GW1-2022-07264_Well Construction - GW1_20220805

WELL CONSTRUCUON R"ECOAD Fpr Dtcnml use ONLY::
This.finis can tv owd for Single oi•.multipk-tails."
l:'�Vcll Confractorltiforni:ttion:'. � k
iJs1�ATER LONI_S :'
Stefan Smith FROM TO M(WIPrION
11"e)I.Cginriclarfinna:, ft: fl:
3576A
NC Nd1 Conliactor Cenifraation Ntin bci =tSsO[1tER CASING(for;mutti card„cnsl"OR LiM1ER'fif a"I1caDk1
FROST V. TO DLADIETRR: ' .THICKNFS5 MATERIAL;•.
SAEDACCO Inc
0 fl: 35 in. SCH-40 PVC
I: '
•-1d iNNER GASING OR 77]Bt�G(1`euticrrnal clauJ lui
Coiigr;ug i�anrc S.
FROM �i.70 •D[AIIETER THICKNESS. •AfATERiAL
2:JVc11_Crins2ivctinn.Pc•rilif#: ft" ft• '` h�
li f
Q. fl. � •,in.
3 Well Itsc(chccl:l�`c11 use); 173SCRi3 N:=
��'atcrSnpply Wcll:' FROM .,TO. PTA'METER I.OTSIZE T1tt(KNF\c V MATERIAL
35 .,'ft. 40 ft. 1" I,rn', 010 SCH-40 PVC
Clrlgricnliura[f tJMunicip:+lf i� lic::
L�Geothemial(Hcatipg,'Coolipit SiipplF) l3Residenti it Water 5uppl}.(Mile))
fL: tt. i:io:
OluddstriallGonmicrcial OResidential-Watcr Supph•(Shakd) 1tti:GROUT " _.. :::I.•_
-FROM TO SIATCRI,\L " Fl,%TmA'C m \rCr11OD R AMO1JNT-
0irri Dtiun_ ::(t. 'ft.
Non-Water Supply'NVcli: I,
tm*-nitonng.:- Mccowly . ft:' fi.
Injection.:%,V'cll:, ,.
ClAgnrfcPRccharbc I7GronlxluhtcrRcntcdiaiion 19SANnJGlttvTLPAChlif`iilkautel
FROM TO` MATERtA1. F.NFI,\(LNEY7Ht.ril011
QrlgnrfcrSfor+gc�ridRgcovc • ❑Sal met f3amct 33 fc: 40 ft. Sand #2
❑Aquifci-Tcst 1]S16mm-atcr Drainage,
•:f1.'. ft. '
o xpednicutal TcOnologt• DSubsidencc Co1061
4O.DRILLING:LOG''f(tiltuh addifionnl stieNs it tttresKn 1
t]G:odteintal(C1gsedLoop) DTriccr FROM, TO DESC'RIP.T/ONrcobnhaNni(�,\tiYnrckk+t n"3,c.ttt.Y
DGeotltetinal([leatin&Cooline Reluin) 0011ier(plain tinder#2l:Reutarks) 0 ifi:. '16 it. silts
16 :fi. 26 ttl. Sandy, silt
4;1)ati'i�Cu(9)1.bonlnletCd: 6/23/22 a'We 11iD#B-305 •
26 f1:a 40 Yr: Saprolite
e e V.L_
Fadil Facility'lUl'.(ifapplivablc)
293 NC-740, Badin, NC, 2800.9.
PhjsicolAddrZscCna.am,zip ;21:R1:MARKS '3ftC'1 f 1
Stanly Temporary well
Carinh" Nmelld.illirtte:06nNo.MN)
All,[atitii6 end[:onditudc iri drglceslmlputcslscrnrid.5or dceimal ilcgtecs: 22 CcrtifieatiitD: .,
(if\ell isetd,•ctio lalllot�tti s�JLci;tU) '�� �" �
��;7� I•
35.410697 80.119653 . ''�1/A"" I 7/21/2022 .
Sigru u!ofCcYfl:dWellConuytor Dais
G:Is.(are tbew ll a):' OPennanent or"AUTentpdrar\
,(.. UrsrgnLrM e.,s form;lGrrrA,y,cir,fvlluurhr n•dlls),tiv,s.(inhri:l cdiifritrcJrrl.fit rrc.•corrlrmee
nitaY t5,1,VCAI•OIC.(1!(tP yr:!&t'NC+tC(13C:02Q9114i!Go�aeeztcrkursl lik?eirds tnu111au r
7.Lv this a iipair fli an caistin 11t `:, ovY*.' •'rt iqo:; <r�r,of rlttr rriniiT lurs h rri)iit�i irlr�7 io if r strll tarircr•
Iflj(S u n rr'jwlY fU l u IT7nINI will Co,Utm1 r ion 111foivarlorr n$!1 i'ipto6t rhl ru,rnre:of rin
rrjrc,r'nrilcY621 n-Madk sevik-Di nirltr brJd!bfrlus farnc 23•.Site di5);rain or additional well&tails:
ou:Ina}:use ilk b:ick'of this;{ijd W.0i6iide addiii&ik well site details or w l
uNni ibcrof.iiclls .nsirticted: i __ constiuclioiidcteek:"1'ou m n'also atlaclradditioiinl pab*es if necessan°. '
Furmalilple#iJeerimp(wnfi.r)intersvph`�re•lls yff wldl igh.snmeconstruction.yo .oin
rupntirnarJnnn. .SUBt11I'M iNCTCrC-TIONC
40 23a bor= all.Wills.,; SubnutI iiis form within 3(i"dats of coin iciion pf tsc11
�.Tot!1-well depth bcioty lane)surface. (ft) . P,
JtinrnnilrJple irrlhRsr:ntf rfejihs fl dl(It reeii lcr[rn plt'•7Q7p0',trul,2 llk]'1 canstnictiowto(lid toliMin , i`
• i
lU.Statie water level b'elutv top of casing!' (jl;) Uivrston aP Water RCsanrcc5:Liin?m�iirin Pliaccr.4nR Unit,
TJunrwleveJlsnLot-ec4it,�,�usr'°s" IGl7•AiailSrrsiccCentcr;IL•llctgh;�IC27G97=1G17�
u-"Norcholcdiamctcr 8.25° (in) 24.Fnr 11 I,�,QB}��ONI Y: 1n addition to sendlnil t11e.tome to thr addras in
24aalw}e•_also subH.ui"a e,op}�of completion ot,W11 i
112:1VI'ell consttltction=method;'HSA constmction la the followtiig"
(CC•+u�.r, than cab1G`dlreei push ci.:? .. F i :" ..
'AMAO'n afWatcrRcsour�xa,Undergttilutid[njcctinti.ContmlPtograln,.
wI(W,ATER.suP.PLY WELLS ONLY': IG3fi bLiil Str tics Ccntcr;Raleigl►;�iC:27G91=1G3G.
i3a Ylcld( pmj �Ictho+l of test• '-Jc Ftir NWlcr Suapl\"&inac�ctt41n%villa
Also subnlit.;om-copy.of this form \%)elfin 3p days ofcoipNletiolip
13b DI\tnfitihont\p� - __ ___.______- Amnunt:: w0l.-consi.n0tor to the'coutity iicaltb dcpaRrocnt of thc•.cotinh.\;licro,
constnictcd,
Pone GtF-1•/ i\onti Carolbla Dcpaltnrocat oC Eui"ironttscrU attd Nanuai RcsewRcs—Di\�Dion ol'Z\'�Ick R�oeites R.\isc�1 August'2(f I:i-