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GUI FORD COUNTY DEPARTMENT OF PUBLIC HEALTH
Division of Environmental Health, Water Quality Unit
400 W. Market St., Suite 300, Greensboro, NC 27401
Record of Construction, . epai r© Off Abandonment of a
Address of Well: jigs eleuzAcip `Rr s+okra )
Well Permit Number: 3.►,a• r tj jg•or,ai f LONGITUDE 90 e]
Well Contractor Company: 40�t1 ai ,.,
Completion Date:
Total Well Depth: . g5 ft. Well Yield; CQ gpm Static Water Level:_TAQ____ _ft.
Outer Casing Material:
Casing Diameter: Formation Log
Lu _in. Casing Depth: ft. Depth
From:.SL_ft, Description
inner Casing Material: _.L
From: .Qo ft. To: 5.3 ft,
Casing Diameter: in.
Casing Depth: _ ft. From: 53 ft. To: 58' ft.
From: ft. To: t ft. . gLicat ;4r
Grout From:_ft.Materialft. To: ft. .
Method From: _
From: Q ft. To: �i ft rjz. i,:a tr is From: ft. To: ft.
From: ft.To: ft. --�__ •� ft.To:____ft.
From: ft. To: ft _. — From: ft. To: _ft.
From: ft.
Depth: ft. Water Production Z 11
ft. _ft. — ft.
Yield: _Ca__ gpm - • ....�ft. ft. ft.
gPm gpm — gpm gpm _ m _
� gpm
Method of Repair:
Method of Abandonment:
3 hereby certify that this well was constructed, repaired,or abandoned according to the Guilford Count
Rules in effect on this date and that a copy of this record has been provided to the well owner. y Well
Well Contractor: ,1� •/���ff y��,,
i0:r�.
�.. Certification #: L't ._._ Date: ? 'L2
Record ©T Pump Enstadtdrslta®n
Pump Installation Company: a ffm/
Completion Date: 07• o y _a y
Pump Depth: _3y _ ft, Static Water Level: `►O
Pump Brand: �t��,,i�" ------to-•
P Pump Size and Rating: h /_
I hereby certify that this pump was installed and wellhead completed accordingto P 6 gpm
Rules in effect on this date and that a copy of this record has been provided to the well owner.
County Well
Well Contractor:
rr -- Certification# i D di 1( 10
ate:
Revised:January 1,2009