HomeMy WebLinkAboutGW1-2022-04885_Well Construction - GW1_20220525 WELL CON-STRUCHON RECORD For ftlenwfUsc OgtY;
This Forin can be UsA r&..kVgId'Qi mwfiPIC wells,
I �'Vel 1:C,un t me"t o r 16 m ia t io u:
Stefan Smith FROM. TO, I 0FS(-H1FTJOX__
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3576A It.
NG'Ardl Coritm6lcir Ccrtifi6ti6n Nfij&6r .15.OUTER CASING w0l.0 OR LINYR(WA H b1c)
FROM 4TVT_1DL"1FTM A THICKNESS
SAEDACCO Inc 0 !tt;1 6 fL. 2 in. 40 PVC
�nqymly,Nam:
FROM TO
44r fl. in,
3.Wc!Wic wiecii-'irill li'lqp�',
17.S CR I.E N
Water Supply lVeth,. = FROM, I TO I DIAMETER I SLOrSIM I TfITCKNFS% FNATERTAI,
'fiw 1 16 1 ,010� 140 PVC
MAgricult,ura I b 1pnidipavl�ibjic:
fi m "ift.
130oothennal(Ileadug(Cooling Supply): ®Residential T ter Supply(single) -
Mesidential Warer.Suppl�V(sbartd) I GMOUT
FRS.'OM, , ;J0. INTATEREAL. I-r,.%fPLAcEAmNT mcnion xmouw,
0 (t.1: 3 (4 Por-Lland/beim..&±.
Nou-W4&Supply'%'
t4, 1�
Idjeerl'on Well:
[3Aquifcr-l1cqbarft, 066un'dii-Mcr Mhtcdiation 19.SAN WMEAVILL PACK fit apiaivabli.-I
"M jNt&TFHfA1. 'T%
.Mqiiif�_u8tokk�and)ke0oNVy -1 S'llinity 13ijiki. 'FROM, F.."IrIA(TAMN MY.T11011
r1. I .I ,-.. 1 1, - I .. I- I �. 5 (t.] 17 A. Sand 2
11Storn m''atc-'r oi*a,
131=xp Ticchnotogy M rimcnial ubsidcncc�-,Cbntrol
' .1 , % Ion.DRILLINGLOG(attach additional shmi if rwes5aryl
DGeodienual(Pused Loop) 13Tracm -FROM VTO I MCRIPTION(C-016r. ILI lx fw?,ivz'cit.)
0 ft�. 17 rt. Sandy silt
13Geoffienual
4.D njpldjed: 2-24-2022 ]Vejj lb#PB3
5J.`NVd11_UC2ti1.11k
Camp North M
1824 Statesvil e AVC ;4 tlr NC 28206 Mecklepqe4 lt,; ft
Charlotte, NC, 282Q6 '7�!SEL City-o�io -7jj—
MAY 2 5 2022 2 foot bentonite sea! from 3 to 51
County -wzIrl-1. Mircel No,(PIN)
. I ., QN
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56.jl wtii de a14:'W-, ,1 1. , , -qTgi or
2L Certifi 6timi-
is surhmf16 -35.247850 80.834801 w 2/27/2022
_
gil*g�� ia_fQ�z well 4701164am' i _Daie
6.Is Marc)the.well(s XPernianetit or OTetujto6t�.
b. I 1mrdU,rerfifv {Phew)cownicled braxTardan"-
INIA 15A XCAC xk,i;20.IVV1j
7,1,s'"I a repair I fij an, _ ,w0i Me,s or NNo i I 11 t abi
jeprir w;dcr 621 rrajark%swr m firimi Me lukk of tYUN form .23.Site dia;ranior additional wdl detail.s.
You may, page to'provide adidifiomd well site details or well
8.Numberof Weills constructed: constmeti6if de6i_s. You may also attach additi'oiml paidi if ireemary.
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SUBMITTa1 N&&616Ni:
0.'Iotalircll:depflt ifeloicladd Wrfice.' 16 of 1�ell_Nyals $Aifidt iihis'fii ddN�' nlpjcf'6r!------ ;4a. i,6r kit fawn
For owhiple consfincti0ii to tIVA01110"im;
I0.Static water level,below ton of eosin Uni i'.
cc n
if)twer levei-44-abo q t�A"Siq-;am 167'Mail.'Scl-v' i ' 6 lier RAleigh N `17699
H.Borehole diameter.8 OIL) tab.F_nrFnjrSijo.!l'HcL1kQNLY, in addition to sending-the forni to-ibe address,in
a 0&�s 24�A&,4.�146bfiijt qopytof this form wallirk 3 �'of C6111filetiolk of %V611
,''�fi if'I f�ll�_ I I - . - .-
ktruction imethod: HSA L 11SIru a 6 6;iWgr
cer-
(i.e.augcr ji*aFY,,dzjbk.,
'Division of Water]Zes6ur&s.Underground lid"on C61"i Propruir,
FOR,NVt%LTEgSUPPLVRrE,Ll$()INLY.I -1636 Akil Serviin,Center,Raleigh,NC 27699-1636
I Vidd 16b'd'0frt6'-' 24c.Fofr WitcrS4ejily&11njcciion Wells-
Md.subtAt one-'copy 6f'ifiis46fl'*tvitbin_30;6"o(vornplati6h of
Ij mm lt�afth dcpartm clilt' k- .C'ou _
w ll,conslinictiOnlo,the cdunty'.
Revised August201-i