GW1-2021-07135_Well Construction - GW1_20211006

WELL CONSTRUCTION RECORD FtW i1�arllnt u�ctlal.Y:
This;form con bm esod fas sinek or na7 4k Rrdls
1.Well Gmtractor information:
,,ENE
IWA l+l
Brian Ewing ,+ ll H T DtSf�itt�fltj?i
Y1`r1P:GCrkr1dott�lArllc ft. tt.
ft.4240-8 OCA 0 202�
tt,
17C1Ve1lCaagaa�xarCcaiirecaliataMnu>VcJ ,��,rQ�essin9llD
%nj(%r0 ' 5erti1011 FROM to nlA ?ftTCiClFF54 MAIERrAL
SASDACCO Inc VY 0 ft. 72 iL 2° te. SCE-40 PVC
cofrvmw warm WON
IA MM TO DMETER TMC NIM MAIVRIAL
2.well onome"on Permit#: ft. tt, to
tltt anappfimmo.w open rltr ar.Cauauy,Eta',Unrfanrr.ftir en ea,) ri, itt
3.Well Use ictwkwell Use);
WatcrSopply-Well: mom TO DIA*MV'M..R SIAT 17.Y 1 TIMCKINM I MATY.rlIAT
MAgricultural L7lvi mitcipailPtdolic 72 ft. 82 ft, 12n in. .016 SCE-40 I PVC
l3t wft l(Heating Coolang"Supply) aResi lontial Water Supply(single) R. % hL
DindusstriallConutrcccial OResidential Water Supply(shard)
FROM TO ATER 01M AC"rU3T MMO]I&AMOUNT
13hTigation 0 it. 68 ft. PORTLAND TREbMIE
Hon-Watts Supply Well: (L
0.
OMeloiton [�Rao�e '
Injection ell: ft. ft.
DA40(crRCCIMge t3Gloundirntcrltenuxi atiml t = rf'
0AquiftrStom8c and Recomy i3SafloW Harder FROM lATtka1A. h 1t/t n T Ir1r r OD
70 ft. 82 ft. FILTER!SAND #2
i3Asqu%cr-leg
tlStornlclat�1 1iva8c R; !r
❑EXPtlimcntal T c1mology t7Sld sid=CW trol
t3" >w' di131i"al3iiattt
OGeotlmull(Closed Loop) riTriacer FROM 'm Des nrrlO�1 a'14r"raa
t3ceotbetuai g!j a Remm) modw toobinunder 421Relawks) 0 (1. 40 (L PILL SILT AND SAND
40 ft 50 ft. SILT
4.Date Weli(5)Completed- 8-20-21 WdiID#B-2 50 (l,. 82 tL SILT MOIST TO WET PitR BEDROCK
Sc We"Itilcation: fL ti
Cleveland County Landfill ft. IL
Fac17it1°lOwmrTimr, Fssiliq TIJ1t(ifmlplicabtc)
rt. rw
250 Fielding Rd., Shelby, NC, 28150 (L (1,
Cleveland BENTONITE SEAL 68 TO 701
Sh.t.atitndc Arid t ongit ft in degrcccfmllrotrstsccQndSordecimal 4%pves: 2L Certification:
tthwalt tl 4 otctMors is SlAtkrni
lK W SlSmtp�Br a n, ,1!n�s: ,2021
6.Is(are)the»tll(s)r rrtnattent of DTempornr} �7v s�mfn.Adi r that rhr%*Afk)gar fw#rrj ,ud d t mar c
s ++�,
iwrh 13A NCACO2C.0100 or 13A NCAG MC;0200 Well Corr nwcOm SwndwAs und'Ow a
7.Is this anepalrtban existing well: oyes or MNo copy ofthir word AwOem. prorldrdterAwwNrung.
Ij+rllPx 4#repel#.Jill out firwm well eawnmfoo i*wwk n m$J'A*obf r#n n@n+re rf rhr
nywiranders2l nwwt x ax in"or en Ow bark of iMs farft 23.Site die'j;ram or additional well dettalls:
You mo}tise the Hack offhis page to pw0de addidolaal aril site:detrMsorwt1l
8.Numb&of Fells coil 1nwted: 1 construction details. You tray also attach additional ppages if necessary.
Fora#Wple kjmkw or ntiui-uwvr sW weds ONLY%frA dw mme c onstrm4m..pou wn
=troth mi-fam SURRMITTALfiOUiC't'lilI@'$
9.Tinal well deplb below land surface 82 (fl.) 24a. Par All Wtft &&nit this form n tldn 30 dgql of taompietion a moll
Farmatri$r wUs flu dep*(`diffrrmilerm*te-3t-dAt1` t2@1tJ€) constniction to tito l'oltawing:
10.Static water level below tote of casing: (ft.) Division of Water Raqu ret5,tri kwustion i'rocesft unit,
1114VIrrr h Fri if dh0e(VAR,90"+" 1617 Mail Service Ctntcr.Ralydoh,N 276"-1617
11.13orchale diameter.8.25^ (in.) 24b..EDrj WggN0,ON1LY: In addition to sending the form to cite itddnw in
246 abm-e, also ohmit a copy of tjtis foal %Ilhin 30 days of completion of Umll
12.litcli construction:metbod.Bored owwruction to de tbllotving:
4i c.mj$m.;IMsy cable-direct paste etc:)
Dh,ision of Water-Rtmur es.Undergrronad lojeMon Control PnW=,
FOR WATER SUPPLY WELIS ONLY: 1636 Mail Service Getter.Ralelo,NC 276994636
13*Vfdd(lion) 144ethod Of tew. 24c.For Water,5tllljIX&lNection Wetls:
.Also submit one cow of this form At,3tbin 30 days of conlplfion of
13k.DiSlnfcction typ4e. Amrju t: well construction to the cwmn bed k department of the county whole
coistructcd. i
Farm XV-t With CamlimDgmulmtaffmioDwwritmANanuWRemurms-DhisionofR*atelft tttft RcOW&VA2013