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GW1-2022-10670_Well Construction - GW1_20221128
i I•VELL CONSTRUCTION-RECORD . Far t��i try orTiv.. y j 56fanncasi.Uo`asAW..tingleormuliipkwcUr,- ` I 1.�F_elt.Cauirlctoc Lef_o_rmation: I 1' ' iMAVATHFMQNES John Eisenman Bn061': TO OE$CRIPtiitN 1�'ellCatxraparl\7sr�: Q. ft. 4439 NC Well CbMmciarCcrfl&itiionMarker 15 OtITFRCe4$f11G'ttoy:niuTllciicU'rscLTsl'ORfiNEti'!tf tlenGlcl'•- --. FROM 'TO D1A5tETER' THiChMNS ' MAMIAL SAEDACCO Inc Caugruy�Nandr t6siNNERCASiNG'ORTL�BING r�erttie'inutrkirwil-too"�„.:• __. FROM -70 Di METER THTC"MESS' HATERTAL 2.we lrconsttTiction l ralit tri 0 ft, 7 ft, 2" ;'tl� SCH-40 PVC Lief tilt nMAirAle;rOpr,rm"16 i:r,.ibun[y,Stoll.Va da"Ve.1*a:gjerr-J• ®® ; 3.'WdtMsc(kitecicWd)oac) t7:Sa RAN W3terSupply•.W41l: a FRONT.. TO `61AMETHR SLOT'917% TtiIMMS VNIATMAL ©eLgT(ctiliulal fJNfiitucipaUPttblic. 7 rt 17 ff. 21, in .016 SCH-40 PVC 13Ge61hcnua1(IleatifieCooliog'Solrply Y ®Itesid'eiltial`Pater 5uppb'(single) ®Fudvslti:tUConmtcrcial ©Resideufial Water:Sbpp1y(sh;1wd)' B82 GROiJT: FROST- Al . M TERLq%k E,TPLACENIENT NIMOD&Ah1otNT OhApation . 0 'Yt•'' 3 ft. Portland Pour ATori=Wttc.'i°Sutiply�VeOf: - ' Edl4tanhitipg � i7liccp�ci}. (t; " ft Infection Nell: �rtntlifctitss6arge'. Mdrobiidaatcrl#enlcdiatiou ,�192S1 NDIC.RILVELPACR'ii(' iiilic bti�l=- - - -, - - s•Ri)Hr -•TO - nrarrstaL Ra1P1,nC1wlE�r yE-rnnn . l;lAgltcfcr.Slotagc and Rccacciy QSalinity 8'lrricr 5 R: 17 ft. sand #2 ❑AgaIfc Tcst 175totitiwatcrllril. fG. ff. []Fzncritncnhal Tcchnci[o •. L75ttbsfd^ncC Central ':0°`nRILLVNG LOG"fatiach4MIiboal beets if-neccssars} 'G;o't tennal('Closed Loop) Mrdcer sltoar TO DF5eRlanvN*lwbal,wncr:u+Itnrtk n trrartul t7 wthennat(HeatinelCoollug Retutn) bOther,(explafu udderA21 Retuat6s) I tt.. 4. 4.Datc Wetl(w otiiplele& 11-1-22 FYeIIID#MW-2R t r �D a �• �,R . 5a;WcOI Gi�atfiin"i. ; f4, ;. NOV 2 8 202Z . Mills Cleaners iL tl Fa ility.t]nusrNasac ROR I'M�1(4ptf.*a- c! . D r �- DIA4�DOG 1305 Skyway Dr., Monroe, NC, 28110 (t.= A. I Pigs(it1:c11idiess City_ naZiP. e2L.REAMIUCS Union Bentonite seal from'3-51, I Cu"My 1'arccl Wilor=tlou Np..MIN) ili;lGatitudcanil I�ingftitilc in ilcoruhui�lutcslke'..,ls ai decimal dcgiccs: 22 Oer¢ifec:ltionr' (Jrivell t"t�CW:One 4it114ng fK suln>rieril) . _11/6/2022.. 6.Is(aie) EPennanent or n'Cetnporui}' ��.�t•�•n� ! `fa • �a H}'xleririi rFi3 jut;: .•r��•f:C.iifu h: ✓,•.n :a�(cur•t.ce:�i lvr M,,eid in�rxrOrrlRnC-e lath:isA."koiC 7�.Xze -i7.02p 7 well Colullw Briar Somide*w d Mffra 7.b fl&s a mojie fu as bdstfn);N1'eik ®Yeti .t►r Olin cajT.ofdrrr iicdnl Mris In err Timr'irkd r'n�i'r.sn l!rnrri4 r. fjrhls.fs d rYlxrlr,fill r�r+hrriret well rausriucrlao lrrjarrnnflr'n 411td ekPtgGi rli�!rurrnre of flee i re�rnlr ruriler�21:remarLs s Arun ar itn rhrLrirL pjrl�ir jeruc 12&Stte l�iR -ant or additional welt.detilll-V: Ybu pray Use_&flack of this page to'°proride adtGGonal�cc11 site detafls.or*ti I(. 8.Nutuherof(Fells construeted: 1 constmetiou iletra You(nay iris((alla-Ch additional pages if ne essFuy- Fer rirnlriplG irl(e erlr,'n ornar-utirer supply'u-elis ONLY irUh Me.Same eon5tnrMi0u,}+a i Vern submit one jorm:: SCTD11117TTAL D&iTCT(0Nq -9:Tiitdtitch'dOplll baton-'land-airfttee 17 (ft.) 24a .Ror A.It «'cllaf sul ntil 011,s fann%vilhin 30 hays of e6inpleti6n['of'tr'e11 Fornrailrlpleic4lts'listrrlld4prhs7Jdljfrre'iulexRm�fe-7@�?{at1°dr�,i.2msl(br), een5(niCtrOntotl►cColionioar- ' � ' r 104 Static ivater.lael below top of casiup ((t.), Division of Water It ourtes,Infi►rmutian Processing Unit, ljn4irer legef-b aLoee edsfr rise"+" 1G1714Ltit.Sixpice Ccntcr,Mcigh,NC-27699-1611 114 Itorchofe diameter.6 im) 24b.roe rtileetlgo Ailb ONLY., 'In addition to sending Ilse fomvto the address in -24a`ab6W also s0rhit a-copy'of this faith`vi'ilwl 30-days'of completion of hell 12.7ekIconsmciion method:Air consiiuc.fao to,the follo%ibt - l (te.anger,salary:cn6l :discit posts,cro.} 01y(s(oit of Water•Resources,Qndergrouitd itij ac tt ControY.Progrant, FOR WATER SUPPLY`YELLS ONLY-' I636 RLziI Service! ter.IivleWi,YC 27639=1636 t3a,Yicld'(ggim) 24c.,For Water Supply.Ye Init'cttttn'.NVMS.. 41Tct1igil of test: Also subltnt o copy of this foltn witbin 36:iloSsafcot11p1elioRof 13b:Disinfcetfaa,tyrle Amount: '%cc1l constnictfon to the county health"dctiartmrnl of rite coitnh•wWm- - constgict�t. FunuGW-t ttonhCamllnaE)ep�i> u,afFlmjiunnxnta�134�tnrslRasourcas-Diviskoolll'alc�ftewutts Rctised�tt�uit ll3. i ! II i.