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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 ,._. _._ N: ...___ .••=.<"iliflRitlaYYanli�irrrlrrr, sip 't NC?N Rm ENTJ! L mmix ca:�s-ntE.cnor wow) 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 i i1