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HomeMy WebLinkAboutGW1-2022-10804_Well Construction - GW1_20221209 1 �W.ELL.CONSTRUCTION RECORD >gr lr��nwi us�.ol l x:: 1, Thfs farncaii be used fnrs[glear maltiplc mils 1:`VeYl.Coutrnctaa'Ilifortuation: `iJ«1YMERZONGS. Stefan Smith FROM 'to pr.SCRIMOn }'.'c1t Coiilrttl3rTirl,uC R, 3576A ft. ft NC Well Contraciar.L�nifE ,lionNwrher tS:�[1TRR Cei[NG-(fnt*atuFti ris'eit iretlsYORi:6NER'fiT: "` FlaotiT. TO, nrvtilr:tus' Te1cK�ess �r,eTetltau SAEDACCO Inc 0 - f4 8 ft 1 �' li9 SCH-40 PVC Gin gt;uy Nhuu. L6+tNNER:CASING'OR TCIBING{irotNerm it eGased la 4 _ FROM TO DL«Tt:'t'EB ZffCKINFS5 b1ATEttIAL 2>'VWcit'Consttrctiiin Fcl rrtit ft. ft Piollapplirrahle weft pa`hRfra rl r,:Com,ta.Slime.-Yn►iumd,Iry:?cdr�yl�J' rt. a. ! i Water SUllpl�VYcll" FRONT' - TO [IMURTER SLOTSO TH C:TIM395 AIATBnrnr. 8 ft, 18 "D•. 1" in . .010 SCH-90 . PVC CIA ricl1ltiltal: r mtWcipallPtib4ic f v, ®C,ea'thelmal(HeatinglCooliog Supply) Mcsidentia(Water Suppi}(.sioglc) ®TltduArialico"Miercial Mesidenti�t WatRuSuppiy(shamd) SIXROUT . ETtQ1F1 10.- i1fATEI2[AL EMPLACS.SHMAWRIODSAMOUNT l9rm lion 'ft., fQ . Non Miter Sujvpl}•W011: SdT�tpnitoring l7l�ccocsry ft._ ft. LnJect fan Well:- ttr' ra. ClAqutferttcchars�c. (�timuiidt<;ticrfisntciliaii0n-. n9:sAnimlcktvf?L't•A�lz•riraFbtieant�f,_-- -= = , - '.:�- ----= r ttO3t TO 1Ltr$ItFAL R1rP►ACt�IF:VT Ht"MODT 17Agiltfcr Slnrtgc attf Reco4ci3'. []Salinity H1mci': (t.; ClArlttifcrTcst C15insrmvatcrr}ttiiitagp l7lwyr,:timcniill Ttrhnatogc - l7Snbsid.ncc.:Cvrrdrol '' �20:DRILLII\G'IAG`dnilach adQltiunilst�cetslfrtecessan'}: t]Ceolltenr t.(ClaseilLbap) bTrjipr` FRONT m nr5ctrtPTie��tu�ur.tn,�ncM. wr,na nrs,�,eta� t7Ge4[Ilern>sl(Fieatitt�Goaliltg Rctuul? DOdterfe!tploiat mRler�t2i Retuat6sl' o A "le ri, Silt! 4.I18ta�YeL(a)Cautjlle[ctl: 11-10-22 �i!ett.LLlrfTMW'2. $a:1�rc11 L ricatlnu @. tL !' _ _ !i Berry GlobalOn Fact�ny,{7ivr,crNnrue Facilit)T17k(ifappiisAb14, R., ft -- �;' 2203 Chicopee Rd., Benson, NC, 27504 Plrysi^.ulelddtas5City.ant[7ilr ZI.RCNtAP.KS" Johnston. Temp well -for grab sample. Gc,rnsty' Parcol 1d'_miCtcatio❑No,(PIN) �Lt,r titudc�atl I unfiCtttdt is t[cgt�c minutsslaccnnd56i•lcemul eietnn�ccs: 2L Cerdfrcativtt: {itnreU ftFstd;�nC 1;1t�'loag i4•Sirtlicrrtt} j' 35.3646212 IY 78.5541528 �� 1 L if 11/28/2022 Si.nat of Cc: >Gd eRCefimtor!: Dafe ,DPeFtlldltpRt,. 05 ZT¢UtpOCet}' yt ligt thix grnr 1 hcrrb �er1r ihci lhr irrl!{yJ i•ur vcrruJ�irrrsriurferl(re;mcronkrriar Tow,151bavotCA2C'01C fl ar,15A NC W02C:U20tJ Tt'rlJ t u,rstrTlcrJar Sfarrfaids'ttndtk lia 3.L�t$%w;a rt jtnii fn ati eristiar`t'e0 E]Vv; or 'ENo i6iimir}rhis ireani kris born nrin'lrled ro lf'c civil rnrrirr. �/71T(S.lf'O rY�UcTJ1j fII Xdf krtrlll9l li'alF t�77J57A,'C116fJ hrfOrrlNJI.a611.rtRll4vp(Ohr rlh lNTKare�cijdie � rellmrrurdcr 21 rerl�ards'secteuri OriAq rile 6rre.C•of thisform. 23.Site dutgtum nr.addiflatral a@1111et7iiCC: Ycnt,ma}-use t16e Gacl of this page•lo p�ow addtiiouat well site disLal]s or belt - S:Numberofwells eottsfriicted: 1 copstrnction del":-you inav itiso aTldeft iddititltml-p*S if nmcssaly. For ina,lalpte ftuevimji iiruiNi-iiwmr aup[dy lvvgs O^y i-Ith rht,.srtrtaeco+ratrue(fou,you crud ' ara(�aiiira+riafomi. SUBhI1TT.[GlNSTUCTTONS 1 9.Tot i(u elE dt.ptlt;belaivIand stirfac"I 18 (ft.) 24a. For all will sabnnl Oils funs!within 30 ils'lys of tt5tpptctio'n'of tvell 1°ormar1r1p1eirllsAarailtlgpal�vi/dl,(,'`errntdexarr;nlu-.1�20D'aruf.?�LOD') ' rnnSiniction'tnllec4'of[o�iag 10.Statle tester level,belpw tall oB i3siRg: 14', (�) tii5'la16, of Water 6ic4'qur ees,Infett mritlpn L�dvc¢syrifi Oitlt9; If Itwerieve*ll i7bora M'Sfe'.him, ..+" 1G17 Nlail.Sen•icc Crater,Raldph,,Xi :276 9-16t7 2.25" tab:rot Welk j El,Ilorchoec diamcl^ei: (ia.) ..�ftJSclltill_, ' ONLY., In addiFion to sehding.11ie Comrto the address in 2�4aalno�e: also sullnut a,copy of this fanit witWit 3(l-days'cf completion of trill 12.Rreil eonstmetibu method, DPT eo»stntelian to tltc f`ollad'in�:' ' {ic.augtcias;uy,cublc�direct push cic:} r - , llivisloit of Water Resources,Underground Injecdon Control-Prograut, TOR WATER SUPPLY{YELLS ONLY:' 1636-Malt Sci'r'lce Ewer,Raleigh,NP C 276994636 13,ro,'YiGtl(80irti) - Mitiaod�ftcst: ='dc,For Wat&.5tipplc&rlt�ecttartVcllvr Mso sobmtt atte eop} of this f4nn tcithin t0;tlaysofcomplztiott.af 13b.Risinfax'tlon,ttlrt: amount, tech cohoniction to iba county t,c'th depaltment.,of the coii",tvhcru ccsnsmtett:d. Fbnu GAI-1 Nop C%-plina r&paavocet.orEu0ionm:nr and Natund RCSauree9-l7tt 3rIon or Auer R attm Rct'iscdvtugL42V 1.1