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GUI[LFORD COUNTY DEPARTMENT OF PUBLIC HEALTH
Division of Environmental Health, Water Quality Unit
400 W. Market St., Suite 300, Greensboro,NC 27401
Rec rd of Conatngctoor> o Gaspaovo © abanr onE nent `:. ' a Wadi
Address of Well:..2Q.0.01.;r1A i;r° PP Si ik,ccio QL ,2235 __ LATITUDE
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Well Permit Number: 4.65 LL%AJHR-Of1C0,2.3 LONGITUDE S10 I .13 e n
Well Contractor Company: A ti r .'fir;it 1nr Completion Date: 7
Total Well Depth: 1465 ft. Well Yield: (0 gpm Static Water Level: ( Q ft.
Outer(Casing Material: Pi'!
Casing Diameter: (�.a5 in. Casing �nepth: rt. Formation Log_GO_ - Depth Description
Ca§e
limierlimieret From:. 0 ft. To:_�,�ft, _CJLL
g Material: From: ac
Casing Diameter: in. Casing Depth: _ ft. From: 55 ft. To: Coo ft.
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From: (on ft.To: I/615 ft. _ �,ccn,to
Grout From: ft. To: ft.
Depth Material Method From: ft. To: ft.
From: (Z ft. To: Q,7 ft. (erne tF
From: ft. To: ft. L�+�;, �.;,1�I�,uc:k From: ft. To: ft.
From: From: ft. To: ft.
ft. To: ft. From: ft. To: ft.
Water Production Zones
Depth: co-In ft. ft. Ft.
Yield: gpm gpm r� -�- ft. ft. ft. ft.
gp _.__.gpm gpm gpm gpm
Method of Repair:
Method of Abandonment:
hereby certify that this well was constructed, repaired,or abandoned according to the Guilford County Well
Rules in effect on this date and that a copy of this record has been provided to the well owner.
Well Contractor:_lift � � �ri (j01 ,9 t- _ ...,.. Certification#: '4,1922 _ Date:
afff
fnacCouI of LIDr ffinla EfltlotaHaidon �. .
Pump Installation Company: .49!(,rq Q,y((
Completion Date:_07-
Pump Depth: 300 ft. Static Water Level:212
Pump Brand: 7C1 o c,r�4sP
Pump Size and Rating: �hp I Q gpm
I hereby certify that this pump was installed and wellhead completed according to the Guilford County Well
Rules in effect on this date and that a copy of this record has been provided to the well owner.
Well Contractor:
Certification #:2 2 -Date• c Lk
Revised:January 1,2009