HomeMy WebLinkAbout389294_Well Construction - GW1_20101206/v(V'lotoisc- Aft,
RESIDENTIAL WELL CONSTRUCTION RECORD 3 S 5 2
rvlr
North Calnt of Environment end Moroni Reeourooe- Vivielon of Water Quelhy
WELL CONTRACTOR CERTTTICATION N 3oo2A
I, OISINFICTION: Typo -10% Ian►
1. WILL CONTRACTOR:
walroRAaI�»r L. UuvER
pridis u 7omo
CRRoua+A / )eta DWt t.Ip+G
Welt odor Comporry Norm
'mar AMMO Coto1L4 (fEDu0
Vb.
Mt:a43tr 28112.
Cr Town State tip Coda--
nloo ao0► Pha* Nm
tL WILL RImORNAT10N:
SITE WELL ID OR °poo.a.)
RATE WELL PERMTINI opposable)
Qr:Q or OTHER PERMR tR(I eppeo.bl.)
/o- ►Its
WILL tUE (Check Applkoble Oooq: Roo°Oentlai W oter euppq 0
D.W11 COLL= /O-IS-Io IL'kiG(4Tto" p"'W
TIME COMPLETED, 5 : oo Am O PM t;d
PAULL LOCATION:
CRY: 4 COVNTf Utor"
rem se Wiz. l.o,.)6vLee* 251
* tkT, dubdhiebn, CorNo., POMO, VP Co*
TOPOORAMAC1L,wND SETTING:
a$I , ov OP* ORtdpe pother
ONO errnondebox)
LATITUDE ..A. 5 S!o
LONGITUDE g=° Lizf.?
Mey b. In Ar/ew.
minutes, woad* a
In a deohnsl brron
LatttIdlllorsibalds, um; EdOPS oTopogrophic m,p
• Ao*4roftm/mnae. shown on R V30$ topo mop ono
1116o18d b /lk Ibrm i not ttsllp OM)
4, WILL OMIIR I
OVINEN8NAMi CIS L3 tAt.A
ANON
STINT ADOREai 4010 (no r rftosE 3x .
fir« Omt ' ' Stet z ,cotes"--
MS OOW Rao INtn*Ir Z
&WILL DOTAL$
a TOTALDEPT#b -73OP
a DOEiMMRLMAN lXTFM WHLL7 YES Q NO LEI
WM LEM Now Top of Cse)rtp: S7 T.
(UMW !Map Top ot Casinp
ti.. TOW CARP 19 1 FT, Abws Lend SuWoe
'TopCI onto Winged aft blow send 'whop mN r quks
, admo,h,00pdutosth 15,04 NCAC 20 .0110,
i Yap (a m 35 METF100 OF TROT ' (L
9. WATIR ZONES (depth):
From /55 To
Fran 170 • To
From 3.52 To
1. CASINO;
Fran,
f rcm,
From
o °Toth 51
To
Ft.
Ft.
To Ft.
Amount
0Z
Fran SO To
Fran 715
irrorn__ To
ThIoknov M
W
T. OROUT: Depth Material
Fran„O To_3__ Ft. Par
-�
fra�
r� 3 To 't' FLWmNrTE
Fran - To^„- Ft.
1. SCREEN:
Fran
From
From
Depth
To
To
To
1, SANDIORAVEI PACK:
Depth
From TO
Fran To
From To
10. DRILLING LOG
From To
0 5
2-8
2.8
32 13o
11, REMARKS;
DI•netor Sbt Sme IAstold
Ft. h,
Ft. In. h•
Ft. In.
Ft
Ft.
Ft.
Slse MtMrMI
Fonnuton Doscriptbn
at Aar
2ow
.��gr,r7E
Inwiriet-wzgoest.:ing Unit
DO WPM CIPIri TWAT NO WELL WM CCl =1 R "
11A $ICAC:Cc,. Witt OoNSTALICTtON ITANOMOS
COPYCIFINI
RICCAD tW eetM rmovoto TO TM Well OWt
r19ivgsc L- t u yea
0 Wit OF PERs6N Cf)AiHO mega
ga
Submit,* orighad to the Division of Water Quality wfthin 30 bye, Attu; Information Mgt,
1011 MIA lento Conar- Rilalphr KC 27599.1 d1T Phone No. (919) 7354016 oxt 650,
I.
Ft,1n ttis .
ROOM