HomeMy WebLinkAboutWELL-05-2015-060709.TIF e
e JUN 28,2016 08:33A WHISNANT WELL SERVICE 000-000-00000 _ page 1
8 WELL CONSTRUCTION RECORD Porwumlu. ONLY
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n, In.J( xd,rml( leal.ns(',rhuy supply) oiJenlwl Watvc Su ......._.IInJInnnl)<tcci:l /nkesidential Water Supply(abided) r.
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Ink-mina Well:
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I'.Jl'wlbarnal lllcatineCooliny Return) ulXh r(,xpinin under 521 RIVUrks) IL
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4 Dale Welds)Compleked:Oe.,,F./ /µ9'd1 11M1 _
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54IabWde end Longitude A 4 ,
p egrledmanut /..mods ur decimal d — --
ui,.Jl vim a LmooY n mfle in 2 �• a_ N - i►
6.IA(Art)the well(s):0 C:rnisarni or OTemporsry
ngting this Pent I hereby"erirly NC4l IM ndml., o-.9n ...L
].Ia ebb r in.
with l5A N!'..o 62C.nllHl or 13A Nem'in' p.00 wall.....,.a,.e..l amain e....at tint
rep.i ea sell: LIYm or Arvn e,.raafthis reeurrl lot Mon lnovidad to th.er1 o.n.o. •,, •., ,•
tram ii e meals,hn a welt:than ntean nye.,te 16.ff��,d I .,..the nowt.el the
•w under Iv ! v n.•., m roc/ / mu/rM. 23.Site diagram or additional well detail.
II.Number I'se1N t eM Von may m m IW 4 01 thin page It.provide.&liloln.l II .ire ihrtml.al ,,..II
umstnwl'u WM'S. 'Min I,wy olio attach;n1660n111 page-.I I ncccsnn
F.,.r4bp'r,ye.n.w.o.,.rn wart npph..o' Nth the MMr co.m.e,i.w,,nit,too,
n,r,Mpn.1 / Nu UMiTTALINSTtdTIONs
%Telal well depth below Sod enrface: (B.) 2e.. yaw All Welly: Submit Ibis rem, within 111
Far man a.Mh Ina N/✓rphu Ihtp.rrw la,.ry.4 3(a1? ](�IHYJ vemetmcdon to the Wowing.
dal,. ,.i.urnph:I l.,Ir .,I n�u
10.Slade Mayer kw el below lop leaaib ; •rjj/lly/V/t///] (N.) Division u(Water Resources,In formation Processing Lnil,
J�.•rr level It Any corms,tin n 1627 Mail Service Center,Raleigh,NI.27099-1617
Ii,Borehole dianner: /�C.% (in.) 24h.jot iniectjoo Welk OM,Y: III ahLc.plr to xenJlnr'h,•.I1nnl to
241 above, 11.0 aubmil a of thI 1 tlro,IJdl o,m
12.Well eonetrvehob method; copy r Ibrin within 1U da\'. ,•1 :ualplcuon .d writ
It a Buser.unary.cable.Ihre<I pruh, c.) [MI6W tmO IU 111.lilll..vmp'
IMviaion of Water Reanuree.,ll.alen erouhd Injection(bar,.,/fragrant,
FOR WATER SUPPLY WILLS ONLY( 1 1636 Mad Nervier,Center.Raleigh.NI'27699-l6.1r.
Este,For Nupp N Inj Well.:L:IN.Yield(FDnl " Method of teen amil one copy n thiS for m within lu ,a
y , hp
lelmu I131). lw0.fecbe ry P ' well construction) to the county haLLh dr p lm.m oY t . ,--.rap•((Ile,:_ _ _ ermau ticked'
I+°n'r'W ' NnMr>rolwl].pem,lenl of Enyilonennl.md N.tu.l lte.nw...
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