GW1-2022-07259_Well Construction - GW1_20220805

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WELL CON9TRucri N.RECORD Foi lracnull Use ONLY:
This form can oscd,for sitiek or.tnultiplr sell¢''.
I:'-1�'cllCotifrictorliifornlationi '
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Stefan Smith FROM• t0 -DESCRIPTION
11'c1.GCainrtgoifiaiui:, rL ft: � i -
3576A
NGAW11ContrktorCenificat ion Ntiiib i IS OIiTE t ASiNG foretultiraseidnclts)'OR LINER Yifa`lkaDk)
FRO�1 TO nCt'ttETER T111CKNE&S: MATERtAL•.
SAEDACCO Inc 0 It. 10 ft: 2" I I in.; SCH-40 PVC
t tiigt;mp h5up IG INNER:C.A.fi1NG ORI12BINW4 6ihcrmA iki delis t'�•'
FROI#1• TO I)MMETER. THICKNESS MATERIAL
2.�Vc11(rinsfiuctinn.Pei inif#: ;der p:- 1n.
riir(rPlajtiliSiihlr.'tseff+n'"itr(i:c,t ornih;Slrrrt+.•lnriarce,Il�[if)otbel+;]
ft..
3.��cll llsc fcheckllcll Vic).: 17 SCREEN
��'afcrSuppl�Well. FROM TU DIAMETER cLOTSIZZ '~Tln(KNF-M 1 NATFAIM,
Cki£ricuIiilra 6munOp►UIhlUlic, io It. 15 rt. 2" ?in o10 sC13-4o Pvc
©ticotllcrmaT(HcadngfCoolinn'Siipplj) f3RCSId , al�VatctSitpply (single):
fC: rt. {.in!
0111dustdalf0jumicrcial 01ksidentialWliter.SupptV(sitamd) 18€:GROUT_,.
FRO\! -To �t�T1:RIA1. ENIPiACF:NIENT3lrYlIOD&,-I1IO NT
I]Imcafiou 0 ?t.: 6 rt. Portland Pour
Nln1,�Vatcr Supply�1'li:. �
ft: ft.
lTvfoi,iforing:, QRccovcl)•'
Yi. tc
InjecUon.1Yc11:. -
bAgmfcrRcchirgd pGioundnhtcrRcntcdi:tiion t%8AND;GWILVECd'ACKttr iilkablc)
FROM ' TO � �AIArERIaI, EMPIAMM:NT NIC"Notr
DA4111fuslortgcaixli2ccovcty,. ❑Salifih lbriics 8 fC. 15 ri. sand #2
❑AgiiifcrTcst QStomrisrtcr;Urijnac rL fi.
13E.V atincuml TRhnolo pSulisidcnce Coitfltil
' •' 2It:DR11 LiNGit'sOCitiliach adiliiionnl�hitiYsif ricticcsiril �;"
06mherinai(60setlLoop) OTracer. -FROAU ,TO DE5(7tIPT1UNfcobnhanfncrt.+m+1'nkkli' ni rrc•Hc.)
❑Cnwtjicnnal(NcatinilCooline Retuni) oOdicr.Nc k n tinder#2 j Remarks) 0 tf. to it.- silts'
10 ft.' 15 ft., Sandy silt
4.Date NVcll s Colnn Ictcil 6-27-22 :;R'cll jb#MW-207
Sa Yell I iic iflow i r 2
ALCOA ft.- ft..
Fact Fic`lii)�1Dk(if appii,tblc), f1:. ft., f)$GiFY1 CnrPrm nTUrt�"
i r^il+,l
293 NC-740 , Badin, NC, 28009
PlnssadAddicicCit}'.aitdZip .2FRM:INARKS
Stanly 2 foot bentonite seal from 6-8 feet.
(?piutty: 1Mrcc1 tttcidifiG�l)ittt Na..(FIN)
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Sti,I uituSlc anti i on rude in ilc c minufc lACconilc ac decimal d
tifsre111'ictd olio I;ttrlritY�Sidlic%tiq•� ��: 22;CcrtiticaHon:
35.406113 N' 80.113352 - 7/21/2022
Si�ri3Cckficl�y ell Conlrartor' Datc
6.76-(are)the e'cll(s)i:XPentianent -ar .MTcmpor ity.
:})y br�rugh r+rr4(vrrrt,1 herebt t.ertify Mai ihK tiell(.�)ims(isrn•)riu urnrcied ig�,erorrineee
tiinl ILL NCoJC•t'12C.(11A�of 1 srt''NeW.02C.-6?60 Well 6ii3mscrioirSr<upkii s(uiif t)uti o
7:1.fhiv a r<parr to an crtatin>;�tcil: .. t7Y�`S' lir ❑lYoc e6py..alrhn mronl haklt ii jtmtlrh{116Ike Itt•Il—;Her,
1/ibfsrxrrre tlrfillrlrinuxvitalleo+trmr[llaaftrjar�iurliorinnrliijilae»thei4mire,ofrhet
r[yu+rtrr7lrrN?Lru»nrLsai criari or cvi die hriA nfthrstnrm, 23.Site'diagram or additional vvell details:
l'ou;ins) use,tlte ick of tlds j.ige to pror'ids addijional icell sne dctail_s-or well.
8.fitunbcr lif)yells irotuliTtcicd: 1 coustruchoirdt3tat6 You Ill t\ Ilso atlaCh"ilddrl101U11.Ih1b�t'S'lf IILtiwS.lt\'.
Far;mililple i�jr eilml 6r.ngdt=t+a:er nrpj�tr'iri lIs ONLY pi hlr'rhrsrtme coris►rucfioiy,tUu cnn
xabmir.nne fnrr». �ii1111iTTAL:INC7`C)G770NS'
0.Tot)l;tt•cll ilcpdi hetorr land stir ai 15. ({t) 24a .1 Dr all Ai'clls:;.`Subnul ibis form 0.hiii-3:0 d5ix of'contplNioti�f hell
Pour+nlrlplr'icrls"Irsr.nrrlrejNh.rr;d)�t+rvii.�(catt»pfc=:7�'200'.rtrul.2�!(k)) canstntction'io'thcfofiot�in�;. �' •' � •
10 Static water level lidow top ofiasin8:; (n;) Division of j�aier]i6ourccv;Informutinn Ptiicc t+m�[Inif}•
If starer level Ii rrhnt�ca'si tom'''--'�"` 1d1711iat1 Sm ice Center,Raleigh;*40 27699=1617
!1.llorchiilc diamctci;8 25" (i n) 2a1r.Far ill Ic is Vt ellq ONI Y: .1n addition to,`sending ilk form to the addri�s in
24a66%,e also suvntii a top)'of lhjs forty)utliiti s0 days'of.conlpleumLof irYll
J2 AWR consr»ction inethod:-HSA colisinlcitmi to site folloMi '
(i:c.•ati�r.'taian:cnblc:ditccf pnsF�ctd)' � i
Div on of. atcr:RcSourt:cs,Uoilet ground.injccdon Control Program,
FOW%%',tTER SUPPLY WELT S-Oi LYi': 1G3f hletj Sci vice Gentcr,IZaleigli 4C:27699+163G'.
13,t Yrctd`(lry►mj �lctlind of to t• 24c._For�Vatcr Supnh''h injection Nyilts:
Alsi'subiun.om copy:of thisi form o)ithin'3o 4a:),sQ completion of
" v cll.eotisilaclioti lo.tlic'counli hcnlih dcjrirsmcni.of the Colipt�.tvticm,
13h DninfitiKiou t�pc:,.;,,,, __ Amuitnt:• •. r
r:onsrmctcii. I '
Fonti GW4 Nonh Carolina 17cpal nu:at oCEni irolunctu arol Natnna l Resounns Division ofAlMei Rmtr6m ltcj;i cd Augttst'2U 13.
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