GW1-2022-01365_Well Construction - GW1_20220124

WELL CONSTRUCTION RECORD for frttenwl Use ONLY:
This form cut be ust»I.W single or multiply wells
,ft 1.Wad'I Contractor lnfortilation:
4.WATER ZONESc
Stefan Smith FRryti Tie DF$(nrpll0l
e' F'i'dl.Coitt�.CtnrNSrne ft. ft.
3576A
NC Well Carmuctor Certification Nunba 15.0UTER2CASUR ObrstlIhlc#V4l�en fs s ORUNERt tlimble)-
FROA1 TO Di%tt-rn TlrrCt6,NF'% ALSTERML
SAEDACCO Inc 0 ft 42 (L 2" la. SCH-40 PVC
Cmngruq.:IltnM lB INVFIR OMS] 17dR#1NG' ` ii�Inrisl a Wsc4 lrri ,
MOM TO D1AWTltit, I TBIC!"ESS AIAMWAL
2.Wel I Construction Pcimi t#", h ft, hL
1,W of/rry.lirakfr.urllfvrnmY 0__r Cnxnrv.Moe,Undarrce,71Y,!r on en-,)
ft, fi, in,
3,Well Use(ehecl:welt use). 17.SC,t1F. N
Water Supply Well: --- - FROM to ptnnrr•rr.,R 5TOrs17Jt: T"JOKMnS I MATFRIAI,
®Aplicltfthral dManiLipoldPublic 42 ft. 52 fL 2" old SCH-40 PVC
®Geothemlal eatin ooli. S 1 l ❑Residential Water Su ft (t in
(� 8� � t>�y i?pIY tsinSie)
❑IndustriallComlf ercial ❑Residential Water Supply(skiTed) ta'"Off:
FROM TO MATERM 1?RTPlr1CIPMMThirMOI)&JOIOUNC
❑[rii Roan 0 ft 38 (L Portland/be T.nemte
Non Ailafer Soppl We It:
Mmonitorin Qitccosc tt
1nJecitott well: rt rt
OAgntferRccbairgo ®GiotlndwAlcr Rcrocdiation 1 .SANbr+ ,C1!Eil.Pa tit Volkablo
PRIM to I RIA97''krAi. FC31iY4,-A�:t`�'11�F1iT:111{;rrttrn
pAgngFer Sionrgc and Recavvy 05alinily Hairicr 40 ft 52 ft, Sand 2
[]Aquifer Test ❑stomm-atce Drainage
ft. it.
❑Egicrimcntal 1'ahnotogy ❑ obsidcrrce Cor ml
'to.DR.ILl lil LOG 66iscb additional s1kelsif puesoni
13Geoillemial(Closed Loafs) ❑Tracer FR051 TO DW-RFMOti tic.
❑Geathettrtal(Hebtii +Coo Retunil ❑Other(~ ain under .1 Re-madw 1 ft, 7 ft Silty sand with some gravel
7 (L 17 ft. Silty sand
4,Date Wells)Completed. ll/30/2021 Weti;ID#MW-3 17 ft. 24 (L Silty sand trace clay
So.%KelI Location: 24 (t, 51 ti. Silty sand
American Zinc Products 51 -ft.. 52 ft, Rock
Facrlily)(h%nerNow Fsc0 bp3D#eit Mpikabls) ft, tt, 62
484 Hicks Grove Road, Mooresboro, NC, 28114 ft. ft.
Ptt!•sicol Addrem City.wad Zip -2 1.,I MAYIfC'S-
Rutherford 2 foot bentonite seal from 38 to 40 feet.
CoonLy N=1ltlr;rsTtirkwimNc.(PIN)
Sh, Atit1141c aml 1.Iingi ml in dcg cslmini3talseconds or dccimal dcgrmFs 22.Cer0wation:
(irlIVIO ft1d,ow l.MQ611s;grrli(ukfrl)
35.193954 Ir 81.850673 W 12/19/2021
5igm1 afCcwwwac..toctor Dak
6.IS(at'e,l the wefl(s): EFer manent or ❑Temporary 4 signin),1hi1jbV,n,f hereby cert fy ahas she wel4s)zvs(werO ixmyhgwmd by mx)nrdmaee
wO 15t NCAC 02C.0100 or 15A,Nt.4C 03C.020P A eU f omorr)rrimr Standards toO elm o
7.Lc this a repair ttti an exivung nelli 01'es or NNO (.0py r"Orrl lays l pri"MM in J r uy-11(nrnrr,
ff rh(sIx a repadr:f ll uru bwim ar•!i earasvnml rn drrfona,rsdwr and t%pfahr dx.nowre Orhe
repair tmde-r02 1 rrmnn@ti axrlion or rm die b"&af'dOx fgrat. 23.Site dia grant Or additional well details:
You may mse(lye ba&of this page.to pfotrid additional well site details or well
8.Number of wells constructed: 1 constmction$@t8i1�. boll ft14!`also attach addilibnal pag€'�if tr cessaA%
For mfNr,4e hrfecrkwj or nay-„wer supply wells ONLY'Airh the mm a construe don,Y"can
,mbnO one,jnrm7. SUB1NI'TTA INSTUCTTONS.
9.Total welII depth below land surfat 52 (fq.) 24ai. Fbr All W0114. Subntit this fond within 30 t1ays of completion of i vll
For oRoM,pler iveffs UP yell Aepa a ff d"�("ierem teremtr fe a?fie t flP`arxf 2@ 1XI'r constnrption to the folkmi ng;
ill.StIdit water IeVel below top Of Casing: 00 Division of Water Resources,InflPrmatien Processing Unit,
if wares level Is abtnuc radn f.,am"+" 1617 plait Savia;Ccnter,Raleigh,VC 27639-161 7
I1.Borehole diameter.6° (in,) 24b.For Initx of Wetic ONLY: In addition to sending the farm to the address in
24aabo%,e. also sitbtaait a copy of this foal[ within 10 days of completion of well
12.Well corrs"ction robod• Sonic consinictio n to the following-
(i.e.auger.rfltory,cable.dimx PMb e(c.)
VtMslon of Water Resources, adergrOund infer-lion Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mae@ ServiceiCtnter,Raleigh,NC 27699-1630
M&Vield(gpm) McNtad of test: 24c,For Water Supply dlr lnlectatn Welb:
Also submit one win, of this fofnl within 30 days of completion of
13b.DiAnfbabin t Amount:. well consinictipn to the counly iwiilt:h department of the counly tri=
etanstntcted.
Form GAI-t North Camttna DgKbunenr of£mironment w d NattrM Rcialme®-Ditiiiun Of NA'n1ar Resotl'GES Rc%,ised httgust 2013