GW1-2021-05688_Well Construction - GW1_20210727

WELL CONSTRUCTION RECORD Fes lsftrnnl Use oxl.y:
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1.Wel1 Contractarinfornmtiolt:
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Rich Le- re
I�$f►wt yttt D t =_.ias'
W141t Ccrmiw Nam R. U.
2593A rt.
NC WCUCQnW&WCcf1ifim1kmNlunlbca
FROM TM: 11M MATMAL '
SAEDACCO Inc 0 rt. 25 ft- 2" 1 ya, SCH-40 PVC
t krtr�nt i' eae <:34,'Nr11�: �n
T� I MM R 71(t CKNRSS V MATERMLL
2.Wc11 Construction Permit rt tt fill.
liUarldticz�'aJavrllprmaPrf+-e.Counrp,57uM�,tgrinRcx,II�i�CtitW'Sru;.b I,� ��
3.Well[1se lchwhmv11 PS&
kcr ttppi v Wcil: wn[a;a ra r► " M�, MAT ISIM �rtM t a►�A +si t, \
DAgftIIt l 25 it. 1 35 % 2" EL
' .010 SCH-40 PVC
McOlhemial(HaitingCoolft Supply) 131kesfifemtat Water Siippty(slnyile)
Dindustiri�llf:atli acial 0-ilosidential Wamt Slrpptw(sitamd)
sRua m t rs nano .rc� r� loi n o..arotar,
owpatiam 0 ri. 21 ft.. PORTLAND TRENIMIE
i4on-Writer Supply Well:
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C)Aq t*r iRcchavgc Ci irDlAilt KAtCT i�Cll iv�t7t 11 -fir: eY,'` -
t`B !I�- _ hih'CtS rutlpt.i[T;1ii<1tT. a
pAcpt r.Sittnrg and ltcr Psxty' fJS?litiity plater 23 rt. 35 W SAND #2
C3AquiterTest OSta mhwatcrDraina8e
f6 ft.
0EV--tio= 1 Technology l3Sitbsidrncr t",om'ml
DGeothetiml(Closed Lodpt ct'acer FROM vwfta
1343,06thetutalflleatir <rGao Remmi 00ther j!2 laitz under 1*1 Retnar s 0 fL 35 rf. RED SILT/SAPERLITE
i'4 rL
1.Date Wells!Complete& 6-18-2021 Well 1DOW-01S
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So.Wt~it 1�rra atitrn: B. ri.
BATTLEGROUND STORAGE ti. ft.
Rastllig�ILtuncrNamc Fttseltl} t,91 xppliahlb! R. tY. �� .ti., ��,-_
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3700 Old Battleground Road, GREENSBOR/Oy,, NC, 27410
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GUILFORD BENTONITE FROM 21' TO 23' �rCC�rg$111 '
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om* llama rtit�itionNo,fPl.ii) ire` ' GVn
5h.2.atFtu*and 1 nug' Jtttnftc in dcgreegmilitutWmmoolis or ilmmal 4egres: 2�Cc[tif"[rntiuu:
f'iftirralt;t"�69,iitt4 IrRtrla�i4 trdi414td1
c�A
lc W4'a� rnaG. 6/20/2021 _._ ...
Sieczaiei:.ot 'r4Pell Canoamax - _. D3ic
6.Is(arr)the mvell(s): wFermaeent or Temporam or signing Jtdir fum,1 herdn.erm -Mar actin ittrll(sd was'{burr!oomr,wie d ur twix+rdmCe
41A 154 XC.CO2C.01M a }:Sri VOIC 021C d 309 Well CmL,0zer*ur StdruAmA crncftlxrr a
7.Is this at repair fa an existihyt well- oVes or M No a vy of hit reroyd has bem lrmviekd rrrzdx,urr;d mumT.
of ibis is u r+em r..01 own W"m v rld emzrgram*rr rAe arorure n.,,f the
remir taraderP_1 romarts_simMor.or fm tine h"I of thty form. 23..,Site dialgram or.additional 4!"W derails:
You ntay use tk bwk of this page;to ptmt'tde additional bell site detains or well
S.Dumber of wells constructed: 1 c3iz gawd oa daft & Youvae also attach addi6mral pages if a&essaty.
frrr nrardal{�de l tdrsrr 6W ra w-setl#er wy wells ONLY ndrh riar snort suratelrmrtfim��rsm
swtumd env form
9.Total wdl depth bed kind surtax:. 35 (ft.) 24ir. Ow All �'1'lk, Subrmit this faun within 10 4vs of caompteGau Of well
Acnr tal VV'itwlr ho off ti l t if d4N'er€rir ie.sxr Tfe-,i0mi'Arad s' 'llkT.l coit5tnrcticnt to the ixati#uipg;
10.Sty water level taehity top of rasirt 27 ffk.) 01vbdoo of Water ReI reol,litforitration ftmvssin Ctnit,
ff waw kh4 gar aborte vmrtag um"+" 161711fat1$cnim Center,Ratciid.NC 216"-16 t7
11.iinrdtnEc dipmcter 8.251, (la.) 2dl> „b Weity ON1.X• In addition.Ia sending title 1"6rtii to the aridness in
24aabove. also subsoil it copy �f ibis fatttt within.30 days of con tion rat'aril.
12 MIell consiructiou nmhad:AUGERS cx m"uction to tk fciiltnvio
(Le.mtpi.rtse3tsg,cable.(1bW bask cxc't
Division of Water Reaout+c%Underground lttjt+-M Control Pmgratn,
FORWATER Sb PPLY WMS ONLY; 1.636 Mail Senim'Pulier.Rak O,NC 276"-1636
13a.YMd( 1) McMad of ttxAtt 24r.For IgMSuggil I 12 ' & tc:
Also sublM 0n cats'of this farm ttrithin 30 days of cmWetion of
13b.DWoftedoo M�rr: u Amount: welt construction to the County health dcwpa"tnimt of the court'whm
consated,.
Faint Gar-1 t+VAll C'Malt a DqXntt of£atesta�usree5 ctt llk tr:1 s—Din iaaaf tlraic[Rex"MCub [to iset?14=22913