GW1-2021-05428_Well Construction - GW1_20211013

WELL CONSTRUCTION RECORD l'ortttermlusctyxl;Y.
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SAEDACCO Inc �,t� �tC �R n, so tr, 6 la. SCH 40 PVC
FROM TO DIAI'1W.TSR I Tnmt7:NiM I MATERIAL
2.Well Const vv*n Permit` 0 M 70 R. 2 SCH 40 PVC
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Witter suppt,Wdl: FROM I uVwjrlr st Itrt►Tt;t TfTTC",, MAt'RRtAL
70 R. 80 ft 2 .010 SCH 40 PVC
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0kipation 63 ft. 3 di Aguaduard Tremmie
Non-Water%Vply Well: 3 R. 0 tt, portland your
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Injema Well: n. fc.
❑Aquifer Recharge OGtonndwater Rcutediatian t9 - ►: [rani
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35 R. 48 fl, pwr
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48 tL 80 (t rock
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1315 Outlet Center Drive North Carolina 27577 John. . M
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bentonite seal from 68-63ft
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ntirh!SA NGaC QIC tN :;#-AZ WC,0200 Wifff CnrrshOrdan Swndards and char o
7.Is this a repair by An oditing well: fMYet or 0No copy+>I(Ah rword habem pnn*W to ev 16W1 nmrer,
1/Thtsixa rrPulr./iTl oar laxii+m w�Jl c°ansrrrreriaq[h�rmerlan anal raptain rlar rmaane ojrhrr
rrytr?r under 021 reastb errtran or an d r burt of arialarm 23.Site diagram or additional well details:
You nmay use the back of Obis page ito prmide additional well site details or tech
S.Nomberef veils©onstracted• 1 construction details. You may also aaachadditionat pages if lxcessary.
Formuhlple-ktjrrrlora or nun-fimrAWph uvgj ONLY ufA thrannewns4wfion,}nn m
submitanelmra. $fjBM11TALlNS ucnoNS
9.Total w dt depth beto+r fa�land anr so ZAa l on AU N'cllr• Subs r this'form within 3t)days gf ootnpMtion of Yveil
Farr""optePoWls11srarldep*#dofrrenstermmntr-3@MQ•eM,2@JWj constniclionto the i0110"in :
10.Static water level below top of easinz (R,) incision.of Water Resourttes.lafbrmatioo Processing Unit,
t/KwurWe/isdhdar rntkg,our"{" 1617 MAE Service Crrntrr.Rnicio,NC 276"4617
I L borehole diamcter:l2/6 (in,) 24b.bi iuM m Wells ONLY !',In addition to sending the form to the[address in
24a above.also submit a copy of ibis form within 36 days of completion of ntll
12.Vlrcil construction method: HSA/Air constriction to the follo1 hW
(Lt.astr,rowly,cdble-t ima p nh.etc.)
Division of R'aterRaao rccs, Tetdergi+oaod Injection Contrdi Program,
FOR WATER SUPPLY'%MU ONLY: 1636 Malt Sr»ioe Center.Raleigh,NC 276"4636
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13a.Vidd(gpTn) Method of test: 24e.For Water So,[VX&ipjoettrai'Wells:
Also submit one cops of this forum Mthin 30 days of completion of
13b.Disinfection t,pt A nmunt• well construction to the ccu my bcMth dcpamnent of the court,where
constrricted.
Farm a%r-t Nimb Cmellm Dcpatmi of Emimnv rnt and Mnt z]Moir=-Iih*bn*MlstcrR Iesawas Raised MOM 2013