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HomeMy WebLinkAbout385301_Well Construction - GW1_20100719O. WELL LOCATION: c n'y Cd4P-14 r/G. RESIDENTIAL WELL.. CONSTRUCTION RECORD North Carolina Department of Environment and Natural Resources- Division of Wetar Quality WELL CONTRACTOR CERTIFICATION N 1. WIRLCONTRAayoRt FRr1N114C L -l9ftaLcMA LIEU DRsw1'6 Welle6fINactor Company Nettle Inner looms lol0iq ft1mto., mot-OPE PC tint 2. City orTavn State Yip Code } -)04- SOBS IR WELL INFORMATION; afTI WELL tD AT eppltt au.) RATE WELL Patfarog ap) W Vo31xo55 DwQ a DTHEP. row Set appecabh) mof,(t G' loon'I(v3(D MUM MKS APPSoabN Sax): RootOorttlat Water supply O DATEOR1.120 -LS-/o I?•� NON of TIME COMPLETED 51 00 AM O PM p' 23/ COVNTY /✓I c Cf4.Et+4W16 lAvrYt0,441 Pay OACI� k`TT1p: 0Ot>1er (:leant spproplapt IA7TTUM, .+L 5 20.I LONOIT WE S. 0° 'N. 44 y w May be In dorm, minutia, seconds a In a dsoimal Ibnnel LattadetIonsitakt source: @(OPS O Topographic map i show" on •V$QS mop 4 OWNER not utile OPS) APO NAMQ uss STREET ADMENlp 2-31 P ttt.n4 ar W 1; 2ES 21rZ cvm " fate fM�nbK �WELOITA* a TOTAL DEPTIk Iced Zip b, MU. REPLAN WIMP MILL? YE5 0 NO CO a WATER LEE kb/Icy of Casing: (Uwe FAWN Top ofCsing) FT, d TO OF t f M u S FT, Above Lmd Wm'd Iwo audio. may nquke aWinyah mord nosINtA 10A NCAC 2C ,0115, YIELD(vPmZ---S MilTMooOFTINT Alt 3oozA 325301 1, DISINFECTION: Type -10 "/o tHn1 O. WATER ZONIS (depth) Fran 75 To F►an_je90 • To From To S. CASINO: Fro n __Q__ To 35 From To From To T.OROUT: Depth From Fran, From Amount jD o z . FI Diameter Ft. Ft MU(I W Fran_ Ow To 3 Ft. Po(txuwb Prong To35 Fl. eE?JTo-►iT. From„_ To FI To TcP To Thlotreow Wtert warhl Ss zt vc S. SCREEN: Depth From To Frorn To From To a, OANWORAVEL PACK: Depth Frcrn.�.�_To_^ From Tor__,_, To 10, DRILLING LOG From To b Es ansnMer Sbt Oho WOW Ft M. h, Ft In. h. FI in. In. Ft. Ft. Ft. Size Miderld Form.tlon Dascr tbn GRA., (L AZ-0 CAL 0 n 69„A..A.,E An I W)111 11. REMARKS; 1k Srt-et, t��t Sao 044 Pt/Jet Ptah. tr Inform .t_ , , DWQ/ sOG DOItiRISY NAM THAT The WELL WAS COIISfIIMITIONIICOOIASCIIIIIII IIA NCAC lcc. Mkt COHOTRUO11ON STANOAROS. AI411NTAOO TC*MS RSCORD hi/ HIM ►ROMIDSO TO T t ram OWNER 15 CERTINED WELL coR'TAACTOIi PRINTED NAME OF PERSON Ell ,hthe , to theDivision of Water Quality within 30 days, Attn: information Mgt., linvIci Center- Raleigh, NC 2759i-101T Phone No. (919)133.701 a ext 60$, PC11110,10 Ran, TM •