GW1-2022-07633_Well Construction - GW1_20220817

WELL CONSTRUCTION RECORD For l WnW Use ONLY:
We,formcaRbe irsed for sftlz or multiple netls
1.Welt Contractor Information
Rich Lemire t:ROS1 TO
_ofP up"
it'c31 Cor,tnrctor lime it: ft,
2593A
NC Weill CotnmctdrCertifiew ion Nwilkr OttTF#t" G atianuftictlicil+ Ott' ticati`
.FROM- TO O1AMFTRR TTnrw-mRs� MA nmu
SAEDACCO Inc 0 ft : 3 ft. 211 SCH-40 PVC
m2m Ta OWNIE`iTR TMCKNESS I MATERIAL
2a'04 Conctmetion Permit q im
l ea oil alnpl rrel ft�srd g(imltx fi r;Gttusuv:StYliC.-1°vir,er�r,l dq crt;i
tt, ft id
3 H'e!F 1}5c(checkndl.u,%p): ltCdV w_ - _
WaterS4ipp1 3)l H.. FRROM_ TO o1AWTER SWTS1rr Tt1i MATERIAL
3 R, 8 lF: 2" old SCH-46 PVC
OAgrkuttural OWO'icipalfi'tlblic
mothemutl(HeatingfCooting Snpph•) ORcside-adaf Water Supply(sire&) It W l*
0I11dustrial/cOtMOMI'lF OResident al Water Str
Piet'(511ared? FROM Taf MATERAL° E;ltPLACPMF%T ati?tt1aD S AMOW :
Dltii iSnn tt. ft:
Nan-Water Supply Well:
R . ttf
(INfonitorinq DRe vc
In . ton Well: -rt ftr
15Agnifer Rccharic WratuArrlter Reinedinoon -t4: i►ND ' �► +t if .
*Aquifer Stomp andRc¢omy` Osaliotw Bamcr TRrt~.t ArAYr:$tat italpr A ,trot tlt1�►`f
2 ft:.. 8 fL SAND #2
*AgttifaTest Dstonnmatsr ral J.,
DEglalimcntal T"x-hoolog}' ❑"unbs dencc C.031101
lit I1 Ut>�+.xitrK7t9 froial alit cis 3!itccescat i
DCaothe l(Closed LOOP) DTracer "M TO nfisCR ON ca1•sr:#aidezx- ,ram typt,Wtu fte.0
DCtodtelntal(Heart o011 Retutn) 00ther(cXplaitfunder#2 t Retu &) 1 0 ft. 8 tt PWR
it. tt
a..Dategtcll(s)Comnleted: 8-4-2022 WclllD#MW-LF05
VENATORAfir
tG. ft
F Ttitl'rQaacrNaitte Facility1Dk(ifapp6O6lc}. ft. f14
5910 Pharr Mill Rd., HARRISBURG, NC, 28075 Pfzx; feg Ufltt
Pltlsin1.Ad4ress;'City.and Zip fi lt>fM�iiri .... ..; .N.,.:. ..
CABARRUS BE14TONITE FROM 1-2,
aap€t? Parcelld:eoto 16*n No,MINI)
56.l.at6dCand l�rn dC ill tulttltttlsecoads Ar ittxintal ChCc:.
' �. 3i.C�ertl�a&itn•
(it-ell field;foie wor is i'alil wi
1Y W _ '�$1Yht.•`.G'�u. 8/5/2022.
SiglnttutofCcnu 7V& 011trktai Dste
6.Is(rare)the,well(s), OPermattent or wTem'pata�'. sa mn rMr �>�,.i hrrt9i rrr s+hw rhr uru,)His
g2 5 f f dj: is f l y t cwrurnir,c d fn a iv,d moe
with t 4A NCAGOtC 0W or:15A AICAC 02C.00200 tt Y Gruromcffrot Stmrimis id iku a
7.4 this it repair to an existing well: OY6 4jr ADNO eopjr Jf ijar rpotiiw has. prOvO4 io ttrr%A flrtudter.
tf rhta tSr,rejrafr,�O ca,r trttsu�xxk�n+urrrrcvi.?n t�rjcjr+rafa�,t enul i�atirnfsi r1,r rarr�ie nfthe
rt it tu,rter AZl rehaRHF ser,iim cr'i drr bmrd nj ttris ferae 23.S(te diagram or additional*ell detaitt-
You ma`use tk bk"k of ilhis page.l0 pto"Ide:ldditioliai t►vll site details or well
8.Nvtobt of details. You may ,€iitav2l'iislditioYs711 pages if uCCttstit�:.
For i iAiwok):+if eti km os 641.4mer lty,fd r i6ejfs ONLY wirh NJr Same tvmvl(Mon'WW can
as�>rir,rr,�r jn.m: SS�,ilQ117'fr#l�,(��TCTCTIOI�`S.
A.Total belt depth below land;surfacC 8 (fit) -UL i:or All N'4'A 'Setbmil i i t;:form xv thin ail days of conviction of ncll
tor maotuptfje^rds.ust oft drptltsllAf/frratr(eean+f,fi l ' fM'wsd,2 7Ot>1 construction tothc-Ohming:.
10.Statue water level below top of caginjr! NA (It;j 6k'ision of Water R knit,
Ijn�uer try!ds boir ctraFirg.ate„+" 1617 Mail$"Titx(enter.Rglcigh,PVC 27699-I627
11.Sor'chale diameter.8.2 5^ (io) 2db. �,�{+ ONLY- In additan to sending the form to Abe address in
246 above. also submit a copy of this formNlAhia 10 days of conviction of 14r!)
12.8)'cit aoastrnctiIIn melted:AUGER constnifftich to the PoTto ving-
(i.esagr:rotary•,cahl4,'dirtCt posFr ck."i ,
DFv6clon oY.WafrrRcsoarcrlt,LTitdergnrond tn)ebtlon Clatrnl Prt►trltrn
FOR WATERSU'PPI'.Y WFEL S OnV; 1636 MAR Senle6 Centex,Ralclot NI C 27604636
l3fi Yield( i ) Method of test 214:•Far Water Snp{Itt&Iq(txtnln�i'ci :
Also'sttblait olio Ofi`of this fonts mitbin 30 da},sofconlpieti000f'
Atndunr Welt c teiivn to the`count)'�hegllh drparinrerrt elf"the catitit�as hcae
Fann.rS1!-1 North c3rolho Dq)Wmteai of Em irormrat and Nawral Resources-Dtvisloo of l%lalcrgesot2'r>et Rcrist d AtjguSt 203