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where lamstmeied.

GUILFORD COUNTY DEPARTMENT ENT OF PUBLIC:HEALTH
Division of Environmental Healthy Water Quality Unit
400 W. Market St., Suite 300, Greensboro, NC 2 401
Record of Constlructoono G°apaor>'o or Abandonment ent of a Weil
jai 1 4)
Address of Well: cK Skie IV) 5 >h,,
Well Permit Number: al•n5 w,U1iR• 0L1746,
LOMOrTUDl; AO i 311 e 3
Well Contractor Company: Air 'Drill 'Inf. Completion Date: L •ary 2'I
Total Well Depth:- .ft. Well Yield: IC _gptn Static Water Level:
Outer Casing � ft.
ffi Material: PtiG Fornaati,i,n Log
Casing Diameter: (a,.,2S in. Casing Depth: 5o ft,
Depth Description
itn�nerr CasingFrom: 0 ft. To: 40 ft. Oa
Material: From: (26 ft. To:yift.
Casing Diameter:
____ __in. Casing Depth: ft. From: 95 ft. To: ft.
From: 50 ft. To; 6_ft, b cn„Ftc
Grout From: ft. To:____ft.
Depth Material Method From: ft. To; _ft.
From:From: r ft. To:__�(__ft, -Crzeni P Li:4h i; , From: ft. To: ____ft.
ft. To: it.
From: ft. To: ft.
From: ft. To: ft. - .,. �..
---_ From: ft. To: ft.
War Production Zones
Depth: 490 ft. ft.
Yield: l p m ft. _� ft. .-.._�.ft. ft. ft.
— gp gpm gpm _._.gprn —
- gpm -,.gpm gPm
Method of Repair:
Method of Abandonment:
I hereby certify that this well was constructed, repaired, or abandoned according to the Guilford County Well
Rules in effect on this date and that a copy of this record has been provided to the well owner.
Well Contractor: _� iii0 ..
�`il ii,o.„_ _ ... Certification #: 145911_ Date: EL au
l/ c C©U of Pump Enot ag8a{ oo
/`14 a�
Pump Installation Company: uG . %�
Completion Date: 7 3/2.
Pump Depth: _ Z ___ft. Static Water Level: I
_ ft.Pump]Brand:—r�r h• �t r
z---- Pump Size and Rating: . y hp /0 gpm
I hereby certify that this pump was installed and wellhead completed according to the Guilford Counts Well
Rules in effect on '• date an that a copy of this record has been provided to the well owner. •
y
Well Contractor: 1-7 ��
.,,,74Certification#: . 9a Date: {f
Revised:January 1,2009