GW1-2021-00327_Well Construction - GW1_20210312

. - WELL CONSTRUCTION RECORD for rrftrau Use ONLY:
'Mis form zap be umd.for sink a multiple aura
t.Well"Cnntractor.ltu d"Istion:
Rich Lemire FROM ITO p reel Y -
«'dlGtir�rapotTF�tttt
2593A
14C WWI Coimuorccnif owlen Naryba 5,0 dt r:eti gi;earrod-s+eits. . bcitbtc
FROM. TO TIMM, M FTIIIVIMS9 MAMI M
SAEDACCO Inc fL ft. 3n.
Gamrrtr�y NAMit t o R`3AlNMW
FROM D1AAtFT6it 7iilt'KRBSS MAi4RIAt.
2.Well Constiveftn pit; 0 it. 46, ft. 2. SCB40 PVC
liar ali appdirv,btr.wklprrmuz(i c:f arnrp.Smu.lrnriaerr,Ir ettiort rl;,j
ft, tt, in,
3.Wdi lse(cbedt well vio, JU
s -.., rti
Water Supply Well: rraOM. O ate+ItrRa sr xstra7"IMN M, MATMI r
C3Ag ttlliltal i MuttieipallPtthllC 46' it. 56' ftt 2- in, .010 SCH40 PVC
C]GetitTrelml IHe21011900ling"Sapp(Y? 011esidential WRterSUppt5 W114le) ft. ir~ JIL
Dindustriol/ConuMnc►al ORcsidernill Water Srrplrl�{Stared}
FROM 7Y1 MAT(3RtA1, $alYtrtt:'EM6�T�'AtETflOD toe AMOlS1kT
Obligation 0 fi. 40' ft.: PORTLAND TREMMIE
Non-'Water Suppty Weil: ft. H j
FSiIVttNittOrin CiRt7Ct}Sfi '
lnfCCn(iIt�YCil: A. fL
C3AquilerRech rp 13drounilmttcr Remodititioal
M fA rt1At. tr,�lf4.A tF"M"f'tMlt"I' .0C7Atli1&fCr$t(kTOgCAIKl1 0SEt�' 1 A1i1liR'llarrlC€ 441 M 56' ft. SAND #2
0AquiferTtst pminagc
13F—ipcdmentnl T=tint>iW ASabsidmc Control
oGeo enuai(Closed Loop) Mram FROM TO ft
oGtsnthennai tittetCo na Rctunti 170ther` `n older 112.1 Remarl s o h. so tL SILTY/SAND
50' ft. 56 fur PWR
t.Datc WeU(s)Completed: 2-10-2 021 Wdl ID#DMK-B
So.Wtit 14cation: tt ft
RED OAK LANDFILL h. ft.
Fact�i y aer Nanac f mGr7it5 ltls(fafpti:abic) tt. ftt
s..
3678-3288 State Rd 1524 Battleboro, NC 27809 Nash , it ry; _ �:
BATTLEBORO, NC, 27809 PlpriwlAddm%L Citg;amZip � z ��.�`
NASH BENTONITE SET FROM 401TO441.
r�tar�t= ��ld=:rdit�aiiorl Ito:dri�>
ih,)Atitpdcand IA ingitu de it tleglectctmiouttslseeonds or tleeimid alrgrew. 2L Certification:
(iti+etttietda(Ate latUgisSiOtlei0)
36.034663 77.895918 «.�. � .+ 2/17/2021
si#mtnic ofCeat _Wen celdwtat Doe
6.h(are)the wdl(sY MPermnent or i3TO mporat7 ey,ignt);R art"mm.l tomb}e, rho+ warmwedftr mYa zt mfr
wth 1.4 NCACIX,01M rer 13ANCAC AX 4200 WW1,Cnarsrrarrlax SmndaMs aa4z rkr
7.Is thix a repair 0 to existing weil: OVO or WNo roc e±�tlrir mtmdfi ib brrAprm Irlr�f m xtirarrtt fir.
tjrl4ta lx�repntr.eft ll zit fierrricrr a�tt ra+x.��t'�Qrrraer&3n mad r.t�tttiic tkt rmrtare r�!rtrE
repz r ora?1 tn an die M&of iIdN fOrM 23,Silt diagram or attdltinnal well details:
Yost.nraj rise the buk of this pale to provide additi0al'nwil site deWls or well
8:lV nm�tA`0f«tits oonstrtlettd: 1 txrtuttitatioa deter. You may also attach additional pages if ftcessan'-
Frrrrratrtlate!"}et7kVi rr WM-io ?swpdv Itylk ONLY with:rhr a nnttsansauctlovr,,ra*a tow
xubaftorlrfmm
9.Total well depth below larid$Urfaec: 56, eft) .23s far Ali Webs: SAtnit this ionn within 3fl days,of OMM*dot of well
Poemwtrtlrte wr/ts tisr it ttrluit s 1/defir",(ewarrdple-3+ 2M,dad2kit OV) Construction to the following;
10.Static water level below top of taslnV 4' t(q;) Division of Water Resources,Information ProteWng Unit,
tf,oywo,Wel is strove eaainit am":4 Rill Malt Service Center,llraateigfa.NC 2769r1-1617
t t,;Dull clitrtc dtain 6° (ln) 24b.Fnr Iniertton Wdte ONLY to addition to sennding the form to the addrt'ss in
24a above, also:saubmJt A copy of this form within 30 days of completion of well
12.,%,di CouStrnetion tnttbod:MIID ROTARY 00nstrocttou to the followiw
(i.e.,wkper:rotan:cabic dindjiuskZft-.) r
Eih'islon of Water star ReRonrres,l7ndeMoand Injretio»Control lPrllgrutt►,
FOR WATER SUPPLY UIELI S ONLY: 1636 Mai}Set,t'iee Centtr,Ralelo,NC 276"46
l3a 1riQd tgpm) t►4edtnti of Mgt, lac.fair Water SaRpis&I W tioo Walla:
.Also submit one copy'of this form within 30 fti of cowletbn of
mr 13b.Disinfeie on OVe A unt., mcli construction to the county health dM#n mn.of the toordy;nhere
contracted.
Farm G%Xf-t North Camfi S Dgwo 1G91t of EinimnywrA and tN;r wW RttRSI yces-fSY loon of Wsta Reotrom Rc%-bed AWtd 2013