384549_Well Construction - GW1_20100615

1. WRL OON}ZiACTCRi
FRAN6uE L. o1 wa
a ame
ouwA (.J1;I.t ►.tl�b
aril.
STREET ADDRESS 6(04 (Ylmu,kh (2%.
ON(IDE. Nt. 28'112.
a
Oven tato
_ o' 1IoLC- go% ..
WELL INFORMATIOR:
SITE WELL ID ATapplloaga)
I: aTATS WELL p1;Ti'IVMTOSIopp_t,_)
DWQ a OTHER PERMIT oppaaatblo)
iP Cod.
do—b2
MUMS LMS (Check Applicable Box): RwlOentlel Water Supply t1�
OT►TEIp - 2S-10
TEAS come ETSO po
& WELL LOCATION:
CITY:ArkiesoviLur
A1t5Hv,L1 — ()Live
AM PM('
COVNTY UN,o.J
•
00 RAPHIC% SETTING:
( t E 5DRaw pother
LATa ti od. 557 N
LONGITUDE $ O `.4.1114..J
L hadolongitadesource: tiOP3 DTopographic mep
ROMbEEIEWMVINO s11o1/77 on a VSO$ Iopo m p Ind
oftwhod bI*hmI mshgOPS)
4'WILL VIWVR
OV4115111 Nag _..__DLi,4 414(SN
STREET ADDRESS 5 (3R+ce �naFFr� dui
APSHVILr.t: NC ".
p pm 28'103
tato
layisL -3ro3
rnkrtg mum w
•
May by In degrees,
minutes, mends Or
Ina decimal Ibrtrtat
NOW
RESIDENTIAL WELL CONSTRUCTION RECORD
North Caroline Deportment of Environment and Natural Raourves. Division of Water Qualhy
WELL CONTRACTOR CERTWPTCATION N .30UZ A
f, DISINFECTION: Typo! -70 le Amount
9. WATER ZONES (depth):
From $0 To,
From_(2O _ To
From To
From
From,
From
22 o2.
To
To
To
O. CASINO:Depth „ Iaratar Wall
From 0 To 'Pt Ft. lD'!8" all � PVC-
From To Ft.
From_ To Ft.__
7.OROUT: Depth Mahxagl
Fran0 To to Fr. foiraNia
From To 36 : Ft. NS •ter.
Fran_ ToF.
0. SCREEN: Depth
From To
FromTo
From To
0, SAND/GRAVEL PACK:
Dom
From To.�,.
From To
Fran To_
10, DRILLING LOG
From To
z
0
11, REMARKS:
Novo
tu-P
aanteta eta Stop MtMaw
F1. In. n.
Ft. In. h,
Ft. In, h.
Slxe World
Ft.
—71Thrrritt—
Formationion Dtaaiptbn
ego. DI=1•%oc,c
84.4.4 SLATE
RECE'\TEL __
JUIt 1 5
information Processing Unit •
100 ARMY CSRTtn THAT THE Will WAS CONSTRUCTED ACCCIlONI U % tW
11A NCAC 1C. WILL CON$T11U011014 STANOMOS. NOWA DOPY OF TIN
RICORC MI NIN PROVIDE) TO THE WELL OWNdL
cz
r lE L. °LAVES-
PRINTED NAME OF PERSON COA$TRVCT110
Submit the *right! to the DIvislon of Water quality within 30 days;, Attn: Information Mgt., 1 -I Berke - Raleigh, NC 27098.1017 Phone No. [phone] ext 888, Fin pVy`1'a
Roy. 7106
a waL DETM.$1
a TOTAL OEpnR • 0D
a Does WILL RPMcR DOIMNO WELL? YES
a WATER LIWI L aMowTip cf Casing: 35' FT,
(UN',Abs.,* Top d Casing
TQP oP CASINO NI 1 FT, Abort UM Suring'
'Top a' casto �^ • at/or e:Pwr Leib gurtan muy, rWauh
e valence h Noordoneewth 15A NCAC 2C .011e.
0 MD Ws* .,,_/0 METHOD OR TEST AIl2