HomeMy WebLinkAboutGW1-2021-00183_Well Construction - GW1_20210201 0
Janes, Brent
From: julie register <registerwell@gmail.com>
Sent Thursday,January 28,2021 9:25 AM
TO: Jones, Brent
Subject: RE:TERRY GEARHEART WELL
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j d MathCaro#inaI>apanmrmeCFe�inamneMandT�xmaIResources-flitisionof Water Qaylity
WELL C:ONTRAC-l'ORC,ERTIRCA'#IO.N*2314A
1.WELL CONTRACTOR: :d.TOP OF CASIIG tS '� �„ FT.Abate Lard%chaos
r}AV ID L RFGI,5TER `Top or ca*V tetmentde+e ArVor ttekm taw u rtaca may MRrtara
well Contractor(Ind tiidttaq Name a variance it accw"nae with 1SrA NCAC ZC.4118.
BEC+#rtiTFR t/dFLL("(y} (NC ;e.YtELO(gpm(: _ ,#aTWMOFTEST Al
Well Contractor Company Name ;ARiTY ROAD L OMNIVECTION:Tn*j:ff��,_Amount Q
Strew Address :g WATER ZONES(depth):
r ROSE HILL NC 2M8 Top __,Bottrmt ., Top eoa«n
City or Twm ShiftCe :Tap acatom, Top Boom
zip
( 10 ) 2§9-3175_ Tip? BoKgm -fop-8--
Area code Phone number Thhcknesy
3.WELL INFORMATION: 7.C.ASIING: Depth 0111"new wwsbt ittatortat
WELL CONSTRUCTION PERMRaR+W,Su2Q20-10flWd ToPp.Q...._Borom-D Ft.A____ —Q--- ..DM----
OTHER ASSOCIATED PER#AITt(s*W"ble)
-SITEWELL1DttrtapPiicabta7 :Tot?Rolfes Ft.
3.WELL USE(Chcr*One Baal)Monitoring❑ Mw6dpaB hAft 0 -6.tYaOLrT: Depth Metartat Mdhod
bdushistiCommortaat0i AgriOutturat0 RQCD"ryE::Injection 0. :TOP�__,BbtSom2Q,,,,",,.Ft MDLEf�UG P�JRED
bdg&Wn,,/Other Lt(Tst use) ;ToP Botloat�,,,_Ft
DATE DRILLED i 2i22a= Tap Bow"' FI
i
i 4.WELL LOCATKNt ;4,SCREEW. Depth Otemetor SW Site a wedai
FROG ,El/EL RQAO :Fap_ _Bt*—_% FI 4 tn. .U16 in. p�
(Siroet Nana.NU.b&$,CamRwUry.$UWirieiaat.Oat NO,P&TOt,ZIP COMI :Top_Rwtom _-FL in„ in.
CITY:WINTERVILLE couNTY PITT ;TOP Bottom FL in. is._W
TOPOGRAPHIC/LAND SETTING:(check xxraP6*w bo.)
O&ope Cl Valley OW ,'^I.Ridge 0081er __ =io.SANDOG 2AVEL.PACK.
DMSORP#35.5305t#t pD = Depth Stznr Abrterial
LATITUDE 95 `..,._ :Top_" .._.. _1gg__FA•"#_ .GHA)EI..._._.,
LONGtruflE 77 _ DINS OR W21.441451 DO :Topptsaeon -" _,Ft
Latil dellongtlude source; (BPS Oropographicmap ;Top Botlarrt Ft
(kuation of well must be shown on a USGS tofu map trrrBst ad*rr6 rG
this taatt if nor using GPS) :11,DRI LLANG LOG E
b.FACILITY(Name of Its business whore the well is Icca#td.) Top Boom Fctmation Description
Q _120 Cr1.l4Y
Facility Name Fadldy tw(4 appwcaw) 20 130 sr"an=6ml
Street Address 40 160 S,t AV
Nr OD_f f,2 AND YA A SHF3 LS
City or Town State 4 Code
TERRY GEASHFART _jQ I 39
Contact Name rl RZ}GK r r r t
a3ci x�Ro�-vEl IR?At] f ^fit
Malting Address
!NL_28 f
City or Town State ft rode i 12 MKS:
L25?6 , fib-s87o
Atea code Phorte number _
6,WELL DE7AAS: :t a0 E°-EBV Cam-'rP t W.t t:Statu 1 c e �xtr r-tM I A0DD aAttc--xtTn
i WELL COWF+X=CR1roll'xtta40"'4ttA�tti4TAIXN"I OF:M�'S
a.TOTAL DEPTH: . - 9cr't rat3 9Tt&tvF oAe#.+a.
b.DOES WELL REPLACE EXISTING WELL? YES Noti;/� r �SIGNATURE OF CERTIFIED WELL ONTRACTCR �0ATE
It.WATER LEVEL shoat Top of callww 12 FT. J) jD ,EGII—
(Use`+`if Above Top of Casing) :PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit wUhin 30 days of Completion t0:D#V# t*n of Waterfrry QVa - htformatiarr Procftraing, Rev 2M GW'1b
16i7 Mail Service Cen liar,Raleigh,NC 27699A61,Phone:.(949)WI-6 D
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