HomeMy WebLinkAbout386166_Well Construction - GW1_20100811RESIDENTIAL WELL CONSTRUCTION RECORD
North Carotin. Department of Envkonment and Netvrel Mammas- Division of Water Qualhy
WELL CONTRACTOR CERTIFICATION N 3ooz A
1. WELLOONTRACTC•utt
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Wd Cantroda (Md of .' Nome
COCL0L044 WEu. bR.iuro
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STREET ADDRESS (do t tt MEIN it,. (� .
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Area oho � Phone number
E. WILL NIORMATION:
$ITNWR.CD£p7s ro).7 __
STATE WELL PUMA, oppodoo)
DWQ «OTHER PERMIT opt applicable) %o -in?
WELL UN (Cho* AppIooblo Door): RoolOonttel Wet« supply I2'
DA IoltlLLED 1-28-to
Tate COMPLETED I' 2 too
O. WEi.L LOCATION;
CRY: /i?oaaoE
412 SoE C-0 •.,s
(N�j�Numb.* .,• •.
TOPOORAPMO/%AND SETTING:
Dlllopo DVe l OW DRidge ['Other
Wad ooproPi leboo)
LATITUDE ,�, �° 54i. (97 w
LONOM.V5_ .Q.o 33 . o2(0
Lethebilongitudo nun* m'OPS O TopoMaphic m$P
• ObelbedwMna ra Mom en.IJSOM fop mop Ind
*Mel kml /rm. trip GP$)
AM O PM BY
COVNTY uNadN
May a In derma,
minutia. woondr IN
In a decimal Ramat
O.WIILOWNER
ONOS ERA ► hoo 1-Avots
STREET MORI'= 12 r0,E A I,t.t s Pb •
oAIMS 61t,
a On1t • tuts
( "loin). 212. - 7012
NSA OOd, • PhD* nurnbw
s►WELLMAIM
11; MAL DQnt • 355
28tiz.
zip
a oatsweu.nvtAOE EXISTING WELL? YEE a NOW'
.. WATER LML wowTop of Cooing: 3 2 FT.
(UMW I Abs., Top d Caring
d.. T IP Cf CAM p FT. Above Lend duAeor'
Moog WI *minded War Wow Irtd owhotr moy rOtiutre
e vtrhrlol h ookot ttlo1/ with 10A NCAC 2C .0110.
e, YIM.D (ppmZ.....L.,. METHOD OF TESTA''?
386166
I. DISINFECTION: Type 10 'fo R114 Amount O2'
p. WATER ZONES (depth):
From 324 To._ From�To��_
From ' ToFrom
From To From__To,
O. CASINO;
To
Thbonesto
Depth Diameter Weleht WNW
►ran D To «9 Ft. to sit " Shay _
From To Ft.
Fran To Ft.
T.OROVT: Depth
Metals,
Fran„ 0 To 3 Ft • arsA++A
Fran 3 TO Ft. �,N:�N17E
Fran To Ft.l,,...��..
1. SCREEN: Depth
FranTo.
From To.
From To
SAND!ORAVEL PACK:
Depth
Fran __ To,_....,
Fran To,_,
From To
10. DRUM() L00
From To
0 /9
i9 3S$'
11, REMARKS;
maw
Some(« .bl Ikon tartar
Ft. In h•
Ft. In. ___ h•
Ft. In. at..,,_._
Ft.
Ft.
Ft.
Site
Folmatbn Da�P
r l„r' Rocsc_
100l IIY CaR1V'r THAT 110 weu. WAS OONS♦M1C1lD N mamas we
I to NCAC tc, WI%J, OONSINI C110N rrANDAROS. MOM, A COPE OV 11M
WOAD FM errs, ►ROVID9D TO Trot WILL Owtrok
5ubmitthe wool to the Division of Water Quality within 30 day., Attn: Information Mgt,
1$17 t#aA I WO WIN- Raleigh, NC 27599.1 $17 Phone No, (919) T334015 ext 660,
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