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HomeMy WebLinkAbout389291_Well Construction - GW1_20101206J kg/C. ,01 C, R1? ESMENT-1414-2111142111111"312liMMBR Nofth Caroline Dapenmant of Environment and Natural Raourvest- Vlvlelon of Wets* Quality WELL. CONTRACTOR CERTTFTCAT101.9 N 3002. A 1. WELL 0011TRACTORt RAOWE Wd Calreotor (YtdMiduL ) Name CAltouNA LJEw..(24w1.mo Wil Canlector Company Nnrne STREET ADDRESS (pfpls{ /nou.„ Ica. "raps Me - or berm fate c ']oq '1b1-SOBS Ataa oho ► Phone number s W!LL INFCIWATTON: RITE WILL ID Ow applicable) STATI WILL PERMIT:Om ppiaeete) Zell 7- Waco OTHER PERINIT root eppoores) Oto -30 WRLUSS (Check Applosble Owe): Reel0erttld Water Supply 0 my, C11 .UD • 10-11-t0 TWIN OOMrLST1ID /I %oo & WRL LOCATIOM* CRY: inoNRot= AM (' PM COVNTY toIJ 3s Z to Sacco, e lb** Cantu r Iy, SubdiNsbn,Lot No., Peroet,34 Code) TOPOGRAPHIC t LAND $ETTlNO: ONps. Otfiiry digit O Rldps O Other LATITUDI .�. ° SL. 81`) fi LON01TUDl 0 ° 31- O- tt 4) squaw: BOPS pTopographic msp • Axiboot Nlmotbe shown on a rises tope mop end &Wed Otis kern f not trsitp GP$) 4 WILL NM OV414911NAtrM,•, T� y Il�imtt 14Afjo�A STRUT ADONIS W5 St,w QRooME Ph. Mori NL ?$t12 May be In d&prow mirwte%woadr a In a dolma! brow CC TVon ' ' . $tot* t 101 ). 11911.- c13(4I iW ccd1• hats busby ',WILL DITAfl* si.toin DQ?IR LIDS ooprtlW..IMP AOR warm WILL? Y D d NO s !ATRR LIM Now Top of Cooing: j FT. NM •*• r Above Top of Going a. T470 OF CARO II 1 FT, Move LIIr10 durtser 'Top d aft 1orminsted etkr beivw lend suffice may rtrcNki mien* h poadlnoe &15,15A NCAC 2C , 0110. • 1. YIRDIW O: 15 METHOD OF TEST /hg- 388291 T. DISINPICTION: Type 70 /e gni Amount ° -' e. WATER ZONI5 (depth); From 31 s To_ From, Fran 340 'ToFrom From 358. To From e. CASINO; Fran Fran, Fran o 1 ToT EoPltt D Ft. To Ft. To Ft. 7, OROVT: Depth Fran 0 To 3 Fran 3 To 354- FromTo F'1. To To, Tblobreav v(a8" w VIVA, WINN Mattutoi — Ft. PU-t,A,� P FI. E,f 1 Tr r.�P O. SCREEN: Depth OterneNr Slot Mai MOON FromTo Ft. In. R. From To Ft.,.In. ..—.— h. From To Ft. in. r. e. SANWORAVEL PACK: Depth Site Mdudd From To._�___ Ft...._...........�•� From To Ft. ...�...— From To_ Ft. , _.....�.� 10. DRILLING LOG From To o /5 5" IS /$ 405 11, REMARKS; Fonnetbn essin9 117i00r 7:76"Q)_oCa I DO /R UT CIIRTIrf 114AT MO WILL WM 0011171,01011140001610111114 iH NCAC lCQ,. WILL CONSTRUCTION STD' AIO TWAT A COPY OF Ti11 RICORD IW PUN ►ROY010 TO nit WILL OWNS F 4Nv L_Ouva'R PRINTED We OF P t8ON OFPNUMMILL i —tin"• ' Submitt a original to the Division of Water Quality within 30 days, Attn: Information Mgt., 1$17 MSA Sink* Cantor- Raleigh, NC 27599.1111T Phone No. (919) 1334915 ext 559. For 0,_ 1t1,e • Rev. TA6