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GUILFORD COUNTY DEPARTMENT OF PUBLIC HEALTH
Division of Environmental Health,Water Quality Unit;
400 W.Market St.,Suite 300, Greensboro,NC 27401
Record of Construction, Repair, or Abandonment of a Well
l
Address of Well: LATITUDE 3� ttl� �.j°
Well Permit Number: LONGITUDE _W!-
Well Contractor Company: A t.n aril 7su. Completion Date: q-0•22
Total Well Depth: qX ft. Well Yield: 15 gpm Static Water Level: 4G ft.
Outer Casing Material: TV(,(, Formation Log
Casing Diameter.(A.,�5 in. Casing Depth: '45__ft. Depth Description
From:_ Q__ft.To:_20ft. [to
Inner Casing Material: From:_M_ft.To:—_ft.,
Casing Diameter: in. Casing Depth: ft From 7 ft..To: 90 ft.
From: c _ft.To: ft.
Grout From: ft.To: -ft. !itftw-Tonk
Depth Material Method From: ft.To: ft.
From:_0,ft.To:, 35 _ft. 6iijerA cth:VcucyiFrom: ft.To: ft.
From: ft.To: ft. From: ft. To: ft.
From: ft.To: ft. From: ft. To: ft.
Water Production Zones
Depth: tl to ft. ft. ft. ft.
Yield: %9�_gpm gpm gpm gpm gPm gPm gpm
Method of Repair:
Method of Abandonment:
I hereby certify that this well was constructed,repaired,or abandoned according to the Guilford County We]l
Rules in effect orr this date and that a copy of this record has been provided to the well owner.
Well Contractor. A, Certification#: LI�I leS` Date:
Record of Pump Installation
Pump Installation Company: E'v j:sr i N\ . ���,` Completion Date:
Pump Depth: l S-D ft. Static Water Level: l+Z ft.
Pump Brand: a► Pump Size and Rating: ram_hp I O gpm
I hereby certify that this pump was installed and wellhead completed according to the Guilford County Well
Rules in effect on thi a and that a co of s reco has been provided to the well owner.
IWell Contractor: Certification#:—aot Date: 1 2
Revised:January 1,2009