GW1-2022-09770_Well Construction - GW1_20221027

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WELL CONsTRucrION RLCORD Fasrtttlr5t9tl�n t�^.
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1.im iContrantar Mormations
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SAEDACCO Inc
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2.Well Construction Permit : ft. tt; tu.
latt5�3a{r�{ire&IrtiziA{.nnzit f�c.Casrnn_itna*,t'nriercre fJt Srh:1 hL
3.WOO Use(cb"-well ore I,
L4 tcrSupplt�@df� rni}'+i TO Y orau1Ktr -tart�ti> 11trCtkx �rart�t�►t.
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00004henral(Heatin Coolitth Stq,)ply) 131kesideutaal Water Supply'(siu9lc)
Oludustttiall0mltntetcial OlkesideutiatWaterSugpty-(SlsMa 'ts 4ra(cR r► cc�t `t rent mon A iannrr
FR13:4! 't4 ,
❑Yeti ►ion 0 h. 28 (L Portland C e-ie
Nsrw'Water°Supply Well-.
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l lr4rlttlfst Reciutrgc G3Gtouadraatcr t;a nt€dittitur
t� Alvflut. � ;flat<rca
vua'<t tt trsrrr;rrtsr; �et.�c�ur-vt�ar-rRran ,�
p Aquifer 5terupandRecovaly 05alilnit4 Harries 31 ft. 44 ff, Filter Sand #2
C1Agari1.LrTcst 175t+7rmezatcrt?r:aia{a t ft. ft.
❑i VCdoicutal Tvchnolog [75yth &-r11Cc Comml 3t1 ARIt<T fltiCrl tattxf`aaF aa.;;; 4i( c rit ! ? -
MswtheutW(Clased Loup! ❑Tij= FRONT TO DIN CEWTug tcour,trmtrnt viAltwk Ao&
, n ire ttr a
�Geartltanrtah()heatia *1Coolip;,Regan) 37 dwrwVl�unnnder ?@Renunks-) o 67 ft : See Geologist's log
ft. ft.
4.Date W1.41(s)Coulplt 10: 9/22/22 Welt I DdOW-15
5a.ATCB Locatieln: % .. ..t4
Chemoura
Farititl OYacrNamx Farilih IBP(ii Vpl�: 10 (, fa.
1248 Sill Hall Rd., White Oak, NC, 28399 ft (l
Plnsical4.dirm City.nadbp 2i'fE11(� -x
Sentonite: 44-67'
Cumberland �J?"©1:
C taa lr Panel ltl azUtu tl9uzy No,(PIN!
3b.Laeihrde and t vattlitude In rle !>raeirrtrtcfisseuirds or decimal degrem 22.C,ertiftratlaen;
rirt.r:)t a�td;Harz I;tttlpaas�is���cie�t .,c�..
W ,� 10/11/2022
Sig uaum orCenif�^r9 W eat CauE ar pa e
6.is fare)the wen(s): Mpermanent or 07ernporary k rgni3tg AIV four,f t4enb}israfti tka, f e ttwflfs!I,=ftwwj tamime-fed itr arCgr'nnce
rEl:s2tieNC,dt t7. fir? r! taYCt rl3e.t2siii74tePdCn!estraeticut&ar marts zttrddams
7.I,S this ItrepairtoanCBi,dirt WCM EIVCS Or MNtl dz��4f{flffP+fa3fl�flrtr{y.=td{ltt7y1fo-41�'tt#Jh1;It}f(rn'nSP.
ffrhis is rt txrer,B1f matmr+na nrff i naar7t3rcric7rt.ufturz rf+c+r ata f<_cspPaT'F rler rrrtrr of for
rr{+�ir rFartfer d�f rr.nurts a�tiur:ur�r ttu:bcrt oP tflis furnL 23.5lte diagram or add'ilintntl well.details:
You tuay use the back of this page to provi&-additional well site Mils of well
S.Number of wells constructed: 1 -- __ a�carstaua tlonitzrails. You auay'a6o dtaclt a ldiliutaal p4 if rxv;essaty.
sa6mix ft� e!? e rh:rr cr fir t nzrear iarr,rdfs O,V'Lt'vefe{t rbs trtrr: euustrarrlovr,vns c<a SITBMI(f,AL(NS 7('I r-UQN
szi{�'nzlt rmc fur..?.
9.'D'o(stl well depth below landsur4'aw 67 -- tft.) 24a. (s'tar All ftlig: Submit this form within?i}days of C4Dinpktion of well
F.,rues{W,pk yetis Hsr a tkptk:€ 302(k)'Nut-Mot!'} conSgruction to O c foltoNVing;
10.Static%vats r level below top of cashw. (ft.) Oh-ision of Water Ruauree&Information Processing Unit,
ff latrtc#..k€l ct t rn a curia..Zoe" 1617 SUH.Stn'i&Center,Raicirit,..VC 27699-1 617
1 L Barchoe diametm 4" do} 24b.Ernes,tla+r W&jh ONE V. In addition to sendingrct the Pot tj ttt address itr
14aabove.also suln it a copy of this funrt Withirt 34&aYs Of Cotrnlletialn Of welt
IL Wcll aft Avetion anrthod.Roto-sonic cwasenx-tfon to the following.
;io.ata sr mmly,cahttdired push.eml Division o€%'ater Resources,Underground Injestiort Control l"roVaw,
FOR WATER SUPPLY WELLS ONLY: 1636 Malt Service Ceatter.Rate►f h,NC 276994636
method of trsR 23c.For Water SOB&&Ipjc�Ykm Welts:
13a.Viddfgpw) Also submit one ,AVS of this farm within 30 days of Completion of
fl3lr Iticla€�xKion '. w. Amount: teeth comunwrian to tic caua;v tic iith department of the r4aunry where
' cOntraz ted
FattuCOY-t IvmtraCrsalteratkpar3nsnrn!E 'ic rmtienram1�aaur'I(t¢maucs=Dttzsioaof1j'alerR ruv� Revis.^dArgarst 01A
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