GW1-2022-07128_Well Construction - GW1_20220804

WELL CONSTRucr ON..RECORD Farh3omtlUscotVL'Y:. I
This.fonn can K uswd,for.sin&or multiply tails:
7cfi'clf6ntra tor Informationi
...., .;.
Scott Hunt, Jr FROM ,TO DESCRIPTION
11'dtCarttndorlatu+:, � ft: 'fl:.
4561-A Tt. ft. I l
NG Wdi ConlraciorCcitiftation Nututici` 15 Otl fER'CASING(for u►ulti ciised�lcilstiORLiNER W'i 'IkabM
FROSi TO D64\tF.TER• TBIMNESS SIATERIAL
SAEDACCO Inc
0 ft: 25 .,ft. 1° I 1`in. SCE-40 PVC
Cofl iaiq ntuh AGi:INNERCASING'OR BINGf`keot6crmalxW►cd4 pj
FROST• A TO DLASIETER. TlnCKNESS MATERIAL'
2.%NeltConstivction Pci nit#:
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ajyilicribl u erl prnrsirt:i:r,Cnti1q.,Sfirtr.1'nrinr r�I�E+cBt�cfr).
A. in.
3.I ell Use(chccl;well use): 17 SCRl.LN
Wka prSuplit Well: FROM '1 TO PIANIETER SLOTSTYX TIUCHNM t VATERtAI: V
25'. 35 ft. '1n. O10 SCH-40 �1PVC
'fr.
Clr\gnculfitraC t�MiniiclpaUi'ltbltc • -
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�Gcothcrn�l(HcatingJCooling Silppl�•) I�Rcsidential�Vatcr Sitppl}•(sin�te) - I
©industriaUContgicr�iar• fJRcsidcntial Wa(cr Su h'(sltar<*d
18-GROUT.i::;:. 7.
pr.- )• -FROST TO A SIATERIAL HAIPL1Cf:SIF_\T]It`iIIOD fi.1AfOU\T. :
Oim'_atian fI.: fF.
Non-W:itcr Supply Nvoll:,
�t
tdMtii)itoring.: tl a
injection•}YcIL•:.
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tid
. � .. = c�-Ithntciti 9'SANDIGL)EL hACKIdCA AiJ(: O R ticab-1
TO 51hR[�.FROS Yr,
F.111IPLACFA1k\tNr'rifoll -
0A46rfcrSt6rtg6•tnd Recol-ci}'• ❑Satiriu fhmct
iifi 23 ft:' 35 ft. Sand #2
QA ICcr7!st l�sxt>ition Pf lwalcr 6m"- c
ft.. tt.
❑l nincntalTcchniilogp � denceCowrol 6.
20:`1)RiLLiNG''LOG;(utlachaddilional bcetsifnecetuint '-
0G:othem.131(Closed Loop) OTnct r ..FROST' TO DESCRIPTION(tobr,hardacli.ttdl'nkklt nm`fie.ge.)
E'otlienttalM6.i,442ooiirieReltun) o0ilier(ceplaiituiidee61t:Reinarhs) ::fi,, tt see jGeologist's log
4A) te' (s)Completcil: 6/22/22 `.wVdlrna!rw-.03
5a AvelI;Liicadoir:: ft. it.
PPG Shelby ft. R:°.
Facdi(}�Olpo r,�IalriG Faciliidimeltapplizab.10
940 Washburn,Switch Rd., Shelby,. NC, 28150.
I
Pansi:at'r'ddcois Cna rndZlP �21'.RENIARK.S
Cleveland Temporary well for groundwater sampling
C<trurt;'. Panc7)dcidir=11 loll Nu:"(PiNj
Sh,if ahtudC dllll I otl>,dtu(IC III(I6'gltCSl1I11nUtC5lSCCrJn1IS Iii'"decimal tic>;YixS: 22:CcrtifIciths is
pt�te1111c.WOi�IaL'lirrtg#+s�dlicirq) '• _
N W .. - -m. «u 7/9/2022.,
5"igmw :ofCcnifi:d 1Vcll Contcrc(oi Dafc
G TS(aic)the\)'ell(s):',iJPcruiznent 'or` :SdTclolxir:iry.'- 11r`srgnnttehisfuns Ihrrrh�ttrr+fi•ilu+rthesrrllts)kw7 {titre)iyihinucrertneaecordc+ice
idth'1 SA NCAC.02C,0100 or'1&VA`CAe-'02C.0'200 Well Cniu rase.TIal'crbWaidi and rifiri a
7.:U-4his'a t'lp'a'ir:"8D C\l tluj \1'CIL' E71'oi -(ir .BINo." Cr1(ipbf rlus t&,nn 14av �rii'lu!�t irriil it tl a tirt ll o�F'iu�Y;
1Jhfs u a p j vylr fill��ii Cr+u1r71rell co+utrlrr r7at Grfornurrfo+r marl i i pinln rlu_juprurc.ojcG�: '' i '
irlicvumlrrN31 n-mRrki:V&ion or nn rh bnil nJrhrs fur+u 23.Sits diagrRrn or additlonufiHC111rLta1137
-You'rni uSc,tlw b►ck,of this I i&to provide additional�)A Site details or_fiell
8.TitutbFrot�i' lls.rvnstructc�:i constructiondetaik S'ou m t�also attach adthUoltal;pjl,cs if necessary.
Pgr mnbJl+le iRj,cftnu or:ntdi ii rr rurl>)�u ells O,V4i'•?t hh fGi snnrr consaucilotr,:yar ctyrr .. ..;
xubniir'pnr jnrrt. ` �,C1B1111T1'Al;� 1iS'��iCTI 10_NS
'l. dwrlidcptlitiLllfuc: 3Tot (ft,) 24a. Fnr III Will l '$nbnul'this ionn i1'ithin.50 a ins of coniple(iori of ji'e11
For rnarfrtpfe ice t/s tut.all rl, t);r'lJ constmcnon to did fotlotiing,.
10:Static water.fevel Nero«tote of casiul ,23. ( ) Div,Won af8vi aer Rtarouni ;'1nGlrinrtiinn Pna�er im),I�n(t;%
lJi her level b c l orr custur a -" 1G17 Mail-Sen•ice 1 enter;,R fldghi�1'27G994617•'
1 tr Borehole diameter:2.25° (in) 24tr.For riii(rti r' V Ic ONi Y: in addition to sending(lic four to the addres in
24aabove ;also submit'a-cop%' of tlns'fiinu��(thin`a4 da�s:'of.cotilpieuon of.:iiNll
12,: Veil constntction method:-DPT ebnsttuctton to the follosVtug
(fc'ang r.'rdtdn i c5b16:directpull,etc:)
I)i)isipn of�l'atcr:Recouiecs.Undcr IOB1id Uljectlon 61ntrolPnogram-
FOR WATER SG'P,PLY%NrBU$(jNLY: 104 Alai Sin rci`Center Rah ghi\C 27G99=163G'
i3p Yreld.(>;pmj� • ' �Nethod cif test• -4c:.Fol 1Ydtcr Sunnly he tmcctiiin��clls _.
Also'subtnrt'b'' c"),.of this fo'irn )iilhin:;�0.d�jsofcoipplettonof
1�d1 coastnlcl to'-1pe'conniy ticalth department of thc•.rairnh.wfil ie
13G DiMnf�tittorl tVpi: -- _-_ :,Amount:' r.
cgnslructcd. '
Fonn'&A Rohh Cawfijia DrMn:ent of Ee'n_MIL111ctu and Nautra7 Rescurces-Unvion of Water Rewrites Revised'ALigust 30 I I