GW1-2022-09534_Well Construction - GW1_20221014

I'�'�
Jai
Aqu@[-�, 8 Inca
ON
8 MGM eBgA� $i¢l;P1fea�'€ ct >tea -
Y S tR
' t
• .r.
zw �—
T E a n L�i4 ,x
• .Y V�iSM1S�gy�,Oltlfy 4�' il� � X ���•..�— U.,�`i�" y'�..«..
a1 ' —
£ @� �'��86 e sp ,= ,
FEC;1;
Ild€iY O� R$3L
ON
or
'f8�1 '4u9ei. . Cs9 op '� �a'��rN!'*sa.2ti k +rdP <Td'a+�StP4L'G�8
° xrsae ee aPaa�a r 6esa OW'& ote E esBba 8��t 8d�g�pg�kid Bsa�P��l d Y�{9s� � l¢s�S�Z�A�u �rG
�gr�edr�ba�ra�'g��aral. �'#at�'a�oem?a+3��ce �a7��P�csa.>p� 7�`,���r.:�...t.se:��)��k�cer.;�e�;•r<„�� �•�. +y��.,;v�t,-�?;��,��,�8e .
fl ��� fl �� � ¢e�fl��rr�ra�rz�Rd . ➢�rcldaaS'= � imfl es ��HflflieH9169�sms you> ya
Wo AMMMU 02a' SASH __��re�e���f l�^� �^�� � r..��aewg3�
q�p ��pppgOQp��a, -br.�_tts�.€ab,��:.�a��d�
®CiIY MfS#W�q�`��DT ..• jYyiL�iV�•1�1.�.•]iL•]llde 14dW1A<•Q .
�Q.8'1'v 11"i Mew t
�urteerecaPBscalm . .�
IL2mj@bdjm,w �IISPli.i @.9�l aL�eo-�B
IRTw,gyp�a
dt'l.i tl d�G2➢�II C�
Am podW Q..ssao�a�oe� ss,3s34�4 � ��E�es ep�B � 1, ftf� ey � .'p
amur flg�� as mY fl
oR
a+aa�m� 1c a g� b `t< �'y @rj a€s st�91€�r�
�B t®tu®f Via?@a&,; ¢�2 f®cog a�aa�G�e��Pfla ds ad Or
Pam t>fl cv�e€e wusat�a d. agmea c�fe tee`°O
e t
b�ee¢� 9;��c�s��7mg �ae�s3 g�aQpa�o�&�a�:e�®f€@�a�saldr� 'c;;

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
Address of Well: . C.��i -c1/,rp1'. A ?r } I - t 6 ��e)'7�i 9r
�... � � � UITiTUDE 3� Iti �, �
Well Permit Number: ��a 1. {,l ,. ??' LONGITUDE �i'C. V �,1�."
Well Contractor Company: r;li Yn� Completion Date: Q. *
Total Well Depth: ft. Well Yield: 50 gpm Static Water Level: d ft.
Outer Casing Material: VUG Formation Log
Casing Diameter: 6., in. Casing Depth; L16 ft. Depth Description
From:_0-ft. To:�3 ft.
Inner Casing Material: From: ft.To: ql ft. C ,�
Casing Diameter: in. Casing Depth: ft. From: L ft. To:_jt(e ft. =�.
From:__!L6_ft. To: ft. 1 rarl
Grout From: ft. To: ft.
Depth Material Method From: ft. To: ft.
From: 0 ft.To:_.24 ft. r, Trke. ,From: ft. To:—ft.
From: ft. To: ft. From: ft. To: ft.
From: ft.To: ft. From: ft. To: ft.
Depth: �ft.
Water Production Zones
ft, ft. ft.Yield: �gpm m ft• ft. ft.
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 Wel!
Rules in effect on-this date and that a copy of this record has been provided to the well owner.
Well Contractor: Certification#: Date:1---:N y-
Record of Pump Installation
Pump Installation Company: -
Completion Date: t
Pump Depth: 1�� _ft. Static Water Level: `4 0 ft.
r
Pump Brand: je-t—S 5.T - lQP)LA-5—pq Ai p Size and Rating: ,I d. hp LD gpm
I hereby certify that this pump was installed and wellhead completed according to the Guilford County Well
Rules in effect on date d that as copy of this record has been provided to the well owner.
Well Contracto . < Certification#. 6 Date: _;
j"Uz
Revised:January 1,2009