HomeMy WebLinkAbout387774_Well Construction - GW1_20101008amcitt t)gi
RESIDENTIAL ELLCONSTRUCTION RECORD
Norsk Cuvlln. D.p.rtm.nl orEnvkvnmSnt rand Norm Raouroer DIvl,Ion of Wsta Qu.lhy
WELL. CONTRACTOR CERTIFICATION N Joo ,4
1. WILL ocerrowrrcin:
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STREET
ADDRESS pro 1k (Y1ei B,U ty
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s WELL PdPORMATTON:
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.00
STATE WELL PEWITI1(s.pylo: )
4W0 a omen rimy nKll .ppno,bM) 10 -1 to Z-
. WELL USE (C11.oli Appao.bN Dux): Reoldantl.t Wader Oupply Ca'
W 1m7O M-0 q- I'1-to
Twit COMPLETED 5 : O o
&WELL LOCATION?
CITY: MorpoE COUNTY
£801 Love' /flak (24
("IOW,, iMb* Comm*, Subd Oolon, CoFNo., P.rooT I,o`ai)
TOPOORAPHIC I %AND SETTING:
Q, . OVIiry 571914 O R►dps C3 Othor
(deb 1gr./rll.
LATITUDE ,. J ° 07: 331
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• PnumberTOTAL DETRIt 18o
a DORWILL RIPLAO11 worm WBLL ? YES Q NO d
s !ATOR LAVIL PdowTcp of Casing: 2 r FT.
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a MD WPM: 2O METHOD Of TOT AR
1, OISINPtCTION: Typo '70% HIN Woad ''2'
p. WATER ZONEI (depth):
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11, REMARKS;
MIWW
Formation Doscrlptbn
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I DO 11IRt1Y cum TWAT TM Will WAS 00/167 10II*Ooos1144. RN
1IA ?CAD !CC,, Wilk ,oN$T111JOT10N STANDARDS. MOTWITA COPYOF11O
RICORD IW MNSN MOVIDtD TO THt Wtl,l OWNIR
Kro L. 01-tvet
PRINIgt44e OF PERsON COH
5ubmltthe WI* to the Division of Water Quality within 30 days, Attn: Information Mgt., Faint ,1a
11IA $.
17 MIrk. Cant r- Raleigh, NC 275994817 Phone No. (919)133'T015 ext 560, Rw. T