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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