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North Carotin. Deportment or Environment end Ninon! Raovro.s- Division of Water Quinsy
WELL CONTRACTOR CERTIFICATION II 3coz A
f, DISINFECTION: Typo 10% ft~f/1 Arnim,
1, WILL OONTRACTORt
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inotiPPE Arc 18ii2
a1!own State rip Cods
c 7bF 710y= 8085 ..
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LW= INFORMATION;
IITV WELL ID for opp•o.N,)_
RATE WELL FIRMS('.ppioaDre)
DWo or OTHER FEW E'p►.pp•a.bfo)
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wm.Luu Pled AF1 lo.blo Boor): RiolOontl.i Wotw Suppy
MTV 1R um 9-3'/D /or6A7oN ONLY
T1NI OCMPLI TID 5:3o AM 0 PM tt!
& WELL LOCATION:
COY' tJAKMid COVNT`T (,1,440,J
MAP•11)1 for .0 351
^^� ^•, •�� vwnttNlNty, St►od i )QnI Lot No., PwoN,
TOPOORMMICl1MO SETTING:
alb"'0Vilrf ciRat ORldp. OOthor
watwtisloNo10
IJITITVDE J. 5 o 00. I430
LbN0RUD0„ ° 4 . 535
May 0. In Ds/.*
minutia. owe& a
In.O..lms! lam
Witakilonikade loam; 'O1'S OTopop•phlc m•p
• • Ovelb ralarDlnn tea atom on a VSO$ lope 1f1M •nd
dlatodblit brmIno(aablp OPS)
4"ILL OMiMR
wool mg 70;4. Bra; J c.
SUM AODREsi 4W 4#'b Wma
rh
1"'G
yCrTa1 II ' ' tot,
t• ik 2413 - 3371
Phcos numb*
a►MIdLMAU
a TOTAL s
a•DOpFIp.LICIEfi MO111rM? 'ma Q HOW
WATIR LIVIL Now NI d cuing: 3S FT.
NNW EA*, Top of Ca•lnp
TO OF CAM a 1 FT, Aoov. Lind I>tiuA•o•'
'TI al 0s+0lernif WO WOO m.y WPM
•vlrtlrlo•h•ooadlno•V,Nd116J1NCAC ZC.0110.
Yt.D(m): 15+WHOP OF TIiUT_„�:......
•. WATER ZONES (depth):
Fran_ I To
Fran4rf ' ?o
Fran- 31O To
$, CASINO:
Fran 0 OTo h 9t3
From To
Fran__ To
Ft.
Ft.
Ft.
1, OFOVT: Depth
Fran0 To 3 Ft.
From 3 To 2.0 Fl.
Fran_,. ToF1,
I, SCREEN: Depth
From To
From To.
From To_
From .2PS,To
From,,,�_�.
From� ,�,_ To___.
Thawrwv
MMottU
Diameter Sal Shoo Wald
Ft in, h,
Ft._._.,.tn. ._.— h. r..�-
FI. In, M......�.�
1, SANWORAVE% PACK:
Dopih
Fran_ To Ft.
Fran_._ _1'o__,_„_
Fran _ To.. ___ Ft.__,_.,._
Size 1,10alui
10. DRILLING LOG
From To vlml
0 g3 N
83 r1o5 GRA✓,
11, REMARKS;
3'
c
i
r 00I*RIST CIRTITY TINT 110 WILL WAS TIT L "
I ICAO t , Walt OONSTNIl01TION STANDARDS,
!IGOAD II011114 MIWIDSD TO. TM WEE. OMMIrI
•
4NwrE L• W
12
ORINTEDl OF ON
5 bl atthe orghad to the Division of Witff Quillty within 30 cloys, Attu: Informitlon Mgt.,
1417 Md link* Cinttr- Raleigh, KC 27590.1917 Mono No, (919)133•7010 •xt 000,
SEP 2 8 2.45 1,•
Information Processing Unit
DWQ/BOG
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