GW1-2021-04156_Well Construction - GW1_20210827

t; LL CONS RUalON RECORD for trtend Use UN4Y:
hits-fortncanbc a9at ra stink or mutter melts
1,Well Contractor Intornmtion:
i�: .IAJ lxa7�
Brian Swing FROM ID f 11p17t1N
A1411 tMFtCtt+t t�8111� tL h. a
4240-B it ft. C
NCC9'tllCOM MbrCenill MIDDISlumbtT 3 Ot1yFJt f3` 4 lnt it tlR ti¢#b .' '
FROM 1 TO atAAtt:TER r TMC.%T M MAT"JAL
SASDACCO Inc 0 fL 25 11, 1" )it. SCE-40 PVC
Co +t1'Ra tk tf+l` YlB24lB11Y >btliiscdl..
FROM I TO I DtAMRTER I TMCKNTM MAWRtAL
2.Well Ctlnsttsttion ttrmitlh tt. (11.
List all apptin Wr wrtl pe"Aftt 0 P.Counns Shin,Varialre,Fr¢bdc rt rN..)
3.Well Urm(cheek well uw)« ;
Water Supply-Wet1' 25 t1. 3 5 ff. 1 a in, v Ttrtt lust sS _ A"KIAt
FROM YQ ptAMRThR
T
OAgrscultural t�Mantcipallftllc O10 SCH-40 PVC
QGeothermal(HeatitkzACooling Supply) QResidential Water Sllpply(silwo) f1,
01ndustrtal(Conutic�cial DResidentini Water Supply(shared) pao TO MA ��LACr.Mmtrarnmon sAm�rnzr�
offfiglition fl, R.
Nor-Water Supply Well:
fL ft.:
mmonitorin t lke o1
Injection Well:
Q1gttftRc tlrgt QCmmodrMterlt moc lefion ,. .. :
t�A+ltriiscrStotage>!n"JRtt GlSttlinity$arrieP tra tri 1AT> tmt atAfl7r�T11 n.
23 M 35 ft, FILTER'SAND # 2
13AgolirerTea QStOt mvaterv1ainagc
tt. ft.
Qi«WrinicntalTcchnolsag}' MoibsidcnccCoadml 2t►:ARttA i�Tti?dD tltehAi4lfftiahsit'etieNs(f
❑G1.tthetnsal(Clow Loop) OTnc�tc FRort okscRrfrtla�ester tisrMn aanwcf;tr n .
❑Geothennal(ReatitWCo HS Return) OQther(tv10in under#21 Remads) 0 (L 20 (L FILL SILTY SAND
20 h. 35 p, WET SILTY SAND
4.AateWcll(s)Completed: 7-15-21 WellM#TNW-03
h. tL
St.WOW Location: 0. t!. o
Wehner Green fL h.
Facility 7n`sxtNanx F iiit}tD8(fepplicabk)
ft rt. O
201 S. 12th St., Bessemer City, NC, 28016 ft. ft.
PltssiW Ax dmm City.and Zip VIS
Gaston BENTONITE SEAL 21 TO 22 e,'t j�� " mp���Cl
tlmttf! PAred idetnif`caooa No.(PIN)
5b.Latitude and Lonf itude in degr ecsfinlnuteslw6nds or decimal degrees: y,Certification:
(if well rretd,One ta00"s is si tt kid)
>� w Brian Ewing, 7/21/2021
s =flit oMt ISW Well C>;;MK= Doc
6.Is(ore)the melt(s), Merimment or WTemporar} ,. �n,t tom,fa„>t I tr�,ttn eerrt rh,u rrbe nrlt{st ( rrrJ c"+nr ntercd;n uwwfamn
WA 1,54 NCRC 02C,01(0 or t;fA NCAC 02"C.aM 11'eti Cmuft arolon Strfr+,anh and Affs a
7.Ls thbi a repair to in tA4 mg well: Ma or M N(t r+ diYt recant ktar term p+mdrird m Atar al it nnrar,
ljrhlt h#updr,jNiemrAamm vellotuxnwrf+nt Jjq'on nrianvW rnatttin,Owmw#of the
rre;nair wtder021 rmardex vrdi6"or rut the hwh of thh jmL 23.Site dlagtslm'or additional well Actaltsr
You may use the to&of this page iu ptm'ide additional well site details or welt
8.Numberof csells eonstrneted: 1 aoustntctioodetatts. You may also aftachadditiotml pages if necessary
For ntAgpre lojer4mi or atua•a r jV#,r w1h Oati'LY,4frA dw atmt tanstnw4bn.y"im
sllal►t E%STUCMNS
9.Total iTell depth belay lard surface 35 ftt,) 241L For All Wells: Submit lhls fours nitittn 30 days of completion of nvtl
FQf$U Fpit taut lift Oil drrThS(tdr11 rMfeWWk'J@dt#'t`OW2@JW) constriction tofttotttming
ld.Statie hater level below top of casing; ft) Division of Water Resot rat.tnfdtmation Pnoeessing Unit,
If vaire Marti is dbokv cwlgg. 1617 Mali Semite Cater.Raleigh,NC 27699461.7
!t.Borehole diameter 2.25^ On.) 24b.Far(nhxtlan Wells 0N1 LY: io ulilition to sending the form to rite addnw in
24aabove. also submit a copy of this fomt>}ithin 3(l days of conipletion of uall
12.Urdl,Corug 4rc i©n 1riCthod:DRIVEN conanac ion to the foltowi rg:
(Lc_atttcr.taint?,table died Vuh etc.
Dhision of WsterResaar+ecs,>7tldtrgroand IaJeclolb G1ntt»t Progtuab,
FOR WATER SUPPLY WE S`ONLY: 16361V1 t Servile Ceir<ter.Rale4b.NC 2i6"4636
13s.Vid#(gpm) Method oft 23c For W:tarSnpply deln jocdoa'lYclb-
Also "submit one,copy,of this form i4'ithin-10 days of completion of
13b.'Disinfection typin Amotank Meti constnbction to the county hcaith de(stiincM of the couuly where
ctbt�mctod,
FannG%V-t Nonh Catarina l7gwbwWof Fm*Diwxm wd Kitrnal Resautoes-:DevfsiunofUlsterReknoMs Rmiwd August 2011