GW1-2022-09997_Well Construction - GW1_20221104

I ,
' I
WELL kONSTRUCTION-RECORD Fat(tmDul Use ONLY.
'!%losacag be used far Sb*or P?Aipla xvadls
1l.Wdl Conjmclor llnrornuittdn:
Shan Gossett
r:Roat to D �
WOUCCrAm4a4me.. 120 121 I I 5gpm -
3528-A 136 139 i i 45gpm
NC WeU4olar0erti&cs4ionNimaber p
FR0 1U DihjjL ; A•iEEM
McCall Brothers, Inc. , 1 IL 75 n• 6.25 b• 0.25'• Galvanized steel
tbn�.ry Name � ,� .... _ •,�,z�� ,•, av:-'ie u
170933 "01% m DUMCM IMCMesa ' MA
2.Well construction Permit d: 0 n•, 81 IL 4 " � 0.25 Pvc'
Lie all01rawble%W11C esraeoupcMd&(de.Ceuar3tStore.vdrlarwe,eras)
tt.
3.Well Use(checkwell use): .VFf ,r.,r k.I$ er!%";',' _'•l�: 2f='tip= '+- •
WaterSupply WeH: FROM .> MAM ' isDUTSUE nu Ess ntA7BRil►L
®Aguicattutal ��tunicipal/Fublic 0 � � •1°' {'
011eoUteun (HeatigglCooling Supply) Residential Waller SUP*(sw*)
abiduslria bn6ea+cial MRestdeutid WaterSuppIy(shaled) :,,• •;,:" ""`.,; ON
NRO MAUSIAL'. + aW titFZ�R "EM& b&A-MO
COMM n tVoaWaterSapply Wch: 0 a• 14 fa chi s' 600lbs pour from surface
UMbi to ing gRpcomy 0 IL81 ikt Portland Trimmie grout 1411bs
rament
EmjMlon Well. IL It.
OAquifet RQdtmttgC .. C1GmURdRitCr'ReDeodiatioR
"•
UAqutfcr Spur gad Recovery OSaH*Barter , momm MA
WAUAL
R Qf.
UAquife.rTmt .. OSboumwatCrDmirmgc
t]F,xpeuituctt6al Tochuotogy .�' 17Sttbsidctroe Conttot _. � •� • i .. •�� ��•.•
ElGeodwmt' I(Closed i,00p) I3Tracor b-r, wiw ndt OI*;O S**,W- c=e
FROM, i�0 DffiCBtliTDN orbs aoH&
aaw (HrObWCoolt Ream) Ofter(ogMaunderM RottmM) 0 f6 '10 d: I' Red clay
d.Date WIil(s)Completed: 8�2�2022 si 65 „n' Course sand
66 % 80' iG' Granite
---------------
5.Wdl Location:" IL (t. +
• °g1 100 Granite wltH quartz stringers
Christine bridges 101 IL "200 �. Granite with quartz stringers
Fw tyx"Name Fa ilty WO(ifAIVV=blo) tit. 6t
1631 ages mountain rd mooresboro nc Y
i IPhys4rntHAdar�.QiSy art�l,7dP � � �'��'� , - '�• �__ .
t •:4� ,1:.,F. d:•7iiti:. .G*�'�r =:�. ��Y.yTti Fr.'N•�+^j a�+.;','
Cleveland
t7omugg• I� Pamd(d�swUirst�aNn+(PiNI .! , •
r
5b.LaUl &=4LoggitudeindWeednunutes/sxxoadsordoeiwal �-� In�v;��assv � • •ram•
(ifn�u6ch4aiefm/i+ongissutlHcusm).• Z2. tiou:.
i
35*2'18.144" N. 81040'46.3512" W i, e/3/2022
SigmcuaefCeutlfdcd4Ye11Cosapctac !; Aare
ChOW)Ihenvoonmkoent or 17Temporarg By sIVft dde farm,/Aff*-W&drat that w to)anus(-WM)wisp ww M W;e w�6"
7 IEthisa wM ISANCAC4W.0140drISANCACO2t;;02W WoU+C'eadraWw$m ckp#daddara
repatrtoane4stingwell- DYW 4•INo xaepyoftLie hat/tempravJ�rQtoduiff91lga7rer,
Vskitisa+qudn/rYlsttulttdratnull amtusuevton&duauriaaarsdaspniabrtluraaau+adfdte j,
a�gnutraselerd2l ezcrgrltanaremdralturkt2J'delsfom►. 23.SitEllis�r,7m4Ct111dttt9QiitWRllrtElatG: '• •' .
You may msc Use back of Ws page to pmW&addill od well sb dwdlil at well
8.11Tumber+p adlseotuttrueGed: 1 CQMWet)gU&tUls• You mayatstiafthatt dondpipifnaotssary:' -
Fds•saratdlsJeb atnaarswa•wRtlersayydguxBat�AtLYa+Ubrlrerameeivatdnedea,�waea+r ', ..
ar+bsetir<raelFrssa 24.Stibn ittalbuttllC kjW". I'
9 Total w4l deptb bellow laudisutfatce:_ 206 4t.) Trtr.,Per All Welly: ;Subw(t tUis to�;tvtthtu 30 duns of iaDrp),rkltott of jvC11
Farsuuililo-fcmx�'s[t�rrdlelrynest'f'dtjj"chmt(ea�yete•.I�244'aml2�I4Q') CODSIDIdion[ott1pf411ott'il�: . ., j .
10.Slane 'level blow top of ca+liwi, 25 ((L) DII(Mon of Water iQuoltt,""kmatfou Prucerk*Unit,
y'mser:erl womY MebmweaAft,am 1611 G►IO-Sawioe Cflali wr RaIdWL NC 276"4617
11.Barchofc dfamr�iew 6 (la.) ?alb.Par 1nle�etlon Weltts I4 addUiati to t;oDdipB the+(bmt ta'tbo odd[Qrs in?Aa
Mom oW sobmk a copy of Oft font!tvltbin 30 ft*of"Walk of wall
12.Wdl CoRthuction uretbad: Air rotary conaawdon to the f4lbwitrg: I,
Ciea+ag¢r 01%CAI&MDAppat;elo,).
Dtvlitor of Water Quality,i ndek*wu d bledlauCOMMI Program,
13.FAIL WA't'1i K8UPP1.Y WEB ONLY-. 1dib 0rirtil�vtoe Ceutes� .x1TC 37b99-tb?d •. ; '
13a.YieWpro) sa tl+felbatloftt«tt• Airlift 3Ic.!rerwstENrl;uDnly� •� al,WalCse biadttlUonloslet►dlnyUrofamtw
The NMVA t(ec)SWV.ails suborn one law of 06 Igpu'Wmk 20 doyc of
13L!!!!±ea Hth Amotin 12ounces ooeaNndlen'to t Cott-Oeolgi dooaAwo4'd dto may,
,
�aS�v-t 4 • A�aAaeemtie�t7eyrt�rtarec�vimuaw,all�t�tt3e�a -.Wir&ckOatotwVat$t�,urilt� ., �,.•isealan.tota
I. I T