GW1-2021-00328_Well Construction - GW1_20210312

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WELL CONSTRUCTION RECORD For fm=lMseOnX
[tab,ram ca be Used for singlc oT MW14rtcwas
L Well C3mtrttcxor.informatlon:
Rich Lemire N M I TO
_ 10 .iP'rlos
Atril;Cortitneaeflhre ft. R.
tL fG
2593A
WC Wdl ContmctorCenifkMionNnmbcr S.,OiFIRR. �iNG iiiitti asedrirA 013 fia1t4Flt k` Rrahle is
trROM. ATADTETHR" TMCNINTM MATERTAL
SASDACCO Inc
CoeattarytZaarar fS3 1NCORBYt�t teFtiftxdd
FROM TO DWAIRT6R I TM M TM I MA7IT:RMAL
2.W41 Consuctitln Permit# 0 ft. 35' h. 2" SCH40 PVC
tie all appilimble*141 penwila 0 r-
ft. A. tit.
3.Well Use(check well use);
Water Supply Well: FR M TO _ I DrArir.Tr R I SATSM. I -MT I M fflAVERIA10
t]Agficultural OMtmicipalf..mlic 35' R. 45, R. 2" lit 010 SCH40 PVC
DGeothernmi(Headn000lutg Supply) 0Rcsideri;ial Naar Supply(iingle) ft III to
01ndustriaMmmercial OResidential water.supppiy(Shared) Tel t3lttl
PROM TO MATtRTAL ts3tNtA A T iTMBMOn fiAMOUNT
Dial alien 0 ft. 29, ft. PORTLAND TREMMIE
Won-Water Supply Well:
?t, h.
MManitorh%
Injection wen:
YL tl.
0Atlttifcr1tccharp QGroundwacrRemedirtion 9r45ANbM R"A" - to "N MNAMMI.Ir VIM P 'Yr n
13AquiforStoragc and RaxotiM OSalinitygarder 33' fl. 45' ft, SAND #2
OAgnifcr7cst OStommittcrl minogc
ft. fG
❑F-xps rimcntaI 7cchnoloa ❑Subsidence Gontml
;.'nRnarr�k� �` it¢1ri?Atilt7tt t@ri�t.1ieit�te �w=� ..
OGeoipenwl(Closed Lwp) OTraou FRO." tv DRSCROM01; e.Ysetrx sow"KA _ W-) '
13Geothetnml(RestingCoLliM Return 00ther(explain under 02tRernatfif 0 ft. 44' ft. SILTY/SAND
44' ff. 45' (. PWR o i
4.:DSteWeil(S)Con)pletcd 2-11-2021 Well ID#DMW-2 tt. ft.
54.Well IJ1C7 40W. fL It.
RED OAK LANDFILL ft. to. ;tti
Facllity0mvrNam Fm okyTD#(irviiiiabie) p lci
3678-3288 State Rd 1524 Battleboro, NC 27809 Nash (L p,
SATTLEBORO, NC, 27809 Plo-siWAddom City.md:Zip
NASH BENTONITE SET FROM 291TO 33-
C)"M Panctltbtr'fticnFJan'tVo,(pfi l)
51%Latitude And longitude is degreeslminuteslseconds or decimal degT•ecs; 22.Certification:
(it xttl IkId.one WonS dt SrdllCictd) .
36.034663 77.895918
ram'"
]� W .�;a/1r,t .C. 2/17/2021
Si�atrtntx of Ctrt 7JsN Cavmrcmr s :Darr
6.Is(rain)ti ewdl(3):.'0P manent or OTemporary By„gning Ah jbnn.,I her&4>#mtjs that 4w mrO(ki aft(wrtr)don8~ed ur&ra,d m
rvNfi t3vt NCACA2C';Ota9 ar.l SA NGAG"fMC;t7'�K'eU Caaatrrzttlnwt SrandaMs artdASeta a
7.Is this a repair to im Wsting well: 01'es or MNi► r� r�1 rhl*rxorrtl+ns 8rnru pimdrint ra afar arlt nrvcrr.
if rAls it a n.pafn fill omr CeT m well ea+aonftvf<m hVarxw*n mad explain dw nature of tar
repair mmtrr#2l retawrU atirtr;ns ar are dw bad of this farm. 23.Site dlWam or.Sddltional Nell details:
You may use the ba&,of this page to pro%ide additional well site details or well
S.Numberof n`ells constructed: 1, coustmetion details. You may also attach additional pages ifatecessafy
For maitlpir lnrrtlout or am-w area wtFp3r w lb ONLY iifM rhr same eonstrurAmt.ynww amr
smbastone foa�a; SUBMITTAL INSTUCTIONS
#.Total Wdtdepth bel*land Sor&CC 45' ((I,) 24a. Par ACE !Veils: Submit this form-rithin 30 duy's of oomptetion of nr11
for muNlplexvilslist all dep*rOdoemitferawl'-.30200'OM?01(0) Constmdionto the:fWming:
10.Stout"crater level below top of casing:,41 bit�,) °lslon of W*tcr Rcsoartd.Info n AtianProcessing UnK
theater level it obvi a trarisr,area"+" 161'f.Mail Service Center,Ralei*NC 276"4617
tl.8a chotedlametcr 6" (in.) 24b.Far Inicetiori'Wens ONLY: In addition to sending the form to ft address in
244aboce.also.Mmit a copy of this farm within 30 days of completion of well
12.Well eor6oMjlon MUtltod:MUD ROTARY CDtt4Wttion to the tblitsrvlitg
(i e.sneer.min y.'csblch dbra ttnsd.etc.)
Dhision of Water Resources,Undergmund Injection Control Program.
FOR WATER SUPPLY WEi LS'ONLl: 1636 Mill Semice Center,Raleigh.NC 27699 I636
13a.Yield(gpm) Method of test: 24c For Water Satrpls Rc 1!?jWJon WetIS
Also submit one cog of this fortes'%,,~thin 10 fts of conTpletion of
I3h.DWn("on"tvpL- Amount: neli constnictionto the cormty health depadmcat of(he County,wh m
constmcted.
Farm GW-t Nome Catelim Mpatuncm of llwitwmm aW Natund Resoutocs-:Division aNkla¢r itemmrs Revised At gust stt 2013