HomeMy WebLinkAboutGW1-2021-02768_Well Construction - GW1_20210512 WELL CONSTRUMON R'QRD P�.ir[sat�ltIsct}NLl`:
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SASDACCO Inc 0 h. 241 } 2° ! ie. SCE-40 PVC
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FROM, TO VL"WUR IMK'KWM MATFIUAL
2.V01100nhtmetka Permit t WM0301057 ft. it.
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DAgriculturAl Ciivintlit[paii/iLtbliC 24' ft. 34' ft 2" ia' 010 S01-40 PVC
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Oindustrial/Comttmrial C1Residential Water S11
ppfi'(shared) i Fttort T!t MATHWAL UffitAc0immmlon�4 A4Iotncr
13hTigation 0 ft. 20, ii Portland Injected
Non-tiitater:Supply Well:
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(Moler$tonc arid R,CfLt1vl OSalinftygarrict 22' ft. 34 ft. Gravel/sand #2
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165 Fanjoy Rd., Statesville, NC, 28625
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Iredell Beatosita seal from 201-'22' , �^1?�r}
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35.763715 T -80.824601 �y 4/27/2021
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6.is iar0 thewelf(s): :OPertmaneot or OTenrporary lj�Amara 1ha f— 1 hrntV t1enifi thm thr*V1ks7 MW fwrrr)bman wod in r,
v1A IJA WCAC 02C.CVM or IM NCAC 02C MOP RIM Ce m0wr6on StaWdrds and Owe
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rrpnrlrrerrdrrt l rerneroEs secliaa,/ir.rm tl�r brirL of"ahir form 23.Site diagnm 1r additionalwdl detASi
You snap use ttte bock;"af ft ppge 40.ptttlift addl6onal 4VU site tteWIS or well
&Numberof nvils awns cted: 1 constructiondetaits. You MAY alSO tittaeh additional page ifftwasaly.
For aratrllrte kJertknl ar Ran-uwet,r goy wits ONLY ntth the aermeWtrstrurtlelr,,,WV4" ��1R1►t1"CfA 1NgTttCTtEtNS
S.Totai rrdt4epth bciew land suriaoe: 34 Ct1P,1 2itfiv r Ali Wcils: Subtttit this tams tiviftttn 3U days of aougtietlon of nrti
For sowfi*Atli 4 1,1114VVAS rfdorew tvrM{i tw t 0,3M,error20-jaw) Ctmstrttcti4ri to the fhttowing;
lb.Static water Inn below tots of easIV {l4,) DIV Eaton ref rater awurtes.Information Prods"Unit,
effJymJ1r kM s rnr edthq 1617MaHSCenter,Rateigh,XC.2760461f
It.13nt cltnlc dismettu:e.2 5^ (lti) 24b.Pttr tnircttor We1tc ONLY, Jn adtilition to st=ndittg the form to t1v address in
24a abase.also submit a Dopy of this fours u-bb n 30 days of Completion of well
32,y1'e#i sirtfl5tt7tCtl0t1 tncthod: 4.25° ESA 0onstructi n to the foilo,%ing:
tic:aawg�ta.raiat .c�bisgdueet�sstced►
Dhiston of Watcrltttyes,�YTrtdtvgrouod,tnjccdoa Conttit7➢nugr>am;
FOR WATER SUPPLY WELLS.ONLY 1636 Mail Sew ice Geller,Reldo,INC.376"4636
t3tt,Yidd(rpm) Method oft Z4c fi r WatczSatnalr 14cln�oet#ad Wells:
Allso:Submit one coif of t6ts i06 M'tthtn 3{l dapaof cantpieti0n of
13b Dlsinfo ton try Aatotmt, M.eit con,�trction to the count}health dqm tment of the CMMI�.whm
constructed. i
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