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GUIL FORD Cr•BARTY DEPARTMENT OF P LIC HEALTH
•>ivision of E ivironmen.: Health,Water Quality Unit
4!0 1 W.Market St.,Suite 31 I, Greensboro,NC 274011
Rey rd -. 01 Eell, Rep. ,1r® Ab. :Ld®n;-1:-g-nt of a y° AR
Address of Well: (WO ' L ' ,' rsP 1 �'>j • LATITUDE 3f_ 10 .54f o C)
Well Permit Nu al:her: &Lf-O. 12101-1R•• etrIGV5 L:., `&GS BE ?9 55/ ?1 .6
Well Co f •actor Company: Art Tr:II Snc Completion Date: 9•?•,;Ni
Tote Well Depth: 4(a5 ft. Well Yield: 7 ;.m Static Water Level: &) ft.
Outer Casing lydat- rial: 91i('- Fo-ri c•don Li
Casing Diameter: CA. 5 in. Casing Depth: Sf' ft. Depth 'Description
Fro © ft.To: ft.
t le,oer Caokg Material: From: f,7o f.To: C<o fft.
Casing meter: in. Casing;Pep,re: ft. From: Go ft. To: `o ft.
From: 'co ft. To: ft. • ,.•
Grout From:_aft._t.To: cl t 5 ft. 'Due S n'Ae
Depth Material Method From: ft.To: it.
From:O it To: �I1 ft. cement 7Ur izatTi ccFr• ft.To: ft.
From: it.To: ft. From: it. To: ft.
From: ft.To: ft. From: ft.To:
Water Productive /o im .s
Depth: R. ft. ft. ft. fit. ft. fft.
Yield: w7 _ �m gpm span gpm _,im gpm gprn
Method of Repair:
Method of Abandonment:
d hereby certify that this well was constructed,repaired,or abandoned according to the Guilford County Well
Rules in effect on•tflais dam and that a copy of this record has been provided to the well owner.
Well Contractor: sl Certification 41: 459U-4 Date: 9.9 ,7?Li
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,teccl rd Ply y L-stai 4 tr®;.
Pump Installation Company:„A/paOr+fl zn C. Completion Date: 69-
u. Depth: e oG ft. Static Water Level: 60 ft.
Pump read: f-1 ran act,S imp Size and Rating: 3/`1 hp 1.0 gpm
I hereby certify that this pump was installed and wellhead competed 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 �'1"7/� (/e yam'� Certification#: Z,677-C Date:UQ•-► -a�