GW1-2022-08812_Well Construction - GW1_20220909

WELL CONSTUMON RECORD Fatte2crm)UscOny:
Lhis faamcanbe asadfiff5ftleor 011111i#ts Rats
I.Wdl Contmmtor.LMoimatlon: 7777777
Robert Miller ttAht
Wct1 Confcacw Nam
2675-A
NC Well Contrscror Cectifotion Nunibct
irROM TeS DUII'►rFTEn 85 MA7IEPIAt.
0 fL 38 fL 2" ter. Sch-40 PVC
SAEDACCO Inc
('aitegetn)NaeR -
t±Roal 7 ni+a rER 71nCIME MAT�Cfi L
2.W401 Ctnstr Obli'Pcrillit#: cL
IAO4ayfJfiEuKewrifFe+'miheke.C.mwln'suce,'in Flame.I4et6Ge4rti:) tL ip
3.Well Usc(cbWc welt tt+u):
Water Supply Wdl: OM ItoD l►tt iTIR ~ qWr Si1C 7mCtc M MArCsWAZ,
48 38
ClAlgrictilatrai �ihttnti�^fpaUPYtbIiC i't; ff. 2" � .010 ': Sch-40 PVC
OGeolhemot(Beat aptoofing SW ly) ®Residential Water Supgi}'(single) R ►t. let
Ltd.. _^ x. .,;�'=..• _r .r-. ,. . .. ":� , ,�= . .> ,..
DindustrialfiComamdai McMdenbialWaterSnlePly(ftred) FROM 1 711, METHOn,eAMOUcr`
ohTigadian tL r1.
Nutt-Water Sappty Well: rp _
I&MottNgrin 17tteco
fr. frr
Injection e
DAguifer ilccharge QGwiritdtsatcr Rcinediation
VROa! 'f(► 14rA RFAI . � till tq.A. �T Mt"rNitn ,
(]Aquifer StorAp and Recove:ty QSalirtity 13.1m cr 36 fu 48 ft. Filter Sand #2
DAquifcrTcst Ostonm atcri]tniopgD
t7i=xpctb CM1 Txltri hV Q si&uce Caretttol
Anyow ra it" -ddili`an't S -
❑Geoihetmal(Closed Loop) []7 erae r oil 10 DIMCRWT(OR ojire>aentn�tr.aua xr€ >` s u z}to f
OGtaQAteflnal(Fle 1 a Itetttm) Ot truer( in under t�2 f Reiullfks) (L t4. See geo s log
eta rt.
4.Date We11(#)Completed: 6/23/22 WdIl]D#EP-5 � tL
54.1'1ellt.ticaotn: a. rt. p fey
Wilkes County Landfill - Eller Property fL eG
Fad1hyl4u•ncr Nmw Fectft ON(if applkabici tt. -
9219 Elkin Hwy. , Roaring River, NC, 28669 tt, IL IRatii:est :i ,�;,r•rt..;;,, L�:,
Pkystesl Addmass,Cif.and Zip
Wilkes Bentonite seal from 34' to 36ft.
Cmault' P=0I aMficatioallo,(PN)
'Sb.Lallbade and t oDgitadc is degrecstatinutatsmads or decimal degm= 22.Cerfirkodeft:
tilwett 1kid,wee taflore fs sufficktd)
8/30/2022
... _'� .. Date
6.1s(yre)the W ell(s): OPermauent or ZTempornty Br sieming A firma.1 kerekt•twmjy;rhea rhr welks1 war tttiefri s maintexed hr atv'onimt-r
i v*6 1.+4,NCAC 0 C.OfM or fS A NCAC QC dtAV WO CoJrstr Man StandaAft Aynd ATa er
7.Is thb gstpairwanejih'tngwc11: M;s or MNO copg<tfPfiasrtv�nih�G�pntLr&dit++trneti�+�r.
(frhtaitarr tr.}il8t�+tker tart.elFemf�f�arcrfcmierfc�rrsQm�rmarecxxfetratnThe rurev/rfre 23.$itetli9�rApt4rAdditiQtialWe11dCtfliEs:
fair wrier d21 rmarU sera m or rer the bar%of tfi&jbrm
You may use dlw back of Mis'pax t4 pw0de additional well site denuils or well
8-Number or weits constmeted: 1 c onsnuction detaits. You niac'atso tittach additiotW pd ges if owesovy.
Far Jerafripsr lee(tuna,((Jute-attar tap ka'tis OJ1tLY TrJfti the s+rnre nonstrtaliore,4nw a arJ
su(mJe(One fo,rn S Dlkf 4L.LNSI�iCTtOt1TS
9.Total well depth below land surface: 48 (fy.) 24s, Fbr Alt V1`eftn Subunit i ds faun Within 30 dais of tompk6on of isell
For twi tipir»errs Kgrafl dexh,iJdGB rrnAffrmrJPh ����ti?" utP 2+�fAP/'1 consuticteon to the folternit1g;
N.Static eater lettl below top of casitew _._ (rut.) Division of Water Rtsourceex,Infortuation Pneessiog unit,
ff xettrr teat as ebow Ewl"S.NM"+" 1617 Man St nice Center,Italeeigh.NC 27699-t617
i
IL.Domb►lc diamctct-S.25 tie) 24b.For , Vlra ONLY: in addition to sending g the form to the address in
24a above. also submit a copy of this form within 30 days of completion of WWI
It Wsli constanction n thud:BSA eoustmetionto the following:
(Le..oeipr.rataty,cft dirm Push tstc.t (Minn Of Water ItesonKe&Uedergl'otind injecdott Control Program,
FOR WATER SUPPLY WELLS ONLY.* 1636 Mali Sei ice Center.Raleieli,NC 27699,1636
13a.alcid WM) l4laahod of test: 2�For Wa#exl±iu�tl„ok Injcealttto
Also submit one coin of this feria t►dda 30 days of Completion of
I3b.Dis(nfcetFnn ttrpa: . slmonnt: -- _ WrjI construction to the cattaty health dcpat nwa o{the=nth whcic
_. .
Farm G W-t Nanib Carafina D.gWftM of Em Mn=ftj and Itl row Remwees-Dh-nioo of Water Roo mE5 Re►,irwd Ategot INH.1