HomeMy WebLinkAbout389295_Well Construction - GW1_2010120644,„) O1011. Q-
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RESIDENTIAL WELL CONSTRUCTION R>zCORD
Notch Caroline DepSRment of Environment end Natural Resources. Division of Water Quanty
1. WRL OONTRACTOR;
rfzIlN►UE I,.. OI.`ve(l.
Wel Conlnota (MtO*SW) Name
S7(24u.t.+G
Well Caleader
Nan.
STREET ADORES, 19t't4 ('flebuw
WELL CONTRACTOR CERTIFICATION N 3002-A
I. DISINFECTION: Type 70e% 14T1i
p. WATER ZONES (depth):
Fran To
From 7s '
From 5$2 To
O. CASINO:
)t 1 r form grate
Zip
C
Chy a ftywn taco tip Cock-
Ft-oi ao► :Thom. eurt:
L WELL INFOIaMAT10N;
BITE wau. ID PV.Fploao,.)
WATT WELL PERMITM(tr appeceses)
DM a OTHER PERMIT E(N eppNcome) OR.-QO (a
• (cit Appllosble Sort): R.ektentloi Water Suppy 0
HATE Nam 11- 21—;4 (0.414611,nol 0,,u1
Tom ccupLETED POO AM 0 PM EIS
i. WBL LOCATION:
tatZi11410 COVNTY (-nao
315 lilLvrtoose Da_ 1.0,4>viE& br 4t
a
TACILAND SETTING:
OS* OV.ky I N O Rldp. 0 Other
(dts(1l •Ppaplstebon)
% ATITVDE J. 5 01.559m
LONOrTUDE_a O e 117. i'U G.!
Latibielonsitudesource: 6lOPS pTopographic msp
`tollbIFawe/ m ono / orll on . V$OS topo map Ind
Nlat600hit km►Ino( (rsrhp GP$)
M.y be In :&peak
minutes. 'weds or
Ina *aims! Mann
4WILL OMNmR
OWNV 1I A% Cates CR.w,
STREITADORESS 315 MopTRose R.
w He- ?lt13
CrAi ZIp
(44j. %►i1-8/S2..
• Phatl number
s. WELL DETAILS;
o• 'TOTAL DEFTI t 75 t
b DOES WILL REPLACE IMMO WELL? YES 0
No Si
s. WATER LIM Palm Top or Casing: v FT.
Nos'+' MAbr.' Top d Casing)��'�
d. ThFOFCASINO O I FT, Abor. Lind Surho.'
'Top d mai MrmanMd */a Woo land swims m.y r.guk.
. wimps h exadino. with 15.6. NCAC 2C .0119,
▪ YRRD (gpin): MEMO OF TOT_ 1 g-
h
From 0 To 4'9 , Ft.
From To Ft.
From To
Ft.
T. GROUT: Depth
Fran0 To 3 Ft,
From3 To 2[>4 Ft.
From To FI.
O. SCREEN:
Fran
From
From
Depth
To_
To
To
9. SANOIORAVEL PACK:
Depth
Fran TO
Fran To
From To
10. DRILLING LOG
From To
0 15
15 le
20 755
Thiamin/
Wool
Zt ? del
Amount
From 444 To
From /15 To
From To._,l�
(o`liwt nor
Malteds;
Dtaneter Sat Mee
FI. In.
Ft.
FI.
Ft..
Ft.
Ft.
M. h.
In. h.
Size M.Isdd
Ms err
ormltlon DeocrOtbn
SoPr'fucE /O4
rrE
1 f•_a ��.9'f•
11. REMARKS; t'EC — \r6
Unit
tattr v _
9nfortr ot. nwQIBOG
DOrRRtlY CIRTWFY TWIT RROI WILL WAS OOIIIf10101mNA00010M I
VON
tOC W Iik1 RE H ►R D TO lift t ANDMOSWELL ►rTIVIT A OOIr OF 11M
chi•. .rramoikrammtmwtrumfgefaija
iwE L. oov es-
R NT 0 ►SAME of liERSON eargnMonlati
8ubndttM Aima to the Division oI WBt r Quality wfhln 30 days, Attn: Information Mgt,
1417 MEA lMce Center- Raleigh, NC T7599.1517 Phone No. (919) T334015 'NI ES5.
.49
Far �V�1t1,! .
Rs TI06