385296_Well Construction - GW1_20100719

REXPENTIAL WELL CON$$TRVCTION RECORD
Notes Caroline Deportment of Environment and Nstunl Resources- Dlv,sbn of Water Quint,/
WELL CONTRACTOR CERTIFICATI
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X. WILL INFORMATION;
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• MALL VSt (Chian ApPtloabitr Cox): Residential Water Supply Df
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DATI D1aLL*o 7 -g- to
TiMICOMPETED_
S, WILL LOOATpNt
CITY: 1111 omits
TOPOSRAPHIMANDSEaTTING:
CS* OWSW (� � �� O Outer
LATITUDE A y' �tiF. a -? N
LONOITUDQ 8 0 °
.38-'� r 7� ..
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gosibNalrached b tit km/ I' not
an .CMOs (opo mRp Ind
dWELL R not Lift GM
NAME l 9A is Rp -(i;S o,.)
STREET ADORES 3sc2. PAW.4.atc S
o
1 o-110
tx c n tate
WEL twat
a. TOTAL DEN 2oo
14 DONS WILLRQLAOE mcmm.o WHLL? YES p
?_$'112.
Zip ..
AM PMQ'
COUNTY UP/00
Msy be In duress,
minutes, ssoonds or
Ina decimal knew
NO 2'
L WATER LVULkowTap of Casing: 37 FT.
(uw••• EAbc,O Top or Casing)
d. TDPO URN NI 1 FT, Abort Land Staled.•
rNano Purim, MP/ WM.
a Wiens h madame with 16A NCAC 2C .011 e,
Yap (WO , 30 MET►roD of TEST AR-
.
3 8 5 ; .6
on N 3ooz A
1, 01SI14PECT1oN: Type 70% I4TI4 Amount vz.
U. WATER ZONts (depth):
From /(par To,
From ice_ To,
From 172- To
From,
From
From.
0. CASINO:
France .DID h / $O Ft. /O' &"
Fran /�..SO._ To /55 Ft. /a%'
From To Ft.
9/ To
T.OROVT: Depth Material ItiNQaO
Ffm, ,P To 3 Ft. eitri a �i,
From_ To 35-ep—
From�w To Ft.
0, SCREEN:
From
From
From
Depth
To_
To_
_ To_
0, SANO/ORIWEL PACK:
Depth
From To„_._
F n:irn _To�
From To
10, DRILLING LOO
From To
0 29
21 /41
/41 2oo
11. REMARKS:
PI nets Snot that WWI
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Ft. M. h.
Ft. tn. In.
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tonnadon Deaalptim
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lt
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001QRMY 0E11T1F1r THAT Re WILL WAS 0210111101lD N AOOOI10AN0! tMM
114 NCAC tQ, WILL COMMOTION IIiTANOAROS. NO TINT A 00r10F 11M
IUCORD tw MIN PROVIORD TO O1i0 WILL oW1RA
t'KFtoY-tr L.0LAvc1R
PRINTED NAME OF PERSON CbT S RUcT htWELL
bmit
Su the DOW W U* Division of Water Quslfty within 30 days, Attn: hformsUon Mgt.,
COON Raleigh, NC 2TSSP-1017 Phone No. [phone] •tct s56,
l
For 04�11i
RN.1I10050