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oulOoRb.county tepolrmawT:OF ro3uctiaALTE •
Division of thiYitOmmental Health;Water Quality Unit
400 W::Dinrket:St.,Suite 300, Greeniboto,•NC 27401
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r.te4toi ef'l Comistructd6oi ROO4firi:or AbindOnmont of a Well
Acklri30.s•otWellj261. ol6, j):cirj'i÷:44nrs4ei•4]ok))...06 040. LAATODE NLilqL1Well _,
Parntit NuMbizr: 1.0 0142- LOGfl1JD 7CJ M 4 0
Well Contractor.COmpanY; 4pt :eDrtill Completion Date:
Total Well Depth agc : ft. Well Yield 10 gpm Static Water Level it ft.
Older Ca.h% M.ateirinl! 9i/C • : : • toranatinit Log
Casing Diameter Casing Depth 70• ft. Depth. Description '
Erom :0 ft.To "40 ft • •
Inner( katerial From: 41 ft.:To:'LIP ft,Casing Diameter:. in Casing Depth: ft. Front: tiri c6 -
.From: risLit To &ftcic,R
ardwit : : Fromuet-jt,To:. 'a/6 ft.
Depth: Materinl. :Method Fromt :it:To: : ft. • •
Prom Qj.To ,Q4. :ft. refft•pill. QArt i 1uôcFrom $a•To ft:From. Jt To '
: .ft From ft.To:
From •ft.TO: . ft, - Ron: ft.To: • !ft. .
Water P4ididinetio 111
POP*: :,2110 ft.: : ft.: : ft. ft. ft. • ft.
Yield: AeL.gptn gpini grim gpin gpm
:Method of Repair:• • •
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Method of Abandonment:
%hotebyeertify.that this well was:constructed,:repaired,:or abandoned according to the Guilford CoUtrOlVel I
Rules ih.effect on this daft and that a copy of this record has been provided to the well owner.
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COntractor: 14*e, Certificatien#: 4590 A .Date : '141•aq
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: ReLV, 61:PUME)Inatialtatt•ilt
Pump Installation Company: tf(jDate: z:101 I 41:ei)-‘-'4
Pump Detlt 00:. ft.:Static Water Level 39 ft
Pump Brand Cko..;t2% ,to• P 1•C: °P;Imp Size and Rating: P 2/L1: hp gpm
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I hereby certify this putviNasinatalled and:wellhead completed according to the,pr.ilfOrd.County Well
Rules in effect on this date and that a copy of this record has been provided to the well Owner.
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Well Contractor: • Ce.rtifiCation#F.P 107173 Date :
•Revise&&R,14,71.NCO