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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__ It. 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 I� i 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. ye 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