386740_Well Construction - GW1_20100827

RESIDENTIAL WELL CONSTRUC ION RECORD
North Caroline Deportment of Environment and Nature, Resources- Division of Water Quality
WELL. CONTRACTOR CERTIFICATION N 3007 A
1, DIe1NPECTION: Typo 10°14 11
1. WRLOOW�TRACTORs
rilANwil: OiweL
Wee Cmtnda (IndMtull) Name
i.t •rA W Ect, .7)gii,406
Well Contractor Name
STREET ADORER, &Wy Maw, A.
teNagle C
2,$(12
ClyaTerm State tip Code
.?O,1 764:$o8C
Ma oo . t�hona numbu
S. WILL INFORMATION; •
SITE WELL ID for wiploeeie)
STATE WILL PERMTOW epploet4o)
DWQ a OTHER PeI MT sr(N epplloabie) 10 —i 28
. W■LL I1eE (Cheri, Appeoeble Ootr1; Reeldenttei Water Supply IS'
DATtcomp V-4-to
TIME COMPLETED S: 3 0 AM O PM (�
& WILL LCCATIONt
CITY: f 1 ogape COUNTY U,"01.)
/Its C0T-rr.1 l2"r :b&
TOPOGRAPHIC I LAND SETTING:
a$1 ps.OVNry &M ORldge DOther
pAedt REM** WO
VITITUDE j. 5 " O(o_Lii#3 N
LONOITVDS .a° 2/. Latitudellonsitude MOPS OTopognphic msp
Neo�arallNnut b• shown on • V$0$ topo mop Ind
ealoMdbMk Item /► of trip GP$)
4,M.OwNER
otirlIIIreNAM5 ...Olt we r zw,
STREET ADDRESS 51,311 Roctur I qn . Cr-
"
Ckf 0111) I.I. zip Cow^
May be In domes,
minutes. wounds or
In a deeimsl Fame'
( 70'1 ). 34,1- 5i t o
Nei OOd1 • Phan nwflber
IL WILL DUAL%
TOTALDEPTII; 3os�
a DON WILL IMAM EXISTING W5117 YES Q NO ®'
e. MIATOt LI M lobs Top of Casing: 31/
(UM'�• M Atom Top of Castria --
a. T17POF CAslN $ 1 FT, ADWA Lend Stlrlso••
'Top d cattle Winged WM below lard swim may rsqufl
• wires ns000lano.Wei 15A NCAC zc .o11e.
Ma I S METHOD OF TEST A2
FT,
S. WATER ZONES (depth):
From 2Ro To
From____ To
From To
O. CASINO:
From,
Fran,
From
From,
From,
From
aorcAtt
386'740
Amount 2� %-
Depth Olarheter
O To 45
To Ft.
To
T, OROVT: Depth
Ft.
MatorlM
From 0 To 3 Ft, P al-L*4
from, 3 To 26
From To Ft.
To
To,��l
Tltbbneel
WeightMsoare ahvc
O. SCREEN:
F romp
From
From
Depth
To
To_
To
Diameter eat eta Malow
Ft. In. h.
Ft. In. tat.
Ft. In. h•
f, SANDIORAVEL PACK:
Depth
Fran•„!_ To ____ Ft.,
From TO Ft.,
From To F.
19, DRILLING LOG
From To
0 17
t'I 3oS
11, REMARKS:
Slte
Metertd
1
I n%�L"'`�' Iocess
DWQ/BOG Unit
IC* MDT CUM MAT DO WEu WAS OPISINI O1IDMA0000CAMOtR+MM
ISA NCAC:c. WILL 0014TRtOTE114 STANOAROS.1401104TAOOFTOFflu
RICatD WV NEIN PROMO TO THt Will 01MQA •
-to
i‘X;)4
RE tSI= WEu. co € .
f+Ki6 L. t9uveit
R NT D NAME OF PERSON COTSTRUCT1NO Mai
Submit thN original to tho Division or WoW Quality within 30 cloys, Attn: Informetlon Mgt.,
1$17 MIA SNWC. Center- Raleigh, NC 27699.1517 Phone No. (919) T35•7015 e><t 599,
poloGyylls .
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