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GW1-2023-01960_Well Construction - GW1_20230227
WELL.CONS' TRUE" ON RECORD Fortricanr W:,ONLY:. 73us form smi bc;used Ear.single ar rnnliipk nc(ts � ' L We11•C4uteactov Information: `-IdI:.%VrE1bZ0NPS- Chris Ru£fer GpOi1 T(1 hCsa ltit*t14Y U101 Ct Arsdor Now 4223-A (f• rC NC Well CootlaetorCcniftcrtiotiNwrlrer >Y5s:0[JTElt•CASING(r®i�'uiisUl ager0+tetJs'OR LINER(if a Ubk1r, - FnONl I TO - DE�IBETan TEHG'NTi `iAtEtitAL SAEDACCO Inc 0 f4 52 rt. 2" i'in. SCH-40 PVC Cnnrpuq Napie 161NNERC ' NG'O&'TIt81[dG; dberitlbFtlusiJa -• a. Fumi - TO D1;1muER I Twmmss, I SrATER1AL r:We14�CQristl•uctiun 1'oi•uiit,*: � R• tt, '' �'� . P.Ltr'tdl�pp7isablr v-alPpranafts(cc.C'nunry,:Sttr!r...lrariamcx.lRfB'0�ctr_)' , 3.'tyclt.ii'so(cl{txi:}xcll aSCJ,i -�I7:sceF:eN - _ Water SupplyWcll: FRONT• TO I DTAMETrrt I STAT517Ji I THICKI't'is -brATnRrAt, mglictdtuial- PJAi9ttniCip�1VI?nUIIC; 52 ft! 57 ft. 2�' iLi 010 SCHr90 PVC ®Geatlreiirott(Hearin oolin 5ti) ) Mesidenntial«rnttir 5u ft` ft; pply{swgle) _ MadustrillYCORMIOM al ©Residential Wnter:Supply(shared) 1tliCROT1T`_ ., :.,.,<:• :__..; ;- FAO51'. 110. HATERTAL I EMPLACLIMNThFMOD 4AMOUNT = Ellaipptian 0 ft. 48 It. .Portland Tremie Nan:-Water Su1)ply}yoll: - 6d�lottih?ring PRwovety fl. tt InJPCI-10 t Well: 14, rt.. �IAgnifer Itec6arge Udibuliilimaw lteincdiWoR I4 S 1ND1[:It iYH➢�["ACCC'(if"r tNi IGtel y "- .- -- =. •TRO1t I 1 110 1 NATMAL I [i11P]AC.tS1F:}IY',H!'rH[In l�Aijnifcr.StgrJ�C"a>ki FtcCokeW C]Si3linity 13attiCt 50 ft.: 57 ft, sand #2 [7Aqui cr7cst ❑StoctiiitR Ce"6nLn:Iga rt. •.rt. _ dEiPra"1Fnl3l Tcchnotogy. (] illb.5,&tcC CDrtttnt %211 DR[[:LTitiC•I.OG"(atta�ti adi[Itibnal sbeef.4 if=rtcessn`rc} OGeoihe nmd(gakd Loop) bTrdcer. FROM -70" PENC tIPTt0:1 wlor.hortluca"ev�kr+ctt x: n�r�tk i O,Gmthettnal ftatin 'Cool ttgRetwn) OOdwr(explaittunder021 Remaiksl ty, ri !• r- „T ;, r.4 LJ 4. Detc 1-24-2023 WeiIII#C-5-D-R. .. ft, See GBq!3 Notes 54;JVdl Lticathid . ft. ft Chemours rl< tt Irl; rw,�#t�sT Prz=, ' Un't facilit},4lnoerNsrrac Factliy II)k{iCapplicable). ft. R, 14011 NC-210, Roseboro,,NC, 28382 R., rt•. Plry§icid:Addicss Ciq•_a A Zip 21 tiEM1tAltiC$' Cumberland Bentonite seal form 48-50'; replacement well I County Yarcd 1Jk_uGffim0ouNo:(-M) 6 iuitcgseimiitucslsceodrdechildges, 0d n 22.Ccrtitration: (ita I:uoL' is gt'Acjj4) l; I, 34.8636267 11 -078.5391507 NV _Chris. Rufferd, 1/24/2023 SigLaat nfCcaTUnd WellCa.mractur`' DOC- 6.Te(iu'L:1 tbe=il'e11QS}t,10perlllanen! oc �TetnpOYut•�' - �..�c„inh ttl�';�;m..l hrrrby rrfrifr thry dl�tir!1(5•J krtr(wry)cWrrsrtnrclevl(n,uexmrrfirticr • ibith`15;t aYC,1C 03C•dllik7 or 1 sd NCi1C f12C:e7:Pf)l}'riJ Corrslrrn•ifar SraLx(a_rds�rrirf rlxer a 7.lS this a r+ejltti r fu ad eiiitinginih 01'er Or " Min ii rnf Afar�erorrl ltrrb beers liri"r&lcal rir ilra 5rt:17 merirr. {f r&.h a rx fxrlr,fill qrt kr A4j ter!l vrurrustlo-A l,rfom ardrn arrtrl�aptabt the rrrrrare of the itirrair rerrrlrr d+21"rivnark,si�rirma aPim Av.UtuS of ehir forme. -23:Site.du►grant or additional will det dN: - , Yian i lay use Ali bacR bf this page,tm')arovid'eaddilional tcell site detailsrori"sell 8.Nuatherof ivolis coustettcted: 1 corlsuuction let Ills.•You in3c aLho attacTraddidonajnates if tieeessaly_ FOP lltnldlplC h(lfCdlDJL i"imNI-iL'drer supply nep ONLY 11-10f dio.sama Z-17 a@A-u 'a t cam sdjam$one jomr: . . S[1BAIITTAL RVSTUC`,__ .Total Fell deplli lieloic land 5tir(neu 57 (CL) •24%.Far Ali Yells Sulintil Ws farm"willmi 30 days of completive'of Well ¢orm1t1V&we11s list all dep*i(fdi*rsmr(csrtrnnfF-.i©200'arti.2GP171Y) c0n5thicdoat0hefollowingg; 10.Static linter level Uelow four of easing: j[f,) Division of Water Re_oti_ree3,Infitrniatian Processing Unit, Pf nv?er level l irba'm edsiq lire••+" 1617 Alatl.Si:n•icc Center,Mciglt,NC 2 7 659-16 17 11,Borehole diameter.6 (in) 2ah.Fiir Uij lan WON ONLY' in addition t0 Sealing the form to the address in 24a abdre.also subtitit a•cony'of this fonit ivittiiil 3,0 da};s'of completion of W& 12.Well cousiruction inetbod: Sonic Lro»stluetlo►1 to the foft6witig! (�e.3u;cy rLk�1}•,cnhler direct pLrslt;etc:) 1; + _ DlvisloitaY�Y.ttcrltesunrccS,IInrIct'gtound fuJection Control.Progrant, FOR WATER SUPPLY'WELLS ONLY 1636 Mail Service C enter,Raleigh,NK 2,76994636 13a,Vidd(gliin) Met11o41 of test 14c.For Water Supply.4c In cction Wet19:. Also Submit al 'Copy of this f6hii iritbitt 30,days of coropletioii.of 13b.DisinfLVtion,4,1•pL..-_-_- ---- _.. _ Armunat:_ _ wctl canstnaction to ft County ficai.th deportment of tits mio,where _ - - - — rnnstrltctod. FurTnG1V-L hnn9tComltnaticpannu�tra.orEaiiaatuucruamdNaurr3lItasaurees-DltM000fR'atc Resatnws Rcvbcd August 2013