The URL can be used to link to this page

Home My WebLink About382814_Well Construction - GW1_20100427RESIDENTIAL WELL CONS ► RUC FION RECORD North Carolina Dcpartmcnt of 1 nvtronmcnt and Natwal I ourcc,- l)i Iron of A\ att.! Ouality WELL CONTRAC1OI CI REII ICArION fl IVCWC 2839-,1 y �7WATER ZONES (oeptn) 1 WELL CONTRACTOR Top Z56 Bottom Top Bottom_ Brian UtleyToBottom Top Bottom Well Contractor (Indryp ioual) Name Top Bottom Top Bottom Aaua Drill Inc Thickness/ Well Contractor Company Name 7 CASING Depth Diameter Weight Mr, aterra 41 Moores MIII Road lop 0 Bottom Ft 4 S a.-7,) !//,C--- Street Aodress VA 24165 Top Bottom Ft Spencer City or To\.n Top State Zip Code Bottom Ft 336_) 767-0747 Material Metnod 8 GROUT Depth�7 %� Area code Phone number Bottom LGJ Ft �G� Top 2 WELL INFORMATION Top Bo Orr WELL CONS/RUCTION PERMITn - 27 -1 Top Bottom Ft OTHER ASSOCIATED PERMIT#(f applicable) SITE WELL ID »u aopi'capie, 3 WELL USE iCnecl. Applicable Box) Residential Water Supply 7( L,.:-TE DRILLED 10 TIME COMPLETED _1 '011 AM PMi"/ 4 WELL LQ�ATION 011 j ,t-0'r" I+11-J COUNTY �✓ Z9-- +S,rec, Ndine NuilJeiS l',OnlnlJ,lrl} SUpUIVlSiOn Lot NO Parcel Zip c,oael TOPOGRAPHIC / LAND SETTING (check appropriate pox) I)Slope❑Valley GFIat )Ridge ❑Other L,,TITUDE 36 DMS OR 3X XX XXXXXXX DD LONGITUDE 15 DMS OR 7X XXXXXXXXX DD 0autuoe/longitude source `_GPS Jropographic map ,Iocauor, or /veil must oe shown on a USGS tope map andartached to ns form rr not using GPS) 5 WELL NER Own(' iJdme Street ^address City or -town ',.ea Loae rldne hinder b WELL DETAILS �+JJ a TOTAL DEPTH 4 LS� / b DOES WELL REPLACE EXISTING WELL? YES a NO iT✓ �``j FT ow Top of ing (Use se c WATERLEVEL+B flAbove Top ofsCasing) (Use d TOP OF CASING IS ___— FT Above Land Surtace rop of casing terminated at/or below land surface may require a variance in accordance with 15A NCAC 2C 0118 7 YIELD (yprnl ETHOD OF TEST I tJt��(ri^' e L-- j M f DISINFECTION Type }/ a Amount f Water ity - SubrMailwithin ServiceeCdays enteroRalelycompletion NC 27699- Division SPhonoe (919) 07 61300 Information Processing 1617 State Zip Code 9 SCREEN Depth Diameter Slot Size Matenal Top Bottom Ft in In Bottom Ft in in lop _ - - op Bottom Ft in n 10 SAND/GRAVEL PACK Material Depth Size Top Bottom Ft Top Bottom Ft Fop Boron, Ft 11 DRILLING LOG Top Bottom — �/ Zso 7.50 /2— La 41€ / 12 REMARKS Formation Description Informatr:in Pioczsstng iUn;r - DWQ/BOta I DO HEREBY CERTIFY THA1 1 HIS WELL VvAS CONS FRUCTED ih ACCORDANCE WITH 15A NCAC 2C WELL CONSTRUCTION STAND • RDS AND T • COPY OF THIS RECORD HAS BEEN PRED TO TH i ELL.WNER '- Zti0--io ELL CONTRACTOR D TE PRINTED NAME O ARSON CONSTRUCTING THE WELL Form G`"'-1E r,ev Z/US