HomeMy WebLinkAboutWELL-11-2015-067108.TIF WELL CONSTRUCTION REC. D nrrnmma , r.)w V•
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3.Well toe(check well use):
17.SCREEN
W'nler Supply Well: rmnM i To (DIAMETER SLOT 510. THICKNESS mATERIA1.
Er A:;rieullurul I IMunicipnl/pnhlie n. n. m.
rIleolho0011 II teal mg'Cooling Supply) aidmilind W:uer Supply(sinflo) R. n. m.
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❑Agnili':1031 I.I.Srofmwulcr l minute -- - -. _. .. . . ._
❑I';gldriumnl:d'fechnology OSuhsiokucc Conlnd
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IlliCUlheminl(t'lucu Lang) fTPnlcer 20.DRILLING LOG(attach additIonal sheets if neerseary)
4100M TO nr:Menlr'1'ION(vdar.hardnew,,•il4rek owe.gram ow,ow)
rlicl,Iha mud(I lcalinp/('oohup,Reform) fl(hhnr(explain under 1121 Remarks) it n-
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4-Date 11'ell(sl Completed: .Y-74.11109
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Sn.Well Loon 'on: _
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/ 21.REMARKS
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('.''a l>ar idcnulicahnn Nn (p/14) ^m-11`_ , 1 •
..('TMICat I l .311.Lollholt and laogltude in dcgremdminules/sccnnts or decimal degrees: t 7
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SI • of cennccd Well fnnoonior
b.Is Iare)the walks), 1'crmunenr or ❑TempOrary
fly.agnaig'his lam?. boson
) corral,that the write') n is(were)cvnrlrvemd m acmnAmrr
wide ISA,vol (/[('.0/(Hl or li-I Ni nr'al( .U200 Well(7001c0n000a Vurdmdr and Mut n
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IN Ihis ii repair to All existing well: I7 Yes 0 ❑N( rnpp of ALI rucata ha.naafi jimmied Iv Ihe well n.'
ll rl ryurr.111 out known well roar/ruction ink ti'm and explain#11''Win'c/te 1 .,.
1 aaorr nmmr N'annul's cuurr Oran the bur* if I/coo pom. 23.Site ding rain or additional well detail.):
x.Number of wells constructed: You may use thconstructed: f this page to provide additional well site details or well
construction details You luny also(Mach nddil lona!pages If Deccomfy
4m thlo l(Iplei jccrrnu or..too wmcr.supplr wdla UNLr with 0.ua m crnslrucnan,you can
Nohow!an,) .ln SIIBMITIAL INSI'IICI'IONS
9.'I nfal well depth below land surface: 4, - (ft.) 24a. For All Wells: Submit this lhnu so ilhin :NI days or completion of well
/'m ruduph:x all,•lime all depths I/dlifov l(econiP llr Ou d?(d l nn') ounslnictinn to rice lillowinw:
10_.Sea do wafer level blow lop of easing: (ft) Division of Water Resources,Informndoll Processing Unit,
//cner/1-1,r/it■•/pre curing,n.o, / 1617 Mall Service Center,Raleigh,NC 27699-1617
11.Borehole dil:m(1er: ��1 (in. fr 24h. For Inleetfnp Wells ONLY: In addil ion to sanding the Ibeni to the address in
/ 24s above, also submit is copy of his Boll within iU clays of completion Of well
12.Well construction method: - (' 7 construction to We following:
(Ic.auger.!Holy.cab&thin(posh.(te)
,} Division of Water Resources,Underground In)er'.tlou Control Program,
1-(114 WATER SIa'1.1 ' .LLS ONLY: A 1636 Mail Service('enter,Raleigh,NC 27699-1636
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I3a.Vlelll(Rpm) a./ ,_ , ,�frthml of lest;_ /G _ 244.For Water Supply& luJnntlnn Wells;
�` 1 JIM` Also ,submit one copy of this Emil within all days of l•.nmplclion of
1.1b.1)1cii Ice(Ii,n type: ��„ / r_J .Amount:__- well cunslmctiou to the county health department of Ilie county where •
I conxhuacd. •<
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