GW1--06944_Well Construction - GW1_20241119

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RESIDEN77444,-- wk. .u.' orsuraucTIoN RESORD . .
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North Carolina Dpswn ofivnint Nt
eHro EsIrane end eursi Resources.Division of!Water Quatlity
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. i............t.. WE.W.CONTRACTOR CiERTIFICRTiON II76 !
... . _ .1.WM-I.CONTRACTOR: , • • f. DISOMICTION:TyPirh ios ki he_ Amount „A-0-04_
1-7 ci 4,6 ' '.. walk ZONES itairhil ' .
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WO Cannata(hill Nod* • Prom To From To
r m iq a 4,4 tA4le....1.. .4"," <,.& Frm____ _TD__ L: -F WM
- woe CceireDifiComporly Nan* Ni Pron. .To ! Pram
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3 T R ET ADDRESS '.?.5aqi./ .117/C30 441f isQl4la - .!...CAlkINO: - 1 Taiesnassi , ,
Deems- 4.. =tirti..5ME Maier* .
,...9-24rS? : Flom_To Ft p vc.... .
ciiv or T 'l Stift
41 - ggio Man • TD FL ,. ........... ..... ••••ailmol•M••••;
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Area code. Phone nun** •
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7. OSSOUT: pew l ' ...Materiel . &Goad .
3.WELL INFORMATION: _ . ' .
. ., Priori 0 To .20 'pl..(147,„ro rt Mr,,
SITa MELIA)0(1.40‘16%) . Frarti...... ..70 ,. ..
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STATEV tp 73 ,
Ftwo____To Ft.
________
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DWG or OTHER PERMIT WO appItabie) .
. ••11. SCRUM' Depth Olinsier' Mu Se* keimelid -
Piero, To FL in. si.
MOLL USE(Cisme Anekeine eed!). natieentie weereueskal • '
Frio To rt. in. m. -
DATIL DRILLED /0 "' 50 - .a 1.9 Frans.,....._To Ft. Wt.
.Tina COMPLETED/0 '--g 0• ..,2 >I MI 0 P4412( ,
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I. SANDIMRAVEL.PACK:, I!
3.WILL,LOCATION: Depas :, Soto . Mame
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Prom To -!Pt.
CITY COUNTY 1,A1 cirrFil.. Frain To !Pt. -
3 S573 5 rtorti plii.C,
Fram--10P1,— ,......—.---
hwa
;S Hams,Paorsiers,Ceissnuney,rwiroasion.Lai ino.,Pspass.1114:‘,46) -.
TOPOGRAPHIC t We, sErritior :. ill:DRILLING LOG
C/8130e OViley "PM DR41. OCRIvr , ' Rain To ! , ItartnatiOn Dleambon
Noose approssiest osno ,
. LATITuDE 3 6 ° Z.6 '5 q_S-1 „„maiwas,71181t41170, i . , .
si) , 4,46 .LONGITUDE 74rc' / "'• oaFr// I"41116i11141124"11 ' • . "7- ,-2
,Latitiadationsitude source:APS .0 TopogrepRic ifilip
• docidan ad wet must g*shown on a IJSCSS Popo mop and _ I , , , ,
itSsened so Psis Sum I not using OM I, r.I..... 'p.,k :. j:: "
. 4.WILL OWNER , — • ..*.
OWNER'S MAIM ara r ir git" -5 e'aL/1‘Ck . , _ ROY 1 9 282,4
* * ET ADDRESS55SS-SCI verk CE1-40 vt, ICI ' ..... I .,
A4d.
City av Tann •StNe Zip Cade , ` rl,t-...,_.-,-., .
. (615-'d--). il,..a.(. 9--'91 • ..
• 11. REMARKS: , .
3.WELL DETAILS:
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• a, TOTAL DEPTH:
b. DOER WELL REpLACE sausTitee WELL, YUS 0 No, , - I ;
_.
i pommy Navy The TwOltrillit.i..WAS CON/1%411D al* CO WITM ,
C. WATER LivaL stoves Top vit cove: g 0 . FT. *A mod sc.vs ,I caospaucTou wrivasoos.oho ova a COP,or Ttel
, OM.'4,'H Above Top at Casing) 04, moon NA; ,, mimosas TO Tesill 1 swats ovnai -
/1
a. rap ce CASING IS. -. i PT.Abbe Land Sunoco* ; ,dirrer/
61
°Tao et caws,Iertniroded War beim lend swims may Ewes 1,91r
Abp.- , -" • a OP A -iiii MULL CONTRACTOR DATE
**voice in mcordeneo nab ISA NCAC 1C.01IS.-
_/ - ! 0-2; e.'grie.V .ia ey
a. YIELD owl* --c--- METH=Of TESTiN id 44 . 1c..t.h. *SEE—. . 3 ra-
PRIPITgO NAM OP Otitso hl,CtleilOTRUCTI640 THE WE'L •
1; I Submit the original tio Dia Division of Water Cleiftly inIthlo SO attys. Attn:Inforeneeon Vitt.
1e17 mill Senile*Center-Ralaigh.NC'27E19.111T Mum*N..(III)133.701S oat SOIL Pcini OW.*
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