HomeMy WebLinkAbout390297_Well Construction - GW1_201012291. tAttt0.L OOMRA4TORs
r E 1-..0t-wztl
flrM
t1TREIT ADDRESS IA014 9 "V+' N ry Qa
NRaE Nc-
• Cty or orm State
Anon► s •
Phan number
?$Itti
zip c—
L WILL INFORMATION;
MITI WELL ID Rr opp000wo
VATS Will P5RMTE(t ppoo)
OWQ a OTHER PRRMR PG/ upppa,blo) its -1I3
WILL Mg (Clndt Apptlotablo sox): RdolOontlol Wider ttupply 67>'
DATIIIow ID )1-17-/°
THE OOM/LETID AM p PM O
S. WILL LOOATIONs
CITY' IN_ Pray is
nLI ArtuN
S 10IN IMu�RAi' - Pray ift w b
TOPOOMM11C/MND SETTING:
Dom' C ORldpo C l Ottt.r
hholkIFFRWROFbotq
LATITUDE A. at. 010.1415 NI
LONOIIUOE V Q° 33.811 W
Latitaillionikaki goes: SOPS O Topographic m$p
• itglitmiwimudob shown on a VSOS tt,po mip Inld
dIChld 10,* kmr /not whp GPS)
cmpie '9 NMI� C'Et11. Qow ens
OM CamJ91<F MACED°w1A C4414..U41 I .
LN
a
Moy be In Oopw o,
wends nds a
Ins dselms! form
Z
G )I
otl++ t� zrp
(alai3(d3 - 56 W
Phi» ran*
LVAILLDOTAL%
L TOTAL CPR o
a OOP MU. mim= ammo WM.17 Yea a NO t>1'
MAM UM MlowTv, d Cooing: lq Fr,
(lloote M^eor. Top of Cooing)""""'"""
TOT, 01911011 1 rt. how. Laid 64irhoo•
'Top d 9 W w 'who, I'm nquM1
11%111 011100ooldtnoaw9lh 1SA NCAC ZC .0110,
0, YIRD(O ink / METH00 OF TEST tfii?.
Subm the MOW to th• Division of Water Quality within SO days, Alm: Intorm1tlon Mgt,
1$1 Center Raleigh, NC 27599.1511 Phorn No. (919)133•7015 IPN1559,
�ai la, AKA C
North Caroline Dapertmont or Environment end Newel Rosourow- Division of wow Quolhy
WELL CONTRACTOR CERTT?TCAT10N N 3002/4
f, 01$INPECTION: Typo -70 ° 01%?1
O. WATER ZONttE (depth):
Fran_ t IwK To
Fran,
From • ToFrom,
Fran To_ 'rumTo
I. CASINO: �,Ir9 TNOAne,v
From 0 Depth .Yn F1. [t3 ` 9" Sb 1
Fran To Ft.,,,�
From To Ft.
sr
T.OROVT: Depth
Frwi 0 To .3 Ft.
Frae To 35* FI. B r1 Nti
From To_____ Ft.
1, OCREEN: Depth a•molor 9I01999
FranTo FI.,__�M h•
FromTo RI.__,.._,.I1. h.
From To RI. VI. h.
Mods'
afrob
FANDIGRAVEt. PACK:
Doplh 8W
From To
From To Ft....r.......
Fran+ ; ,,^To,_ Ft.
10• DRIUJN0.100 >• •
-From . -'TO
0 /5
• /S 705
REeEP9LEE
DE
t TER
Informal n Processin UnI
1I, REMARKS;
Wolof
Mellsdel
Pvc
MtAaW
I OO PERM Ci,tTYY MAT TWO Will WAS 00187011410oms. NC MTN
RICORD FW 'elmPRo i. Tc not wv.Milli
FRINThiNii5171)Vir"
MirRon.1�6
01