GW1-2021-05684_Well Construction - GW1_20210727

WELL CONSTRx:LT_10N RECORD 'or l rnalUseONIN.
n1s farm c a be used for s[Vt at mmi pk wclis.
1.Well Contractor Informatiotr.
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Rich Lemire lino" TO4► [ttM y _._
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]YC.Wdl Cos arCertitimtionbirtri rrr MOM itf MAN MR MUM,," WA'—MTAi:
SAEDACCO Inc 0 (L 13 (t. 2" in. SCE-40 PVC
Cafivaily i+t*r 3 .ti+lot
i IN9Cs; afit6ird
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2.Wdl C+msttuction Perailt
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.4.Wdairas(chart;well a").-
Water Supplp Weft: rz 70 I tistAMY C6 r r1)!t 7tNitttNR4S +AATTRIA1,
Oftykidtmal 13 ft. 23 R 2t, ;R,` .010 SCH-40 PVC
C3Gw tu:tnial tHeatiugCooliud Suppty) OResidentlat Water SiVph,(single) IL It. to
l3lndttst+rialhCtatrtniereial OResidemial Writer,Si ly(shred)
BRtYIH t MAST( EDEMCOMT ME7AQU&A-V0VW
❑ 11tyu 0 fL 9 fL PORTLAND TREM14IE
Non-tinter SwtyWell:Injerma Wen:
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i Ailtiifer liccttarge 00mun dwamr Itcowdiatiou = ,
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(3Atjl*r CCCrrMp MM.l wovely i=1$Aniig l3anier it rt: 23 ft. SAND #2
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QG00dM sal(H*Mit Gic M Return) 00ttw `t ufider#21.Remaft 0 (L 23 (L RED SILT/SAPERLITE
+4.Date Well(%)Completed, 6-18-2021 WdI ID#MW-04S
5a.Welt Lvcatittu: � �
BATTLEGROUND STORAGE
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F2cdttpak Filar l+talt Fwflrly JD#(if a pllrwmblo)
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3700 Old Battleground Road, GREENSBORO, NC, 27410 tt Ft
V103iCtrl, ruffs.1rt!".end.2rp
GUILFORD BENTONITE FROM 9' TO 11'
Cant t}brW tgrttt 1140tae No,(t* )
fib.Latitade and 1-otingfrufFe in diegreegminnoestst:croatds or dcrtirrssti 41 gr : ertitlteaatitru:
(if-.Jilt rtd,#rr tet7arifi firctfieltfdl
k —W 6/20/2021
fi.Is(7n i')t11C well(H)i xPeriti 3ietit or z Temporary 4--signin. ttct,furm f here6y eergftr ti ul the imftlsf wmr twiseq vmwmmeied in aw"tim"
xis MA,YCAC 0I',0Intr or f TA NC4C MC AN N" )h eft C`onm rdfw SrroAdarafs arrrrf rl err it
7.Ta;this a repair to an existing well. M Yts or K itiu fcrfrr rif th�v nrsart f ,dm-r,iAr.,r fda d rro.afra rrrtf pan mrr,
tJr7;ia ax c te,�,rfr,�i9it rrar�.r}drrCRl a'e^tf etvaSrrrreltaar trtfrirraarrlaxrr itrad egrtratn nrarr martdrrr�rJ'rhr
trprir rnrfarA?f r .WA-s rerriar ar on the btwt of thtrhra t 23.Site diegraiti or additional Wdl detal#s:
Yogi.n,use the Sal+of this page to provide adilitioiril well site.deWls'or well
8.Nvmberof,twelh atHste o md: 1 ea titii Liao t#r tails "You rna9 also atlaeh additional pages if tecessan.
For*iMpfeti*,ikm >rrarna4wer xW:troth dT,LY»eth the mmraatratractFmr:y","M
Auf mir rate feria. 9jJBMMAL.QJSjjLC22M
9.Total wdl depth bit'Ind itttrfatsr: 23 (a.) 24a, For All Wid Submit tla#s farm-%%'thin 3tj drss cif CoMpietion.Of welt
I'(,-,r mof?wM welts bsr rrf A (frfWerent fexwjpfe-J o-%1M'rmd ZQ Mr3 usintwon to am 1 1towing-,
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11).Staft water ltvtl bdow top of rasing;N/A (tt.) Oh-ision of Water Rei'onrres,tnfonasttbe,pr&eessiag Snit.
If wairt kvd i_s aory E-d* am t 1617#!Mind Serriee inter.Ratek0h NC 27699460
ti,tlwrr3tntc digtnetar 8.25" 2dlt.EM[nketia i-0{NL`I": :In addition to scrods the fuM t0 the midi=in
24aabove: also n* a covy of this focal Within c(i dms of conrptetiait of well
12.Weft Crttst9•ttg Jon tt obttdd:AUGERS conamcdon to the fotlo`t==itW.
(i.e.sawn.►+sail?,able dinei pn eitc.)
Division of Water Resourcics.Underground tnjettion CvntrolPtmpram.
FOR WAM", PLY WELLS ONLY: 1636 Mini Serviee jCenter,Raleigh.NC 27699-1636
13a.Ytcld(gpnt) NUthod of test:. 2Se For Rattier sonpl�dtr tnjtxtioti Wells:
Also submit an of this fdrtit n thin it)da-
ys of completion of
131►disinfection 41= ,. n Amount: -WV"Coustmetiuu to the county 1te4th*padwaad of flee caaudv wheve
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