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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: .A tmtE _ L _ (3t,weE. Wdl Contr.ota (NdM1N.no 20uNq W u. �Cz.1aw6 arrsa STREET ADDRESS pro 1k (Y1ei B,U ty I It2f117-- Dity or 8c.t• zip Co�"�' IVM000► Phone number s WELL PdPORMATTON: W TI WELL ID ORsooso.01.) .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 LbaoatioE g O° A- (.)Lalitaionon_ tit5spurt,: teOP3 tTopographic map aVal Mtby shor,rm on a V303 top, map Ind dicholbllk Ibrm fnot tat" OP$) 4,wmLLCTN m OMNI WM EN?) Aft, P sssel OTREETADORE'S mot Lave / .. P . AM (] PM La' M.y Po In domes, minus., mondr a In. d.inei Former frbgaa NG 2$11.2 a,Mn Z NSuhno y • PnumberTOTAL DETRIt 18o a DORWILL RIPLAO11 worm WBLL ? YES Q NO d s !ATOR LAVIL PdowTcp of Casing: 2 r FT. (Usa'w' V Aeon Top d IV OF CAM a / Fr, Above La10 5urtsos' Icy +0limirsied-Viraftv WO Wow mW "gun svolmoah"Nadine*rMth 15A NCAC ZC ,0115, a MD WPM: 2O METHOD Of TOT AR 1, OISINPtCTION: Typo '70% HIN Woad ''2' p. WATER ZONEI (depth): From_ 1S To From Pill To, Fram9z_- From- l Z To I. CASINO; From, From To�� Thbaa..r� Frwn d DTo h ,f Ft. ' q /& MON vc From To Ft. From To Ft. T. GROUT: Depth Matorl.l Fran0 To 3 Ft. PP-TiA"'6 Fran 3 ,To 35Ft. &'4'1"fri'rr From 1•0_- Ft. I. SCREEN: D.pth FranTo From To_ From To_ MOW Of irMA r Sot shoo Mom Pi. In. h, Ft. In. h. PI. In. h. SANWORAVEL PACK: D.plh SW F►° nTo Ft.,�,_,_,. Fnmr TOFt._.,,_..,_ From To Ft. , 10. DRILLING LOG_ From To 0 4i �F Igo 11, REMARKS; MIWW Formation Doscrlptbn gaik.. * %DIRT I DO 11IRt1Y cum TWAT TM Will WAS 00/167 10II*Ooos1144. RN 1IA ?CAD !CC,, Wilk ,oN$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