GW1--06363_Well Construction - GW1_20241025

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WELL CONSTRUCTION RECORD - FarlriostlaluscFiNLY; ,
This-form casrbcuscdfatsiTigtegr.tnultiglaicclls. .
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1.,VW'c11:(4itfrietOEInforutatioic - -
:1-4AVATEt ZONES
Rich Lereire GIIWi•• TO . . DEC9CIUPtlON' . '
Well cor tiictor Ratite - R. - ft,. . . l
2593A ' ff, ff
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KC-Well .'=15;OUTER.CASD1G'ttul'riiiiitIkiii 18;ii rtsIVR DIER-fitiiiAieabkJ% - •
•V OM ' TO '- TLt6icrrit; ' InaticKCSS, MATERIAL • -
SAEDACCO • .. . . ft.• ft. . . 1' in: •
Chruyhvly ltynti $16'INNEFir.AS1T G`ORiT77611$1G40,00ei'rc$'c1d i1,40 t --
6ROM' . To DIAMETER - THICKNESS. SrATERIAL
• • .2:WYc11 Con'tl'DCtion Pctnukt#. • 0 'ft.. 20, -ft; 2 -ig. SCH40 ' PVC
f4gfili Ti;i 1c 40 p.R'nei.'YYrC..Cmfnn::S?R.r,'Yariairee.Infa0't*Ur,.:] • ft tt►
3 WVc11_t3 g(chcsl.Weil use) ci i st RILLN
Water-Simply Well:: - .tHIYI . • .-..Tt) • -:1MA11ETER SOTSIM , III ECtt1EtS .1 MATERIAL
- -20 R. 30 -.ft; "2 'ili ' ,010' • SCH40 , PVC
llAgfcitIntrat, Ci ignicipalTliblic•
®Ge'otltemial.aleating/Coalin Supply). DResitleottial Water Supply tsinle) ff, ft.: :tit:
. DlhidustriaUCottuttercial ORcsidknual WaterSuppb•(timed) t9::GROf'' ?- ' .-'L _ _ : ;._
•FROS• • TO - MATERthL EMPLACE-M1_T•31.ETIIOD .UOtIN't .
Dlrrigatian• ' ' - 0 •ft. 16'' iti• PORTLAND TREMIE . '
NER-Water Supp-13'Welt:. - ti. ft,
. iiiMcnituring-. . • []t ccoyety , •
Iujectton.Weft' ,.ft: . -. .ft, •
• ClAQitt1Ct124fntge f3905undtriictR0tedt:ilio0-' . }19:1•SANDIGRAVELPACK0fapiiliecilile - - - .
.. . -FROM•• - . 'TO • MATERIAL HUPL.A:CE'1)rENT.W T11p»•- .
MAgni[crSiori aot1 tcco't y f7Salinify f3arncr 18 ft:. 30 -if." SAND- ; #2. -. - -
17AgttEfr:`ecst• ❑Stiitiil atcr Ota(na;e R. ft. f
O xpcdnmr-1 pl Th hnotog}'.. i7StbsidcnCe:C oninsl. -
20;>b'RTh ING'LUG:fattacli.`addilionitstrce-li'occcssars}'
t]Ctotheronl.(CLnsect-Loop} DT13cer. - . -.ER0Ni' TO DtscRIPTlONtuibr,tianlneiv.w+Thiicktfue.emir-ibe.iYG1
DQeoilteninat(Ikatingtenoligg.Retutn) t]0ther(eeplaiu under al Reloads) 0 ft. 15 - tt ORANGE' SILTYSAND
- •15 fC, 30 f.,. SAPERLITE .
4:Ditto Wek(y}'Cauipleeei1;.10-8-2024 WV M dit 0 W-7 ' ' I'
5 is Well tiicdtiicn: ft. '' `�
.. h.. ft, r ( .,'1.r, d 9'',:,L..!
JH FOSTER STORE • . .f4. f{,
Factdityotrcirler rcisef_ - ' Foetlity lDR fkapp. r:ableF . . ' • ft.- ft: 1-C T •r `= 024 - -
7147 NC-Hwy. 801,.MOCKSVILLE, 'NC,, 27028 : ' , .fta. - . ft, lr 3 ' •�'^•G:f.„'T„' 9v`3:-
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1l?7nvrr..t.., . ,
P19'001.Mdiess,city,anil Trip ;.213RE6IARKS'1, D .- 'fl..7,:.
DAVIE • BENTONITE FROM 16' TO 18'. '-
County. Po el ltk�itificA6or N0.(PIN) - - • - '
slir LLaWEtudeand 141igittide in degticeSltninut4ite. nnds'9r tlecimal deg,sea 22.CcrfitErttirt t t,
{itstulf ftitttl One l u'1w is stdliasaii} - .
. . -- •WV rre..
71, .-1' ti.-tr 10/10/2024 •
' • Si„iviiire'of.Cc V/CilCoiuractar; ',' _.. laic
6.blare)thC-srell(s):-BiPcrutallent or 17Telnporai}'.- cr NF i;Sning nYu.fotm,.1 linear• TifS.dmt..rhe 1'024)tvas.Ir rnl a{n.ytnrc•Icd it.:rrcvirkinrc '
wide'l_fI NCAC OX 01i10 or.ISet NCAC:02C 020.)Nell Consrrrirrtoit Srcvt4 r Ts ma'am";ix
7.Is tfiis. rrjiair to an ex sting O'eflit prex or Fits t pvpf Mir wad l ac grcn firm Edh'7l rn,ihe in A mriwr.
• 1Jthrs,l'a repair Jill,o i;.Cian a niff'crrru7nrcNaia llrfarauri wi timi i.'.p oJat Aie'ruttare of dic
repair riiii r elf.rcwirtrik:it t&6'or1vt:hebr•eLoffioform. 23.Sttediltgranior.idditioua1R,eUdetaiti:
'YOU nick use the back of this pageto pro►ideaddiiioiwt%sell"site details:of well
S:ilu :dieitof wells eiEnsenttitt,d: 1 • coustiuctfmi•detuits:You mag:ialso.atiacitadditional pages irt:essaty. -
Fornrril:ipklrot..alhn or non-NYI;er.supply iief3'ONLY pith il4e.tar c.oH5•frgcrloo,;.a.i 610
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su$rtt1t ono fat>a CI11114f 1 TTA1.INS PtIC PIQNS
9.1ttcut sett detitlt 11.elM•lead surfaee: 30'. • . 04 •2-la. Fur All Walk( Subiail ibis folio within 30 da}+,„of_calnptetiott oftpell-
ForsifliNiilck'ellrli=roirltkFhe ffdlfrtoir fe.wropte 3ۥ200'arirl.2@iti0') eonsthictiglh to-iliefollowing; I, ' -
10.Static water level hallow top'ofrastit}r,. 22.7 • (ft,) I1ii•i5 art of Water Rstspurie,lnformatfaa Frdees ing unit,
.Ifilatirlrv�it rawly'Orsrnt;rise'•+" 161'7 Mail.Set'viee.Cen(ernRalcighg.NC-37699-1617 .
-I1 Borchote diameter:8.25 ) 241i.Jro fiileelion Weil ONLY: h
Va.) addition to sentiiog ka fomt..to tile address-in
• 24a abose..also Wm*a;copy of this;fnntl within,30 des s;of'cotnpietion af'wlell
ta.Well eonstrntctiota Method:AUGERS 'C'dtiStnn:tlon to Elie fallowing:: • j '•
(La':xpgrr:rednry'::cabh;di ect piisi etc) j. .
lli slais;9f%Satar Retource§,Itndergruuitd Ictjeetion Control
FOR WATER.SGPPLY WVELLS ONLY:" . - 1636 Mail Service:Ce ter.Raleigh;NC 27699.1636
A3ia W Tad(�tni) tltQd itf test:_ ? :.For Watec Sap(lly_dt ltticctiaa Wells:.
Also submit one copy of this foiut)twitllai.30 day�sofcompletiottof
13U [Ii infcttiunQyh : Artisan% . lviii.cansinlction•tcE.the coilnty healthidcpaitmcnt-of the county.wIere•
. . canslnicted.
FonuOW-i t'onhCarullntDepeitlnent:ofEnvironmentaedNetunsiResources-DivisionofWaterRsati+c • RevisedAugtat'1,41A.
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