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HomeMy WebLinkAbout387611_Well Construction - GW1_20100920/41) aDlc9UI C RESIDENTIAL WEL•L- CON U ON RECORD �'Jii. l �S� 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• (� Wu*. c. 2&tIL Ctyor C n Efate tip Oo ii 1oM 1b4=RogS 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 f eh dk tq/np 111111q VITINDE � S.: 59. It, c4 LbNOITVDE1 O ° 3/. 2.55W May be in hem. minutes. woonda Or In s d,aimml Mom LatitWorgitude IiI'OPS OTopognphicmep • Aoeblr4frlelmoetbe mown on i VS00 topo nip end *ChM dIONO Ibrm/rattahpOP$) mats Kum 6MNMAR `oP (tuaToe+ �+e STREET AGGRESS P• o • 130x a 31 own" . 843- 933$ • PhCM font* dWILL O TAREt 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, • .. SEP 2.. Lt%Q40 Informat onYP VOG rocessing Unit