GW1-2021-07136_Well Construction - GW1_20211006

WEM CONSTItUMON RECORD For trrtt aml Usc MY:
Ttih farm can be used fret sbl&ormwrtplc%as
1.Well 68tradorltt 011"attomID
\N`' tx 5► 2rt 2ON
Brian Ewing ROM I Im DRSCIUMON
1ltlit."+lmltlfrlCiQTt�tatril' q ft. �'
4240-B C.� 0 ft. fl.
NcwdlGnmTad"otCaaiticmionNivabcr �551(19 .atit17YR Q. ari iHl+iietid; tlR4JN i r i" pcf6le
r�J(Q t\ FROFn TO DI.MNIr 1tR THXW. AS MAlMATA1.
SAEDACCO Inc 0 fL 63 ft, 2° ter, SCH 40 PVC
Cbaa Una tYafn¢ —may, 16 1�F R:Pti$IN ,' k��iUe1C�%1
FROM TO DL1S11:TM 'rftWKN''BSC I 14A7EPLOL
2.Well 00"strt ediln Permit#: 11, rr.
tSu an alryat mum,wrdPe mhs(i r.CmmN,Stmc,Variawe.14kok"rtr^.)
A.
3.Wdl l3se(Owdc well arx) � R
Witter 3upph'Wdh FROM 1.70 1 aursrsinte' StOTSIV, _ uact MAr1M1Al,
63 ft, 73 f6 2° in. .010 SCH-40 PVC
CtA�gridrtrirlai DMtTniitipaltPabtit
DGpasthemial(Heatirrgtr~ooling Supply) L'1RewdtrTtiai Water Supply tsingfe) rt. ft.
DiitdustriaUConuT rciai CaResidetmotti Water Supply{shared} ]t1::t31t u
FRAM. TO MATHIIJUM EMnACO.; T XWMOD A AMOr1Kr
01tri tion 0 ft. 58 fl. PORTLAND TREMMIE
Ron-Water Supply Weil:
13Moa ttvn tlltecos
1:0"011 Welt;
DAgsrift:T)tct hargc DGmundwitcrReniediat at4
DAquifer StoineaW Rectrvvy Malinity Barrier Ya fa Re t,. 4p4 a rr sT�4rT t »
61 M. 73 ft, FILTER SAND #2
DAguiter•rest 0sto"Mmttr Divine 8-c ft; R,
Dl Verimcrttal T=hnolqu QSabsidmc Cos4'r'o1
2 : RAi13 ClfG. i4i¢tridv7i .. 7`. sf ' ?
oGeod ieratal(Closed Logs) DTracef "MI TO DESC UP"Ox(tour,
❑Geothelml(Reati SSgLjhjRensm) Modletrr(` -M Under#21Retuatl;s) 0 ft- 40 fL FILL SILT AND SAND
40 ft. 50 ft. SILT
4.Date Well(9)Conrpleted; 8-20-21 13rC1ltDIRB-12 50 tt. 73 (L SILT MOIST TO WET PWR BEDROCK
$4.Well Locsoon:
Cleveland County Landfill fL (t,
T'®c7ityll?nvsarNambc Fircf�itrlDir cdr�t1N
250 Fielding Rd., Shelby, NC, 28150 f, rL
PkOcrd Address.City;ar d Zip 21,
Cleveland BENTONITE SEAL 58 TO 61'
tbfaruy Parcel tdr fttitgraioaiNo,(PIN)
Sh.Iartitude`ind Longimilc in dcpneestrninutestiselinds or decimal degrees, 2L Ccrtifci:don:
ON-011 fiete,tarn 1411ett it sldkkfd)
R W E_Sri a n Ewing., 9,1,2021
Sign t le ofctitmcd Well carim im ]Sate
6.1s(are)the well( ; 3�Famanent or Memporar}
LIr sib+cn this farm t htrnbs ir9ify that thr%*fi(s)woo trace)cmarmeted iR tordcnrge
u1 A 15A MCAC03C.111t10 or,15A NCAC 02C 410 M-11 C+errmw rion SfrtrAirdt mu1 A"a
7.Is this a relratr to an existing Welt: 13Vt s or ENo roff t+f ilia rwonrl h"becgT F+orhw to the wql aunrr.
1JtA#r'ta tf rr�fr,,{1N car fitxw u�71 rerar+Yi�F�j'wwenntlavr aRsl rtpPsin rAr+asrurr r�rfir
temirawderd_11 rMarb sztma erml the bad of iks faruR 23.Site dhigrtrm'or additional Felt detalta:
You nW use the back of t1lis page to pmNidt additional well she deaalis or w4l
S.Numberof Wells C4tLStt"aed: 1 coustruttian details. Yotl mad a19ti altaeEr tdiuistlal p if tttGGSsOr{'.
For i kirde ln/ealanr or om-gazer Rgg.+tr°'wrib ONLY%fth thr saarre rorrsgwrt�r,u�xr.r�ra C tRiiil'PI A I11t fi CfiIb1tC
subadtararfarm. �_.L k
9.Totalwdt depth betm land surface: 73 (11:} Ida Vgr Att Wells: Subimt tins lonn jtiidrlm 3tt vs cd coisspletiott+f Hell
Fnr;ngotple wits 14F0l/drprlrsj(di*rentlexmpte-30340,0nai2olo0'f constnrclionto the fottowint,
10.Statte water levvi below top of tolov {tl,} 6hislon of Water Rcaourcts.Information'Pror5essing()nit,
!f water ltwl is atow cadq,usr +Y 1617 Mail Service Ca r,ltalyd*XC 276"361T
It.Borehole diameters:8.25° ((n.} 24h.Egr IU j ,gt4 Wrens ONLY. to#Milian to riding the form to the address in
24a above. also submit a copy of this form Within'tl days Of completion of well
12,11rd1 eoVMtttT¢tlon mdbod Bored constnicticn to at following:
ti.r.atitget,rmmtnry,csfblG diteq prlsh+�) r
Dirislon of ester Resources.underground JAjectlon Contlni Program,
FOR WATER SUPPLY WELLS ONLY 1636 HAD Solar Center,Rate o.NC 276"16366
134,Yidd(gpm? lMicdeod ofttau 24c.Tor Water Sa segX de kjw0on s4l'dW.
Also submit one copy of ibis form tvitbin 30 days of completion of
13b.DWofcetioo t Acmnant� well constn ict on to the caimt_r*health departnsr it of the colony what
con�iri;tcted, I
Form Caw-t Nb4h t am1ina DgvAm nl of Ea%4m fmmd and NlanvW Rewtms-Dhs1DrtAf tVatcrR poised Alt gu;t 2013