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
•