GW1-2022-09180_Well Construction - GW1_20220930

WELL coNsTKuc-rroN KEGoku Fort,a<n,alt.:s<ON1.,•:
•thin fo,'tn can t+a used Car single or on01 ipk tr<lls
1.Well Contractor Information:
ti.\\Ai ER ZONES
Zach Thompson FROM Tu OFY('RIPIIUR
Well Cnttricrnr Name ft• p•
4478A i►. fl.
NC Wcll Comiac►orCcnifn-wion Minter 1S.OUTPR CASING for Toth crtscd NrRs OR 1 iNF.R'N a 8cahk
FROM TO nt��tTTF.R THICKVFsI st.sTERut.
SAEDACCO Inc 0 it. 33. to. 2" in. I SCh-40 PVC
(.bison Native its.INNER CASING OR'_I '11ING.` ►bennal ekined-taupe
F F.' — nI.�MTTf•.R TIIICK�ERS MAIT.RIAL2.Well Construction Permittt.listall r.Ih'tiirivhlr-aril arnri:r fi.r.Counts.State.Varirarrr,140rlim rn-.rf-T—o
--• -.. ---- ---_.---Wm••-•�-•- -- -_ ---_ -- - _..___
3.Well t Se(check-well use): t7.5(>'Rb3"N
Water Supply%Vell-_ FROM I TO nuatFTF:R SLd►T.A.►: I 1111CK%FN% I st.ATERIat.
1Jr\ nculUlthl E-Municipal.'Public 33- h. ( 38- A. 2- in. .010 Sch-40 PVC
0(kothemkd(Healin3z)47901ing Supply) 011csidential Wafcr Supph'(single) If. ft. in. t
i:.l hidustrialfCommercial i.31t sidcnti d Water Supph•isbared) ��ROB TO 113TERlA1. 1I EPt1(lT.\fi h1\T FTti10D A A1101:\T t
❑irti vtion ft. ft. l i
Non-Water Supply Well: 1 tt, t►.
00hlonitoring DRoco'.rry !
in Tcl on Well: rt. f►
0 Aquifer Rcchargc DGro,mthinictRcoicdimion t9.SANDIGRAVELi'ACt►{i( H�caUlp)
F•am► -to �1A'(t:N11t. @�IPI:�t;'f]IEVT sif:Tur)n
DAquifer Storage n.m andRrn' MalinitvHarrier F311 ROM
A. 38' ft. Filtered Sand #2
DAquifer Tcst ❑SToruncater Drainage
f►. ft,
❑T\p;rimcntal Tcchnotosn' Muhsidencc Control
-20.DRILUI1tG tOG i'vitach additionalshms i/necenan-
❑Grotheniml iClused coup) OTr►cci I FROM I TO ! nF,s(RIPTIU\tiv►ir.h°rdncrt,.tru4,Nkh►,v. ,:n mi.r(e.l i
DCriothei mal(HeatingVoolitie Rcium) OOther(explain under 021 Remarks) 0 ft. 311 ft. Browli silty sand
311 it. 381 G, weathered Rock
4.Date Well(s)Completed: 8-1-2022 W'dIIDpB-304
ff. ff.
Sa.Weill Location: It. (l.
Alcoa ft. I,-
r ax, ,�,.
facilil)iQ+�nrNanrc Factlin tT)ki.ifapplrtblc) ft. G. ��� -��,�=.,Wl� `l���
293 NC-740 Badin, NC 28009 Stanly County, , r
Pin sical Addrss.Of%.and Zip 2t.REfl1ARILS' SEP e
foutsn Parcct 1J:nliftcvion No,IPt\'n D!VQ/60.c--
ih.Latitude and Inngitudc in degrtcs/minutesJscrnnds or decimal degrcm. 22.Certification:
(if acll field,alit taa'lot k%alliri;ull
35.408161 N -80.121192 W tgtti4i.^ofCen' .dWcllCon(ta,tor 8/6/2022
Disc
(I.Is(are)the OPlrmitnent ur SlTeinporan• H,mi"fining thiY from,I herrbr rrrfifc tbm du•nwflla)'v(n jurrrl rvrr+_t9tucied in rl re+•r k:nrr
oath I qA MCAC 0"C AIM or 15A NCr1C OX AMP)11"41('unctr'rrt-tien Stai-lo is omi that o
7.L.this a repair to an existing well: JVec or 'RNo rat n_l'diii rrt'onl ha..lA•.v p—rijJed to the,n-Ii owner.
IJthis ar a tc7xrlr.Flt r : tn,:nr,„ail sort>:vt tinn t+ifs-mt(trian emA rt7+lasso tlq•nr7tr�re of Ou-
relwir mnlrr F_'i rcrnarA.t rn-tirnr or rvi Orr hrw.f of rhos f firm. 23.Site diagran►ter additional well details:
You may use life back of this pao to provitk additional well site details or cell
8.Number of wells constructed;1 cottsUuctiott det riL,. 1''uu map alsolaltach additiotl t1 pages if mSes5 tt)'.
fits rntd,;^(e nt it-cvwi e»newt-nrr:rr,iiTtlhrs I,ols©ATY"-,erdr the mime ronsrruc(ion,st+a a•err
a umir<>tu form. SU}NIIIIA( ]INSTLICTJONS
t).Total well depth below land surface• 38 (ft.) Zia For Ail Wells: Sub►ntt this fonn within aft days of completion of well
For rredliple n'r'fli diet all digahs if illf i•rrnt wvornpIt••arn.?CYP solo 20 i00) construction to the folloxiing:
10.Static water level below tap of casing: (ft.) Division of Water Rniources,Information Processing Unit.
if-'atrr level ri at.prr tostax,rose•'+" 1617 Mail Service 6111ter,Raleigh,NCB 2 7699-1617
11.Borehole diameter.8° (in.) 2Ab. n nA,NVc-j2 ONLV: in addition to sendinsg fife form to the address in
23aabove. also subsoil it cops of4his form mithin ;p daps of coolpleliou of mcll
12.Well construction method:HSA construction to llw following:
ti.c.auger-ratarv.cable.direct push etc.1
Division of Water Resources;Underground Injection Contn►i Pn►gntnl,
FOR WATER SI:PPLV WELLS ONLY: 1636 Mail Scmice Center,Raleigh.;NC 27699-1630
t3a Vidd(gpml Method of test.- 24c.For Water Sunni'A Injection Wells:
Also submit one copy of this fund within .10 days of completion of
13b.Disinfection gpe:. Amount well construction to the county lic 11th dcpan nu mc of the county where
consisimcd
Form G„r•t Lonit Catelota Mpannicnt of Ent itonnatu aid Natural Rcsoutces-Di.,ston of,lraicr R0olrees Rcs tsed August'-N)1?