387611_Well Construction - GW1_20100920

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RESIDENTIAL WEL•L- CON U ON RECORD
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North Caroline Deportment of Envkonmsnt and Natenl it assumes- Division of Water Quality
WELL. CONTRACTOR CERTIFICATION N 3aoZA
1. WOLLOONTRACTOR;
tiWNWE L. ()LAUER.
Wd Calksalo► (InclkidaikNeme
Nrnonbector Campary Nano
STREITADORE00 (Slob' O')Eels.+ R•
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Phone number
WILL INFORMATION;
SITE WELL 10 Atnop aea.)
STATEWE'.t, .. r'R+' e)
' MQ a OTHER PERMIT PM applicable/ 10 - 15i
MUM (Check Appeoeble Om): Reelderttlsl Water Supply GI!'
OATSOI um 8- Zi- Io
TIME OONPLETID 11:00
0. WELL LOCATION!
cny; (oNaoE couNT'Y Lt io.'
AMc' PMO
3311 MAa(ttociso i Ukki Po.
a I
TIC/WM:ETTINO:
OVA/ ORldpe OOther
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VITINDE � S.: 59. It, c4
LbNOITVDE1 O ° 3/. 2.55W
May be in hem.
minutes. woonda Or
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STREET AGGRESS P• o • 130x a 31
own"
. 843- 933$
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s ?OTALOPT* 3o 5 '
tete
281"13
Z C
bi Does wauesp ,Aci ExISTIwo MIT Nis a NO el
L. "AMMO. blow Top of OWN: 2t FT.
(threw/10m Top DI Caeinp
d.. TOP OF CAM a I FT. AAvve Len0 WNW
`TW d +o Mnelreled efJor below land evneoe met regk:e
•wilnlosh eooadrloew1 h 15A NCAC 2C .0111.
YIillDlppnk.. ' I L METHOD OF TEST A R
T. 015INF[CTION: Type %0 Off'
9. WATER ZONES (depth):
From ToFront
Fran s To ___ From
From To _,_ From,
e. CASINO:
3B76 1.
Amount (..,.� •
Depth 13; _lamas
Fran 0 To Ltc Ft....WIC:.
From To Ft._,�.,_..
From To Ft.
To
To —
INcenea►
Weight *NW
T. OROVT: Depth MMe W
Fran b To 3 Ft. P o.x wb
Prom 3 To 3S4 Ft. GEr-root.*
From - To Ft.
I, SCREEN: Depth
FromTo
From To
From To
asmeNr 0114 Moe
FI.,�_ ._... h.
Ft.h.
Ft. In. h.
P. OANOKIRAVEL PACK:
Depth
Fran To Ft.
From To Ft.
From To Ft.
10. DRILLING 1.00
From To
0 5
5 15
IS 30s
11, REMARKS;
SW World
MINIM
Formetbn Dee ton
t.) Dstvc
8,4, E S &Mc
I CO lWY cirri THAT 1110 WILL WAN TN
iM NCAC t . WILL ooraTRUCMOw OTANOAR01, •
COPY OF Id
IIICORD W4 HIM PROMO To we Well omen.
Ir
ArbuE L.00%02- +`
ORINTED NAME OF MOONRu1.
Submit the origin, to the Division of Welter Quality *thin 50 cloys, Attu; Information Mgt., t u E
1h1 - R�lebhr NC Z7i3911.101T Phono No, (919) T33•7015 ext 500,
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SEP 2.. Lt%Q40
Informat onYP VOG
rocessing Unit