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HomeMy WebLinkAboutGW1-2021-03345_Well Construction - GW1_20210603 NVELL CONSTRUCTION RECORD For lianna!Use t7NL.`;': Blip form cast ba mead rm sift orinoltipi=%vtis I 1.WcM Contractor Information, Brian Ewing FRr3H Tr? o "ttlM01S, Wol C'ntArpow ham ft. to. h fb fl. 4240—B NC W""ell Coimucrar Ccrlifie:itian Pinaribcr J :OLt�'4fl G`A��Clttidfne Miflh .il`w•d . O!t t�iik �, #tank FRONT TO TO 01A1tit9M T"W" SS MATERIAL SAEDACCO Inc 0 ft. 5 fL 2" I Its, SC8-40 PVC Camtanif Mamrti >N0 ii►�r+af� 91r5ht1 FROM To otA.MITEe I THICKNESS MATMAL 2.Well Consttaetion Pcrmit#: 700002858 tt tt. Liu all arppflrvMr ict-H pits ri.e.County.Ss".Variame.:fifarfial rdr.3 4.Well Use fa;leck well U.40. L. � ater:Supply We11: FRFROMTO, WUN OTrit stor�rtx Ttrtcl avirts aH4rtRo%t. ne .., DA_erkultural MirttrkipatT ablic 5 n- 20 tt. 2" in. 010 SCE-40 PVC 013cotheri tat iHetltiop(Coofirg StgVtyl OIResidcn iat Water Supply(single) tr. ta: io 0MdustriallConsumcial CIResidentiatWaterStippl►-fshamdI It1:C,RQU1 ;;. "• . ., t FROM TQ IATERE+ll. ryIMPF.At"83ItM NI OD&iMOL\'Ly OltTa n 0 FL 3 tt. PORTLAND POURED Non-Water Stapply Well: ®hrtaraitari c �Racowet%' - nion Well: tr. fr 0Agp*rRcch:argc 00roundtatcaRentcttiaariilaa Fg.>. D. !.NA Gi itiferSt XgHM ' iu�l aaa Pr-4pp'ATM' r"PA Aq Storage aarad Ro owvn• Cafialintly Barrier 4 ft, 20 0. FILTER SAND # 2 0 Aquifer T� O.Stornmater Drainage. 01, timcnial Tocimolo 7y CJSvibsid¢wc Canim! 2A RII:d.11iG i°aft herra��" I3C,eotha:rraan1;Clased loop► Effracer FROM I TO nR5t RteFiO�fc e.rxnebe .,[riarrura atte t 13GwtltemW d•lcatit 'K;Otali Return) 00thet(t!t `fi Undet#21 Rettaa&) 0 ft. 15 (L FILL SAND/SILT MOIST TO WET 15 (L 20 fL WET CLAY SANDY 4.hate Well(s)Completed: 5-13-21 Wd.I;m#mw-1 (L ft. 52.Wdl Lncartiaa: h n. CA Body Shop R, Ft. -- Factlplr'Claatacr Name. Facub)-lD 548 West 32nd St., Charlotte, NC, 28206 R rt. n Uf111 Pita skal Asisim s.Cir<.and Zip 2L 1t77. Mecklenburg BENTONiTE SEAL 3 TO 4' Comw} ,.. P�cse7 irt�rdaC`�atitam.NO.it't'\l ., _. 5h:l:stitudc and Longitude in dcgrtes(sninutcstseconds or decimal degrees: 22.Certification: tit„clt tt«f8.�L>r Nitrintr is fiasatiti�aril • •i >, W v..Brea t#t_ Et ►�rig 5/24,2021 Sigma=of Cmifind Wdl Con Date 6.13(mv)the%irell1s): 3 Permanent or OTemporam- Sti,av�ninr thu form,I Arreby ceroy r&a fix,rslx+rd urns rtirrrl amsmua-rid ih r.%vvrd=re 4+1111 d.`rA NC AC{)mt:.r 100 0r l tet KC AC t11C.01 i ta`rli{'i>n+;rrKfiriu�i St�iadtiaris aNitl tlarrr sr 7r Cc this;a repair to an existing%sell: 1 is or IS.NO r,rrsr ;%drat riu�+ni{ref hpaai{rr rrittt'd ra ha>nrrli nr`rirr. lf"W h a fovi;r.fill arrar 47trmiv urdi i(mo ,Min orkarr Thurarid rxpbJ#j rats nirrwre n(rfie- r crie rrrcrler S2T a^hn�rlFe ae.^tieas arm die br.t1 ot'Niiv,fOrm. 23.She diagram or additional well details: You may ttse the baclz of this page'to provide-additional%veil:site details or«ell S.Number of%veils oDustrurted: 1 construction details. Von utav also ouncb additiotal rigs if trecessary. &er rit,4Npre rrrjo fiv,4 or oiva-%wwr snip.+:,tve?h ONLY well dir arrow tv,rtstraredM.ysaai i-an snrbmirrw1e Juan. S.[111 IMAL IMIMC UCTFONS 7.Total well depth below%land surface: 20 (ft.) 24a. For AD Wells: Submit ihis fora; wt•itbin .10 days of completion,of iwll rr r m+.rblWr Ice"Is"ber trff'fi r+lR t if l a 5 re rrrir:tam i?le. Lh'4 f??'and zQ 14y;1 construction to the folloni ng: 10.Stadc water level below top of casing: (ft.! Division of Water Resa umes,hifinmation Ptocessing Unit. at rizrtts lrsrrl Fsrrfrraie rriai'tar ttx"j" 1617111ail Service Center,.Raleigty IiC Zlfi"-I6t7 i 11.Borehole diameter:8" (in.) tab.For InbXdW qXtilw O:%LV:I to ataditiou to sostling the fort to the address in 24a above- also sobiWl R copy of Ithis lbrol within 10 dot's of c'orvoetion of well 12.Well vortstrur-tion method.-BORED c:orignwtiam to the followbig: fix.auger.riaatf,imble.di=ecl push.em I llis°ision of V4'ater Rea+ vrres,Uederp'ound InJeclibn Cantrril Pt+oArawr, FOR WATER SUPPU WELL$ONLY- 1636 Mail Semite Center,Raleigh.',NC 276"-1636 tic.For Wrater;Su ►&Ipjeeta►I�leils:j 13a.>,idd(4[pin) Method of tesC. Also submit-one copy of this foisn')jwitlaita 30 days of coanpleWit of 13b.Disinfeainu type. Amount: _h r^t tv �ulth dep utaar+rt of tdc erntnl};w 11 A _. well construction to tlia coam ' cntasttnctt�i. 3 Form Crw%r-I -Notch Carolnaa tk*iatiacat of Enaas wmiti aim Natmal Rewurees-Div is.to of C1 atea Resovtn Rsti iced taaglNt 1C41 t