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HomeMy WebLinkAboutGW1-2023-01963_Well Construction - GW1_20230227 W4�LL CONSTRUCTION RECORD Far Itstcrnal4fsc. " T'his form can bo rlscd.tor.singis ter tnultipk ncQs' ��/ 0 I , , I ; 1.Weti-OntrnetocInforn(adou:_ 14-AMATEEMONFs' Chris Ruffer FROM YO iiR.SCRIP11ON 1011cottitrmtorName. 4223-A NC Well ContmciorCcrtift®tionNuwhex ^15i:0[C[ERCASING'4tai}miitilra4e�Q�i'eQsl'ORLiNER'(Ifa"tkable FROM TO DIAMETER IMCKNENS' htATERIAL SAEDACCO Inc 0 (G 33 (L' Ti 'tat. SCH-40 PVC . . (onsglroay Naaa -I6 JIMER'tASING't]R 1IJHBN as ai6errtl d'ediseitdn(i' .` _ 'FRONT- I TO I DL METER. I T1RCKNF.SS ..v 51ATERIAL 2:Wclq"Conirtr•µcti+in Pei•titit#: R, tt, j, "b� litl all nppiliru6le urHprnmi�fir..L'Hann+.'Sttr:ar..lraria+xr.It�ecriret er�J 3:Wcli iisa{chccl r�cll uiScl: 47.SCREEN Watcr Supliky Wdh FROM- TO WAAMTF;R SLOT817Y -MICKNESS I MATERIAL rJAgtfcultural [i11•ftiuidipaUPublic. 33 ftt- 43 'ff. 2" ip .010 SCH-46 PVC Meotttermal(Heming(Cooliag Supply). Mesf6ft taf Water sup*(single)' ft. fG: its, ®hidaseriallCoRmtercial ®ResidzuialWater-SttPpl}'(slxited) 18.GROU1'[._-., FROM'. TO. ltATERUL 4 EMPLAMMTAWHIOD&AMOUNT OkTi Rion 0 't(, 29 ft, Portland pump 9 au-AVMonkt Injecilon WCII' rG rG IaAgatfcrRcctiargc. l7(;wu6d4-,acr•I(einodiatiou {ts:SANoIGk�Vi?L'1'Ac[t7lfa'a'111ia1atet~ 4. 'FRO\r TO "IMURTAT, 6:toP1AC.t:{t�;NT51L'rn0ta l7Agnifcr.SiQragc anj kcctiyc4' 13silinity Baicicf. 31 R, 43 ft. Filter Sand #2 ❑Aqt tfet Test• Q5t9irrinatcr I}taina�c ❑�yTerimcnlal 7c hnaWgy f75nhsidcipcc.0 orNtpt ' - -,211:DR[CtiNG'I:OG7alhcd`adaQtio�eiil'shcets lfncccsstirvl OGeoelmcll(ClasedLoop) .OTrdcer FRoat TO ®tGRtPnoY(wleatinaaUuen.�t,wamrc a,�t�tictat E16,oiltenual(Readge/CooilugRetuin) OOtlter(explain under:.121-Reminks) I 4.Dete Wells)CAuIIiI ICd: 1-17-23 WMWOW-57 ft. r4 11 a 5d;Hrc11-Gicrthm: 9'i`^ See Gpp s notedG Chemours Fricilily,`On•txrNnrtic Facpiij•II)k'('it`applicnble) i L R. R,• I Inform alo" 22828 NC-87, Fayetteville, t.NC, 28306 tG', a ax - t'1g3icnfAddiss Cit}'_aixlzip �zt:RlnuFe[fS'• Cumberland Bentonite chips from 29-31' t'uuuly' Marc]1tl•_nlirb:fWon No;(Ph-4) S6',•I.iltifadcanil'fgngitndaindc�rce�/minutcslsceondsnrdcsifiutlJcgn�ccs: 21Ccrtiffication: titoell flp:d,cite 1:1001 g Js•salnCicaat) N .v Chris. Buffer;, 1/20/2023 Sigti�tv4c ofCentficd Well Ccnirtctdr j Wit: 6.Is(Ake)thetvell(s); MPenrianeRt oc OTenyoraiy Mr rlcllins,!liar fliarr,_11weby eerll�v Mar the ivell(!_)I%wy(4rmj eanilme-led hr;!YLY'9fY16RJGC 4 5A A16C QTC.O100 or JSA kk Ok k720 ll ell CnrcsfrTredwt Srann'ards anB Axrr a 7.Ta this:t r eji lit fa an czistin„p'cli:, OWN or ®Nq r i ofrhGr tor". 1141 en P1z ridrd r,stir w11 m,6 r, rhe.wrare of the rh1S.(t 0 7e�kTJr.fast GC1P i.71011711t C1J C?71f717M71Jf,1 h�JiJrf1N'f1Pn a7nI C.{j7laJJr reilufr rmJer821:remar%xs rrima at t:the hard-of tlalr fOrn4. 23:SEte 11lugCRnt Or additional will tlehtils: You play use the back of flits Pa.,ge to-prov'ide'sddilional well site details.or tress S.Nuittberof wells con;tmeted: 1 constriction deiai(s; You rote}•also'aftacli udditionaf pages if ne6e'ssaty. For'lfatlfrl lelr�e flora.*rnrui=+�earersupply'+vd(1sON4Ywirli rlis+.snmeeoirstrurlFnrr,,yanate - sebnilroric foam: SUBMITTAL RNSTILICTIONQ 2:Tofal*ell depth licloii land sti 6_- 43 ((i,) •jdb For All Wills.' Sirhinit this form%vilhiti 30 dsp;of CdiHp1cfi6d'of'tirlt For)frofrlptcimis list alldeprksijdiffervia(excrn+l+fe-9@a20D'mul.e49717b) cian5(nrCdOntolltCtgi[ai�lun; .1.0.Static%ater_16el,below tap ofcasiilgt' {ll(,) Wvisian of Water R'o Trots,InforufatipnFrpeessing Unit,,iawlaP trred Js aliora eaa(e� USC"+" 1017&Ia l$mice Center,Raleigh,NC27649-1617 I 11,Borehole diameter.6" (tr) 21b.Lam i`jam oti We is ONLY. In anion to sending the fort to ilia addms in 2#aWi v also submit a.copy of flits forin wiiiiin JO"days'of..complction of Wdll 12:.Wclhconstractioumethod:Roto-sonic cronsiiuetioutiatliefollotiin>; 1 ' (Lc.3uscr,pftgy.cublt:'&W lursb-etc:y Dlylsioa of Watgr.Resourecs,Undergrgund Injecdon Coutrol Prograui, FOR WATER SUPPLY NVELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13»,Yicld'(giim) <Ietli4d of test: 24c.l;nr Water Supply&rue-OLiR,Welts:. Also submit'one'eopy of this f ii tsithiu•3Q.daj's of couipletion of . 131t.flislntiYtion.type Amuuat: wc16 coustnictiQit.to the county Ucalth dcpartmrnt of`tEtc,cailiily tyiicte constructed. no OW-t Nonh6mltia Depatlme avrEmiromocni and\Tararel Rciamecs-Dh irlon of 1Yafcr�Remtrw devised Ally>St'I1113 ti i-