GW1-2021-06303_Well Construction - GW1_20210915

WELL CONSTRUCTION RECORD 'For itkm-dUwONL.'Y:
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1.Well Coukt otor Infurmaldon:
Stefan Smith I DF�. tt}1ttO;+t
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3576A
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FROM TO is 7ut+Gh`Ni•63 MATERIAL
sAEDACCO Inc 0 tL 48 (i. 2" In. SCH-40 PVC
C49020Y Nam
FROM 6Lf RTER Ttr -Fss ATtJtL%L
2.W'dj cfanstroctdtrn Permit#: tL ft. to
UMaftaPPliCONO•wrapenwOr 0Vr C•"auarry.$sow,4'arinmr,lgw6 rl Ov-)
.jsYtl#iFxe{i C trcdl nsel:
.. ham, ..•_.� •� _ ,h . .<,..... .z , z �..�
W'ttterSupply Well: MAI. TO LOJAIMMR,I StA S"IN, TNtCK. MA Rrnr
Oft iviittm] 48 1t. 58 ft, 2" hL .010 SCH-40 PVC
DGeotdteanat tHeaatilo Cooling Stappty! ®Residemial Water Suppb-(single) ft. I
171ntdusttiaL'Gomtttercial ®Residential grater Supply Owed) r. M a{
BAoAt To ,nn t t~tt'rtrnU sz AMotnret
Ofrr% tiou R. ft.
tiTott-WAter Supply Well: � tL
M!22 Ari put
injection ed rt, ft.
DAquifcrRccharft~ tatourtxdxttterReowdiatioat tt to
tAtttfF;r Sta1 ri ."t1iv [] atlRlt+yElrliCi fit1; rYs' 1r2h?t i[t3t, i4P1 [ rpm T.1�1
46 ft. 58 fb sand 2
C3Agnifier TcO OStommatev Drainage
CIEVcttncnial Tcchootogy►` 13SQb%id=c Control t3. fG
OGeotbeantutt(Closed Loath []7 Melt rear Ttr n�itTr rwx tcatar.6tednrhn�i T �e c
❑CoothentatlO thou+Coati ReCan; 00ther LeMbinuuder 2!RCusati ) 0 fit 25 fr, Silt
25 it. 60 ft. PwR/rock lcw
4.l1Ate W',elt(x)Cbmpie1ed.- 8/26/21 Well ID#TMW-2 �
M It.
U.Well Location:
taehner Green ir, tt, reS
Fwift`thvrws Nam Faci<dy MW trf sppliMbTst
201 S. 12th St., Bessemer City, NC, 28016
Pt-sied Address.Oly.and Zip y. _
77
Gaston Temp well for ground water grab sample.
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5b.Latitude and Luaga- de in degrecAdminva secon ds or dwmal 4cgrcm 22.Certification:
cit''.,ett MWMV bocce is MOkitto
35.283964 K 81.283680 W 9/2/2021 _. .x...
Si of Cc PlcdtCniiE®ctor f'.v.. �,..wv_. !)ate
r.I3i(ttael the wedd(S)r uParrrintnent or $1Tettiporarr i�*sdgnbig AisfivT,1 hetrky rerafa rhaf she iiWifs!wo 1'nrmf ewxsrtrucxd in mCtvxry 4mm
4*4 154 NC.'Af.02C,01 M er VTA SCAC O AM tii'rtl Comirfrt om 5vjWards en14 A..Va tt
9.U thbx it npair to an edsti ag ivelk ClYts or MNo e.rr e.171,if fmoni has&-nr pmvidrd t&Ow v,rll rm we,,
#rfrfs lx.rs rtp�m1r,}'aft exxr firtnuw ic�rff rrmrtwexturr tatferrvturrtcaanartui r�rtaln.r7ie narurr of rAr
rr it nmfrr:i 1 r.watu►kr rn rims ar rur the t o rsf tiriv fnrar. 21 Site disc m or additional well details,
You may use tdie;back of this page to provide addilitmal well site details or%heel!
8.Dumber of wells cansbucteid: 1 cui>stiuciioa detasls. Yloa mw aloa tuach additional pages if tnecesany
Ft>r-4twli le,iNjWthar ter"1-1lwwr rri vy WIts Oft »drA the arratt goM tuv#On,x?aer em:
subm temir jams. $ j'( •iAl�4'i E1,G770N4
9.Total well depth below,lead outdate 58 {t 24a. fbr Alt Wells: Submit this fdmt within.30 days of completion of%ell
Fear rcailactwtn+ t1s tfs[t1N deDr r AiJfa r+mx a nmal+he i 4 2t1�`roar!ZOtWj Construction to ft foltos ng:
M.Static grater level below top of casing 49 014 Division of Rater Resiaurcot,Infursistion Fmeestft Ctnl4
1f ivilmr 1rexM& w edli tg,&M ' 1617*14 Service C"tater.Roklo,litC 27699i-M 7
11.isorebnle diameter:6 On.) 24b.Far tn, OM WAS ONLY., In addition to sending Ilse form to the address in
24a abos•e> also itsttiit a copy of this fount within 50 days of completion of well
12.W dl M011 Oon MdbtM:Air consauction to tie following:
j e,riugct;ta0arf.carbleL di>ec9 pask crc.)
Division 2of Water Reaoutvas.Underground tojectdon Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Ma Semice Center.Raleigh,14C 276"-1636
I
138.Yid(dgJm) :I3ethod of text: 24c Far W'a er i Bit
" iR' taiu;i'Vdly:
Also submit one of this fdn i tMhin 30 fts of completion of
13b.r14i nt7147#ttlR iiMj7i: � , Amount:__ -%Tn Owwruction to the county lcesttdh 4 trnratt of the crnmtt nl=
constructed.
FermGW-t bt met FJt tmtetttutEatttusgticnisnd mnnzttt wets-t #stsamofWstrrtt�0uro�s ftsg e+iAs teed if3
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