GW1-2022-08813_Well Construction - GW1_20220909

WELL iCONSrt`RUMON RECORD Farl,�rntalt)soclNllf:
'rnfsformcmbe umd&y sirgleorr3tta wel1r,
1.Wd!Contractor Intbr matlon:
WAzo
Robert Miller TRH pisit fttt'fiilR
ft. ft.
V�`cltCotmnaetorifainr
R. f�
2675-A
Ne W01 CannaerorCanif=tlos Nuither 15.°AItTER" l�tG f'tYR' " 19t9lk
rxo:+r To nc��Tee TnrCrCk�Ss rr.►tEatkt,
0 IL. 38 ft. 211 le. Sch-40 PW
SAEDACCO Inc
Cr M;Wly Name neon TO MILMETER 1 TBr
2.WCU Construction ftITAt A': ft`
Lda allafflumbir uvtrperm.(ts(Lr..cowaf:.swr.Voriorwe.I/Yaceen en-.1 f f b4
3.Well Vw(ckdt well ttsc}; 17..E ... s: rt,
till
WattrSnpply Wes: YR01t. Tb DIA1i�tR y LUl flcrrt !+tAt 1 t
DAgricultutal DMmlicipallPubiic 38 ft. 48 ft, 2-1 hL 010 Sch-40 PVC
DGcothen"Mcaling/Cbolirg Supply) ®Residential Water Surly(single)
ffr fL m.
Olndusui lucomulcrcia) ❑liesidetttial'Water Supply{skated) FROM 170 MATERUL gars r 1rf�Trnm&AIMJOIINr
❑hTi n h* tt.
Non-Water Supply Well: ,
�Monitodn Oltrxot fC, ft.
!*—,ct tt wen:
f Aquifer ftbargc Ot3rRurmdcs:ttcr lterrtcdiafiml tI„ I,, ACtc',it"
FROM irtwt trm�tsitr�r .r..rwn'
MAgttifer.5torAgcandltACatr'et3' ❑Salii►ityfarrier 36 t, 48 ft. Filter Sand #2
❑Aquifer Test ❑Stornmrttcr DMMge N, ft.
❑J=Vcdmcnt01 Tbchnatogy OSubs1rknzcC9w mt iK:fs G: $ttufi ""ttt. ""4fii
❑Geothenuat(CidsedLoop) ❑?'racer YADJr .70 D"CR :bard i�>krrleYc Ot....t,,i.
❑G5oikmtd tReati " Return) ❑Other in mider#21 Remarks) tL ft: See geo r s log
fL (L
4.Daie Wetl(s)Cbmpleted-! 8/23/22 Well1l)#EP-2 ft. IL
Sm..Well Lacntlrin: ttr fL
Wilkes County Landfill - Eller Property
Fxil jvjV%,wr Nuw fxcitity iDl(if trppiicabie)
9219 Elkin Hwy. Roaring River, NC, 28669
f tn-siW Addrzss City-adM Ztp y� R J
Wilkes Bentonite seal from 34 'to 36ft.
Cstnoty Pared laerifi ds;tdou No.MM
ib.t4ititude ond-Ungitude in degr ccOminatestsecands or decimal degrees: 22.C m
(ituen CeCM,Ow>, 1oegis arrrficicrd)
N �. 8/30/2022
Slgrramrc of c.... _ . E r-Y 12.4c
6.U 1pre)tine we1l(A): OI'CMAnent or ZTemporary rh argnin Arb AM14 1 hereby ergo#Thar 1hr Uwa(s)ears ny'")Imsmremd in&wonGmrr
wart f fA AFCAC 03C.01M or I SA NCAC 02C:020 Wrfl t omometkin&erwrds gVid 00:a
7.Lstitiz to repair to an tsistindaell: OY*p or MNn fOf1FO�7111�rPk97fy1)dl7C lKfv!(lMrukd rnt��+r((m��rr.
ljrafs dre rrorr6r.fll arrratlrrnvn wale ararrrarrhm drrjaroaarfno anal rxr?Peln rfif aurrarr of t1M 23.Site diagram or additional well details;
!r�lriru arr;vicrb3l mnnrka src7cmr an w!t1�rlaxk njtlus farrrc
You may use thin Back of this page 20 provide additional well site details or well
8.Number of lavib constructed: i eonstraetian details; You ff also attach additional pages if tMemly.
For maMple frd'fcYhm or afal-water 140d'""Wilt ONLY narA rile area camvffedmm.,vac cm SUBbiTTAiK_�T1IC170NC
aUbmif eme.,lino.
9.Total well depth be m land surface 48 ( .) Oda, For Ali Wdh: Subndt Ws form within 30 days of Campletion of Well
For mid.0 r1r KIr Its afar all rlrptfas fldW'errxt(example-I@200'and 2@ 100) Construction 16 rile fottowi ns:
10.Static water level below top ofcasin8: tt1.) DIV61on of Water Resourm,information Processing Unit.
1Jnwlt s,leiv!is atiote rxtahag 1617 Atarl Service Center,R210eh,114 276')94617
i 1,BorcWmtc dittmctcr:8.25 (in.) 24b Esrr In om�1rella.ONLV, In addition to sending the form to Sire address in
24a abovv. aiso gAmi# a copy of this faun Ritbin 10 days of Completion of writ
IL W dl cMlrTtstion method: BSA romttuction to the followinz
tic.car.rater},cable,dirm push Mi Division of Water Resources.Yndergmund bjeWon Control Program,
FOR WATER SiTP@LY R'ELiS ONLY, 1636 Atari SenicelCenter,Raleigh,ANC 176"-1636
i3a f kfd tgpm) 1►IaKhod of Lcet• 2,te.For Water Sn►21Y&Injection Wells:
Also submit one copy of this f+ann within 30 days of co"49efion of
tab.Disinfection t*�m: __ Amount:
,well canstnrction to the county;health depantimtnrt of the count+when:
coded,
Form CaSV-t Monk C'amlu a DMsma cat of£mnoluuetu and Naft"Rewurres-Dit•rsion atWstar fterom Rcviud Aq�M V13