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HomeMy WebLinkAboutGW1-2021-02768_Well Construction - GW1_20210512 WELL CONSTRUMON R'QRD P�.ir[sat�ltIsct}NLl`: 'this form wn beuxd rw S71mb av mwlivk weva; 1.'V4W Garin etorlurarmatlon: tx ttc Dylan Fierst room 1 10 n 1F"9y ft. ft. 4507-A NG Won CaaorCartiftiouNnnties AM tici FROM TO DTAMr.TF,R TOTCXNM 7MATSRM SASDACCO Inc 0 h. 241 } 2° ! ie. SCE-40 PVC +tnpnt Nam6' t>Y tt: lid ";''Mivrts`d!"�thedaaa FROM, TO VL"WUR IMK'KWM MATFIUAL 2.V01100nhtmetka Permit t WM0301057 ft. it. Liu llaaptirum,ugtlpffne,Y(ir.County.Starr,Variam llyTeC60%W) A. 3.Wdl Usc-(ehcstc well m") f?sS. ' Water Supply%Vdl: FROM, T1D A1AAfP.XRR -STATS17F 7114 AfA1r£R1At; DAgriculturAl Ciivintlit[paii/iLtbliC 24' ft. 34' ft 2" ia' 010 S01-40 PVC DGeo hermal(H ati poling S' Wp ') DReMdent%1 Rf=Sty Jp fsingie) ftL f] 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: mmonitorin ❑1tt�oir tt. A. CaA.gaHctlteeharge OGmvtd +tcriieditttiot+ tl.; ` FROM tA7ttRfAt; htacas+trvr ri (Moler$tonc arid R,CfLt1vl OSalinftygarrict 22' ft. 34 ft. Gravel/sand #2 OAgoiferText OS omm`atrrDMintlgC DEVer mcnial TMbno ogy OSttbsidmcc Oavitml tt. ft. '3ti,.t►Rff `tr"LtJ6(tittticNttl `itY` StT;°" 13C"dlletnt d Posed loop) OT Rcer R.0 M, 1 01 CIUMON c1!Miarrdn e Mft1t IT Ft ff 0* OGeotherml(HotingX02ag Retum ❑other ain under#21 Retn#W k n. fr. fL 4.DatCWell(a)CDmple"- 4-21-21 Weil<1D#MK-ll U.Well l oeatirmt 1� Merchant's Metals tt, tL EE F®Cft,o"=rraw ThCitih 1DR(ita3lplibic) ft, tt. MAY 12 20 165 Fanjoy Rd., Statesville, NC, 28625 Ph}�sira!trddrtss Cin:and Zip T t l! __....-: : . 77: i113 Iredell Beatosita seal from 201-'22' , �^1?�r} Cx��iett_r° i',alsdtderitlla~iltonl�er,(f'i�f) Sh.U t do and Unghode in dc9MC%%1M tW,-t c6ndsor decimal ei€gr r 22.Certifxl�ttinn: 6twell fietd,Ole t Mwv is sditekfd) 35.763715 T -80.824601 �y 4/27/2021 Si4mttiiafCcttitfQd Wrdf Coanlmetnr :Date 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 7.L+t#Eti skmpdirto*nod.-iOn;wdl: Mts or IMNo e"Mcftkir*W01dh"bV-Mpm-111*41os16caV114ft9Wf. ljtika'i tt a repttr.,}lll out h WIM u,,rlle'otar I"to"t4ortlumw dRd ew(ahl 0V owwre of drr 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 6 FMMG%V-t NDrihL rrob= tmrnioffmimuTmmaWt'tarwWRmu=s-Diti-"norwotarttmLroG iic�iscayAt tLCt2613 I