GW1-2021-01270_Well Construction - GW1_20210209

"ELL CONS'FRLc-nON RECORD ���� Fd lncmalluONf\
Thn L.nt..r.It"i'n 1.-,an.A tmdnpk udls ._..
I.Nell(unlrAcwr Informaton:
u wA1EE #8
Dylan Piernt rwoN I to Rea
Aau I iuf(JCiOr 1AIK It. n. _
4507-A h. ft, _
tit U,II(anrxtnr fcnmcwp t4■�rr OOTER CASING INr_ �In'__and ee4�(M 1_IM P IY -
raDN m s.,w.a il,N N\(\\ NAtral Al
SABDACCO Inc 0 n. 10' ft. 2• I. SCH-40 PVC
(auq:.N, IS.MMQ CASING OR 2VEOMJ�AermelsbvJ4wpt j
aaoN I TO TaaaNrrr■ Ilnt F\,�� - w\TTll1i
2.%AI Construction Permit/e it, ft.'— .'
List.. ,:mfveW adfprrads fir.Catty.Saar,Parmee. star) .. .
R h. t.
3.Well Use(tl ick well asek N-.-.. ...
Wfiftr Supply WdL. [lON rut nIN1111N _ Vltral/1 111116\I \I\IIMIU
OA)p!kskoul OMa■icgaVPsbK 10' ft. 25' IL 2• 'e .010 SCH-40 PVC
OGeodwrmd(Fk■tl■dCooY Supp
ly)ply) ORside[Irl Water S,pph (single) It A
Obdoob&K)ommaeial oRaidearid Water Srpph (stumd) I&
►i O2 IO MATERIAL [m7lA[LTIA'1T NEI■Oa AN '�T
0 R. 6' 0. PORTIJM POURED
Ne■,WMs 8MP4 W4k
fl. R
LO ORao\cn L—
■ r fl. R.
❑Mlmfcr Rcchsrac ClOtamdwattt Remeehwion is.SANDAMAVEL!
M)m To [NM uvwl%T N
❑AgmkT Sinmf;c a,d Rtctnm OSahnN) Ham" 8' 0. 25' 8. FILTER SAND #2
❑?,puler T" ❑5tomm mcr Dnttmgt
h a
❑tgsrnmc,ual Tachmbga OSohvdcric('onml
❑(ieoU,en,nl I('luxtl Loop) 07ractt ram IM ■Ociorym1 w0'na4 that.pt.
[Xe tbemw]Mcnlue(ooh ng Ream O011st(expUm unlrf a.l RcmaAs) 0 w. 25' IL
IL R
4.Date N'd1U1(innpkled: 12/21/2020 We1J M#MN-1
As.Nadu IAwation: R. A.
Ceatral Baptist Church R B.
FlcdgtOesr Wee Facdtb TDO lYApicabk) — _..
11. ti
311 Connelly Springs Rd., Lenoir, NC, 28645 h I ti
Pydd Adhrss Clq.Mud Zb 21,UNAEug —.
Caldwell Bettonite seal: 6-8.
Camp t reed limOEa'sYaa No.(M)
S►.L4aitude and Inn#hade in th•[reru mimtrx'Ntewr lR!wind 2L Ctarldicsidew
Id sea ftc)d ma U,HnF la%id lvI it,
W 1/14/2021
of C"&ed R'dl(7ow=tw, Bale
i.hlmeltbrwdlls): 8Parmanrm or '.:'ire GV—,\, -- Aa�rrtiM1 l6rnF„rrry.,)tmr)r,rlx,r t.rn)...safef l..wd.a•
mM IAr N(-AC 0X A1Q?,a)/A N(A('TC U2(e)NIII(i+un■Oter Smn6raa and AMa
7.In this a repair to an misting w rS: _Am or 2:Ne rantft tq"r ajAr•mnnf bus Frrw pms,tAM v,rM.t.11,•rn..
Ir,sn norrprnr.iill,:ur:no.n,Al ow dw bankwidAvAnnm and r. ra,JaJtrIL
rrfwo eelr,r2I rrsnurA, u:n,s.ee Arid{Ab)b,a � �.r�FtI,ow dw br L otb is p;,W tMoils:
us nx Iile b;1ul of this pap to pn,s,de udJluo,ul Dell vie delaib or well
I.Number of write mass wit r(011 CdWMvml deea,h. 1'ou lrus alxr att:a'h aMlrholcJ µtees dltecessan
.,III O.AI.) „A "'were(#e�14Te rem h•,wnlrn4.„Ir,r..n SURMI"ITAL INS'l UC(IONS
snh,n.r.wlr r:,rw
f.Tmdwdldgmbbebn lasdear(are: 25 IR) 31a Par AN Wells: S,tbnao dos limn wninn all d:n\ of :onpMrm of well
Ft"wWapfr.e b)i!h ire drf.&'Ad)Irnw r.uwp4. F''0011 N1'a.pa/1 comanuetmo to the folbwtW
1■.Stack water Mel belew lop of casinC (ft.) Dh ision of W at"Rt+a■nAM Information Procr%Mne t nil.
lf.w„lr,rt„yl„t r ,three.u,. 1617 ALii Set ice Cawmr,Ralri[b.NC 276'n-1617
il.Eerebeir diameter.8.251 (fa) 24b. Far luiectba Wdh ONLY: 6■ddiipa 10 xmdhag 11R form ro due addax m
24a;,bme, also utbnol a cup) of fla, form %Nlun lu "s of conpklwo of well
li VIAeartrrctlea metMd:AUGER wlaimhon to the fouow nag
Ift.wor.near).cable.Ones INsk thin t
Dh Won of Water Rewmnra.Us,dcrpvand IeJmkn Control Program.
FOR WATER SUPPLY WELLS ONLY: 1 o36 Matt Smite Comer.Rakkh.N( 276'w-1636
M Yid Was) McOsd of WM 24c.Far Water Sapd)A Injotiow Weth:
Mw snbwul mac Cop% of Ow fmu, w 0 nl lu J:n s of cuogdown of
LM.RYI■kldM type Assistant: well conumcuon to the comet heahh depammcn of the coups wlK,c
conamcicd
Form Gw-1 pr,sad slgusti l'