GW1-2022-07630_Well Construction - GW1_20220817

GV LL COt4STRUCnO.N RECORD For I ormwl Usc ONLY:
'iWfarinsspi tv-tad foi s0,9lc in nudtipia sscils
1.Wdi Gintrmor Infortttation:
r:WAT81t
Rich Lemire FROM I TO PKS.ttn'T1 N.
Wol Corttacto't Name
2593A -
NC Well Cotmsetot Cettikation Ntuibn op'idiidtl�easitills�lixl i3 7i4 "ti
FROM TO PuLAVETrit -TMCWNM HNFE UL
0 ft: 10 It. 21, id. SCH-40 PVC
SAEDACCO Inc
FROM TO DIANfF7rR 7tf ASS. M.N
2.well Constfvctwil Permit tf tt. it:
I.wV114404'.4hr Wrlf kineft"tie.,Grtuno• Suite.1+neiawy,h7wee n n")
fU A.
3.Well Use(check yell u ti): T? iGR
�VattrSappl►+1Nttll: roo'M. 1.70. OtA�rlrt'C'R SI CiY.> Tt114MI S}^ NtATFRtAL `
0 AgFkUltafal 10 ..'(14 20 A. 21.� 1* .010 SCH-46 PVC
�C,eoihrtut([dent;n oolin .Supply) Su (Single)
�TndustriaUt otnittttet�i taRcsident a►Wrtl Supply(Shared) =t iDtFf t =-a%-
IrROM TO MnY6RtA1,. 3.'YJ[P Cf'A!A\T Ml?TROD tQ A,Mt)tl\T ..
❑idi Eton 0 fl: 6 .k PORTLAND POURED
Non-MIAterSuplily Well:
Wd fonitorin C]Recotr.
Injection Wel►: fG.
0Agni(&Rechar9C oCtrwodwater Renlediittion itr
GAgaifcr Stor:+ge aticl Rtxot ly t�5alinitt 8nrricr m YrATVRIcr- tit r >G�mratt n
9 fl:. 20 ft. SAND #2
Q Aquifer Test oSfinumaixtDrainage
ol„,�rimeatnl'!'o¢lula►a� oStihsdcricc CorrtTol
Ytb I1RH ' w ?atfiicic'n ' Gon itakrctsif:' -.... r
0CSeathe(1wl{Closed.LOOP) QTtace7 fit:' .To I.aESCR,IPT ON tow.A*rd? : shflljtwltt y'.. .13t4k.0 .L
oGtotitetotal.Meath ooti Return) 00ther irtunderi121Rettta&)j 0 ft.. 20 ft'. bRowN SAND
20 fit 30 ft;
4.Date Well.WCompleted 8-4-2022 Wa)ID#Mw-LF02
s
Ste.�1ttll.I litatinn {t ft. :;�„ '
rLl
VENATOR tt,: fLAlK
' r
Facitiu',0r.mrriatnt. Fachih,iDo tr3pptimbic) ft rt. _
5910 Pharr Mill Rd., HARRISBURG,, NC, 28075 R ft _ r19C�€titC� rat?:?C,;!1,�Unh
Pb5z5kal,Addms.City.and Zip
CABARRUS BENTONITE FROM 6-8'
t'otttpl° Pdntet 1�itit`iClligtt Mrs,fP1A')
Sh.:4.atitudt'and l op itnde in dt re€/ininttttslsectiridso�dccimol ds �rrs: 22.OTdf A ion:.
617.elt field,#ae t ttnt u: utb,elz lul.
401
8/5/2022 p
Slg[cttur~of CC Cit CQatt:Mtat ©a4c
6.Is(Are)the Well(5): WPermaeent :or t:lTewpofary. aY n tMt Awth,l hcrebt erififi,!/url thr xr st ur+Y wtirrl cemainrtrerl in ia,danur
with W XCACOk'010.9 or.13i'XCAC 02C.02W IWII C PAOrFto0m strarArwls ernil t&W a
7.I:5 this a stpatr,to an exalting)Yell: t:]'Y6 .of MN0 tYgrcQJ tliit rECT+iYI has jiim hid xn 11u srWlms icr;
1Jahla U a tejwr.fill out buvh t 1:7ii rc+ns11ftedoll eegildb;rite Wtiffe of t(r€
repair tmder&21 mnar widen or rur the bail of rids farm:. - 13.Site diagram or additional will details:
oti tna} asa thi IxtGl:of this pNie io provide addittona►well site details or well
S :Ntttttlf�':$f°s�tllS�ns#t4trtetl:-1 �nraitiotidetalis.`'�'puiita}.alstaltlteti<h.stdditicsttal S if aaSs&�'.
Fev iitaarfrlplr iri/e�rk�ter ri(:rr•r W'Pi upl#dells O M W;A the rm a coostriwWon, "ear
sab�nir wxJnrna c.�tB1►1[:IlAle 11�c�'jC�h�
9.'Tntal*ell depth,below land:sasfatci 20 �fkj lltt Far AN WeUy..Soninit ibis forot Neilbin 3t)dots of'Corapietion of well
lrnr nvtrVpte hstls Hit 0114.r4hi Ifdioererrt(erainy+Ir-,39200`a)W 24f'MY) Construction.to tW-follt)u'frf&.. .
10.Statit+eater 1mv!below top of 4 is ngi 16 (R) Division of Water R60urtet,:Inforination pikefsinit Unit,
TJBiatar les�lls alrone rnstn�rtite"�" kill h1ai15ettittc Center.HaleiRh,IVY`27691=161?
it:Borehole diameter.8.25tONLY: In addition'to sending tic toritt to the address in
246 abbe. alto subtuit a:.+copy of ibis furor"wilbin.3t► da}3 of completion of ti+*ell
12:'Well eongroction ambod: AUGER r onstmelion to the Wowing:
tic:mtr#er:rotary',rml+tc;dim!putt etc'1
Dhiclon of Water Res6ove s.Utide otid iajeetion Control Program.
FOR NVATERUPPLY WELLS S ONLY: 1636 Man SerN l+ee Gcntcr;Rai etgly IJC.27649.1636
13n:Xield(>;pm). Method of teat zdc.For Water.Sa:jgv 4i In�Mttnn'Wei ts:
Also`swilit one cop}'of this fonri within 30 daysofcompletionof._
tkcll consoiction to the count}•health departnxitt cif itu count}°Who it
iJb:Dislaftxiian,gyx Ain(hint:,
Faun Gar-t &Glib Carafma DgKnntent of Ern tons rttt and Natural Resotirees-Division of Al°rtter RtSdtY�s Rcv kcd:Atlglnt 2i}t+