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GUILFORD COUNTY DEPARTIMMFNT OF PUBLIC HEALTH
Division of Environmental Health, Water Quality Unit
400 W. Market St., Suite 300, Greensboro, NC 27401
ecford of Construction, Aapaoro or Abandonment gent of a
Address of Well: ,2616 Ca kiln/)en 9x), ?lea 5r:14 C r 4en; LATITUDE 3, 5 _o_
Well Permit Number: ,;?u ©3• LividA• rx'o) LOtGlTUDS 7q 44 t�,
tc .
Well Contractor Company: Alta �rl�> ?��. Completion Date: 1..10•.24
Total Well Depth: v7v?5 ft. Weil Yield: in gpm Static Water Level: WC ft.
giant it Cais71 g Material: ?vc Foration Log
Casing Diameter: G.2.1i in. Casing Depth: 45 ft. Depth Description
.
From: n ft. To• p
1l�rme>r°CasingMaterial:
� ft.
From: 5 ft. To:.15ft. 'iA Csnnr'
Casing Diameter: in. Casing Depth: ft. From: 3-15 ft. To:_,22,1ft• la1 uP �-rrrn,,4e
From: ft.To: ft.
Grout From: ft. To: ft.
Depth Material Method From: ft. To: ft.
From: O ft. To: .01 ft. (rmer1- '9rr i; L&tfi jruckFrom: ft. To: ft.
From: _ ft. To: ft. From: ft.To: ft.
From: ft. To: ft. —__
From: ft. To: ft.
Water Production Zones
Depth: 130 ft. ft. ft. ft. ft.
Yield: 1 U gpm — � _..o.� ft. _____ ft.
gpm .--gpm gpm gpm gpm
BPtn
Method of i;epair:
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.
Weil Contractor: Da.. oQLer, _ Certification#: L S(1 LA Date: ' ;.
-94
namisinsmummummeminis
accord oT Pump) a98attro
Pump Installation Company: n' c
—
Completion Completion Date: U 7�/7
Pump Depth: ii?) ft. Static Water Level: yQ ft. /
Pump Brand: % 3��
Pump Size and Rating:—1.L__hp ft) gpm
I hereby certify that 's pump was installed and well ad completed according to the Guilford County Well
Rules in effect on ate• that a co y this r ,ord has been provided to the rvell owner.
Well Contractor: • ar
Certification #:� t Date: C71 L7,/ t
Revised:January 1,2009