drys of eompleson of well
Fwmvlgple welAllerei bydm fdlf/axm (xompia-f®aBa'add®IBp1
commrgdontothfdlowing
10. Stetie water level blow mp of wdn, N/A
(R) .Division of Water Quality, Informadsu Proaeedng Unit,
if.", rani babe. mesh& we "+-
1617 FAR Servim Center, Rakish, NC 2709-1617
11. Rnrehole diameter. 6.25 (iv.)
Uh For. laleetial Welk; lit addition to sending
ft fans to the address in 24a
rotary
rota
abora,:else aukmit a copy of this. fmm within
:30 drys of cmnpletton of well
12. WeR<petroetlav mNhod:_
eonapgcdontolhefdlovring
(i.e. augv,mWy, oahle, froniIA In.)
Dlsdrlan ofWakr QneRty, undee moos) hdation Central Prepare,
FOR WATER SUPPLY WELLS ONLY:
1636 Meg&rvim Closer, Raleigh, NO27699-106
13a:Yie14(gpv) Melhodeftmb
Ma.ForWrae EvuoH&hieiinn Wwe: Sn addition to aendinp tha £sons to
We ddress(es). snort, also cuba:it:! copy of No form widdn 30 days of
131sDlekfeefion type: Anlooan
"fission of wdl eassvucvm as the county hosith depaenent of tk. county
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