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GUJILFORD COUNTY DEPARTMENT OF PUBLIC HEALTH
Division of Environmental Health,Water Quality Unit
400 W. Market St., Suite 300, Greensboro, NC 27401
Record ©f Constvuctrione Qepaorro Dp Abandonitnnent cif a Weil
Address of Well: , 2(:),2 ' ')cji, to II) Sk-e)YiP Semi e,,Oc ;7357 L ml'dti® 312_ I .2g . I
Well Permit Number: ..2t-1•6;,tai.JHR.t i45t LONGITUDE SO t 3,2 e 14
Well Contractor Company: Ara Dr;lt inr Completion Date: 7 I di/
Total Well Depth: 7)5 ft. Well Yield:. I gpm Static Water Level: 61) ft.
Outer Casing Material: 'Pve Formation Log
Casing Diameter: 6. in. Casing Depth: 55 ft. Depth Description
From: © ft. To: /19 ft.
Inner Casing Material: From: (2© ft. To:_jr) ft. I
Casing Diameter: .____in. Casing Depth: mo ft. From: ? ft.To:_1ft.
From: . ft.To:2 ft. Lie
Grout From: ft. To:__._ft.
Depth Material Method From: ft. To: _ft.
From: r) ft. To: .;?( ft. reyw,:-f '►per,,; f-h_/IAA From: ft. To: ft.
From: ft. To: ft. _ y4_ _ From: ft.To: ft.
From: ft.To: ft. __..._. From: ft. To: ft.
Water Production Zones
Depth: (1,:lo ft. ft. ft. ft. ft. ft.
Yield: I gpm gpm gpm gpm
.o..do ft.
_-.__gP 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: ,;_i?tiblyi Certification #: 1/594.A rate: 7 3"024
w••
Record of Pturnw EnstaBBafd©rn
Pump Installation Company: i,�ad 11 I Completion Date: 7�3 / 2- l
1Pum Depth: 0Pft. Static Water Level: 60 ft,
Pump Brand: (riK),Ired
Pump Size and Rating: / )1 hp 5 gpm
I hereby certify that this pump was installed and wellhead completed according to the Guilford County Well
Rules in effect on this-dote and that a copy of this record has been provided to the well owner.
Well Contractor: --/ 4 l ' 7� .� ,
_-_ .-. Certification#: 7 i7 6 Date: 7/3
Revised:January 1,2009