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HomeMy WebLinkAboutGW1-2022-10671_Well Construction - GW1_20221128 i WELL CONSTRUCTION RECORD Far lacmdUse:DNLY:. { Th"s farm c*W used far dfigjc ar M"Iiipk n'etls• 1.W&.Conirktor Information: IJ.--NVATEMZONPS, John Eisenman FROM to nPSCRIPTION Willcox rmctorNanlo, 4439 d4 fti NC Well Contractor C}crtifb=ionNuther 7M'OUf6RCASiNG fbi"Eultt4m4d;se[ls'ORIINER(tf.a [icabk', FROST' To ntANUMM• TFItCt{NiEsS SIAiERtAL SAEDACCO Inc Gnurpuy Nau - I&INNER CASfNG•OR-TU0ING: 6aiMi'A'cW'sciblon"ti tFROA11To DUMETER TWCK..NESS SIA2"wW 0hitivown P' ,Ti»t#; 7 ft, 2" SCH-40 PVC ft, 3,Wdf.Tjsc(shed:welt dsej: 17;SCRta':N Witter SD1ip13;glL• FROM, TAD nrAaroTPIt ST,OTSIT.F T111CICN1S5 51ATnRrar, OAg t flit.ml dMt.itiicip.'tUf!ubDic_ 7 )t. 22 IL mil 010 SCH-40 PVC 13Ge6themial(IieatinklCooliaiSig)pty) ®ltesidrinfial Water Supp13•(single) R. Olvdustrial/Conmtercial 13I1csidenfiaiWItet.Supp>S•(shamd) =38 GROUr_,.,. FROST: .To. HATERtAL. EMPLACESIMT810MODAAhtomr Odlri aeon' 0 [t.. 3 ft, Portland Pour No WaterSupply«eil: ft. .. . . ft, 59Monitankg QRecm c1y [n tenon Welt; ft. MI l314iinlfcf Rcctlarge ClGtoutidil ttcr i(enrctlitlt ati.. ",MSANOIGRAveLTACrcV0 +llobtel" - -._-' FROAI 1 To _ - MATMA_r.• -PIIpI.ACF:11vsv murIInn. 17A(piMuStoragc and Rccdyirq ❑Salinity04tid, 5 ft. 22 fG Sand;. #2 OArjn}fciTest ❑5ivimst iter Rr,`istagc ❑Eigrciimcutal TCC'I la L7Sltbsidencc:Cdigrt l 20.DRILLINGIOG7nftucfi idditiotial sficets7f ncnssniti} L7Gwrilnud(ClrisedLonp} . OTrarer. FliOht TO DtsertmrlQN[w>3r,hartlnea.l,rWmcrr n.1>�tki ElGeodiemiaUffleadng+CaolingRetuln [30tkr.(explain under-#2IRemaiks i.Date*611 s).Canlpletetl: 11-1-22 .,Weft i D#MW-4R ft. ft, iiL Well G'icaturdi tt, f4 Mills Cleaners ft,• ft �T �1 Pi, vy,�:N�lJttii PaciTlty,'Otvncr7Jtuoc - Fact7itptI)�V(ifspp)ivable}, R:. ft. ,' a� � � 1305 Skyway Dr., Monroe, NC, 2811Q fb fl I, 01 rsid: itdd ass City_and?'P 32r Rti61ARK$ Union Bent onite seal from 3-;5 Cotituy Nttel itt_I,liRpliou No;(PN) gn; atihidc aril II rangltada in ifcgi ceQlminut 1.csJsci dnd�ai dcciliatl.di ccs: 22:Certification :• {it+roll treid,wr 1,udotiF iK Sulrekrd) - - - 1V `V f ' : __ -. _--- _11/6/2022 . SigmWma 6:Is(;ire)We:11'ell(s}: $Permanent or ❑Tempairary 11x ri[,ir,RIM�j4t,a4v I du;„ r'a �.� izmslrucred Ar;Ccrorr&mcr WIN lS xatC k-1.;,+ti.'-i s,tr}: iCAZOA{YrllCn,raltrrtolwiSramfaata,rrufimra 7.Gthlrtarelia(cfuas6isting`velh 17Vc+ iir IbNq, cajipofrlurreronPhrrstm�nprnutkdro�lri stti:l7mrrirr. if Ims:it a r emir,fill un krrinidi veIf ovkrnfedon lrrjgrrnaflini an-if 6p(Wn Me mrure of drc { reliclrn,PeYb'21:remarks:seCliur7prfMAmbimkofAivfgrm -23r Site dltil;ranloraddltioual,well,detaik YCill[1L1}miss i k.back of 6s'paw ta:ploride-additiotial ivd site.detaiis:or tseli 8.NutnherofWells eottstrncted: 1 copsuucdolt detnits, You imV itLS6'ailaclt additional pages if trecessaly. For inalrlpde lr�eeiliy,i or nrut-tttrier supFrly�vells.4i1 GY tidrli rhi}.srtnre enrrstnrcriar,•yeu,uur ' submit nnc Jomr: 5Si1111[iTTaL:iNST[TC.TiONQ 9:'><b,tsil Will depth Ii Ed land Wrfa& 22 (ft.} •2Ia .Fbr All tVls Silbinit lliis fnnn within 30 Oys of edutpleti6d or Ivell For rrealrtptc icrldslrst adl drpahs iJctf(f frrat Pesan,rfe-3@20•arulMP7r11 construction to the foltoning, I0.Static xutc'1�•i'el below top of casiRt* ((1) Ui�'ision of�dllter Re�nurcea,Infarrnrttioh Pfpielsitig Unit, ljmier hvex is above cdsltrg iiie-+" IGl7 mail.Sdvice Ieedier,RaIdgli,NC-27699-1617 I1.ittirchotc diameter 6" (ia.) 14b.Fnr pi ern Wetle ONLY, !in addi[ion to sendilig the fomr to ilia address itt 242'`ab&e;also submit a copy df ibis form 1t-[thiii 30-dacs'of completion of wdu 12.-Well construction metbod:Air eolutnretlan to tlis foil vfivn ! • (i:c.augci:rola�}',cnbl�.dimct prsslt cf,;:} 0.11'fyiott of Water.Rescurecs,puderground fajectivn Caatrol.Progratu, FOR WATER SUPPLY WELiS ONLY.' 16361 li Scrcice+Ginter,Raleigh,NC 276,99-1636 13.4-Vfdd 24r,.For Water.Sakiilg&1n�i0ti.Wells: (fit}�n) it(If Also subnik.0nr'coP3' of t6istonii 1iitbin'16da3�sofcottipletionof 13b:Dislnfatetinn.t3Tie: Amouat• =11:corianlction to the county health deparupr;nt of the coimiy Inhere constgicted. FdnuGR'-L NorlhCamltnafLparimcm.ofEudrommm and Natural Resources-Dlvisl000kWate�Realrcm - R&IsedAugust2013 f