HomeMy WebLinkAbout383438_Well Construction - GW1_20100513R1SIDENTIAL WELL CONSTRUCTION RECORD 3 3North Carolina Department of Environment end Natural Resources. Division of Water Quality li •e 8
WELL CONTRACTOR CERTIFICATION N 3ooz A
1. WM. CONTRACTOR:
FRANKIE L.OLWt1.
Of ame
IrMA (,)F,4, P4LL,.J6
WWI Contractor may' Nano n
STREET *Dome blest Mtbt.lr (ZD•
t`.Ny or Town tate Zip Code
t oy 4 'Ilor(-Ea$5..
L INFORMATION;
srrI WELL ID ORepvaestse)
STATE WELL PERMIII/Ropalp )
DWQ a OTHER PERMIT t0(I► applicable) 10-48
WELL USE (Cheek Applicable Boxy
t7AMOREM 4-21-10
TIAQ COMMLETEo 5 DO
i. WILL LOCATpM
any; WAScNA+.1
0D • Lt *52.
TOE I LAND SETTING:
OW*, f‘a~ C Ridpe O other
m ak tgrAgfeePe �4
. LATITUDE J. £° g, 2Im
LONGITUDE./£ 23b w
Lath elerlpnsipde aot°o0: dons O Topographic map
Akesxperaesn tAtpo+hown on a VSOS topo mop and
doted lo ilern f not wig GP$)
d WILL 01 ie
ITREET Alma
2ot LJaobArh.L. be
OAR .. tots3$ l"13
�w W00 1 Z�
vi
rnOla nu1N
a WILL DOTALS*
a TOTAL P PM 305`
a Does WM REPLAN morns WELL? YES D
Residential Water Supply 0
t #46MIo0 ONLY
AM O PM ar
COUNTY (U-►br
Ms), be In cleaner,
minutes, summit a
in a deoimel brat
NOW
a WATER LIVL Now Tcp of Casing: 3o FT.
(Use "/Abwo Top of Comm)
d. Top OF CA$S1O IS I Fr. Abotira Land Suffern'
'Top d none aNa b ow land nurteoe mar nqulre
a mimeo h aooWino* with 16A NCAC 2C , 011 t1.
O. Yap (WM):.--? s.._ METHOD OF TEST Au
f, DISINFECTION: Type 10°To N'M
0. WATER ZONES (depth);
From I10 To
Fran $D ' To
Fran 220 To
0, CASINO:
From
Prom
From
DePh D
From D To Si Ft, ir"
FranTo Ft.
FromTo Ft.___
T.OROW: Depth
Front ? To 3 Ft.
From 3 To 2o'tpt. u l...1..
From�w ToF.
0. SCREEN: Depth Diameter Slot eta NNterw
From.._. To FI. In. h.
From To Ft. In. h.
From ToFI. In. h,
t, SANO/ORAVEl. PACK:
Depth
From To
From ToFt.
Fran • To Ft.
Amount, 2N o z. ,
TO
To,
To
TNolotesar
SU.
(YlpalvuW
10. DRILLING LOG
From To
0 -I
1 2s
3if
3 eFp
3o5
11. REMARKS:
Ft.
Materiel
Sias Martel
az° Dttu-
QQorw+ 6frA L %SANS
R-ovr 9•2cri
Gt2A r►yTE
E:.r")ar`f.'11 ir
MAY 1..3 2010
Information Processing Unit
UVVLUBLK..
100 WIRY NAVY THAT Tlnl WQ,I WAS CONa1UYCIWO N AOOOIIaAIU NIIIM
IPA MAC IC, WELL OONIMILICT10N STNAMO,. NOTNATACOPY Olt lie
ROCCr101N0 INN PROVIDES TO THE WELL OW1411.
OWED NAME OF PERSON CONSTRUCTlNO?hhIWELL
Submit
u the Division of Water Quality within 30 days, Attu: hformsUon Mgt,
Raleigh, NC 27599. ;1T Phone No, (919) T33•T016 eat bad,
FamieyhtS
Ra,1105