GW1--06364_Well Construction - GW1_20241025

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• . . WELL tONSTttUCtION.RECORD \6\ For,triscpai,us411i.X.,- • . . . ..
'This'fa.ttn Qui bc..esofi ref singla cl,t tneltipla walh., - '
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• 11..Welt(4hit•iiitiiirlitformatiOu:• . -
• s MU-AUK-ZONES' ' . '...i...-.
Rich Letaire . FROM' I /0 . ettiCktPutri
WO tOV4ra,c.iorf4Ong - ft.... ' - • ft4. • • .1
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2593A
ft.* ft. f '
NC.Wall Conharter Catifwatiait Nuirhei - ,OUTEItCA-S.LNG'ffa:i• sietriVetisVORTANER-fit•aii ith':-ab.W_ •_ _
-FRONY 1 10 ' VIADIETEIC ' . ITOICRNERS' - MATERIAL
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- SAEDACCO - • , ...ft..' • . ft, 1 .1a. . "
O .:,f4',.,,INNER'CASfXd•-•.(lft fi/B.INILMa.".3the'rthiat cleidifoill9,2' - ,- . ..-"" • •
mi-ial.nt:Nan*. .
.FROM . TO DIAMETER• THICKNESS- MATERIAL
2;iVelt Ottittittitbip fitili th • .0 it, 20 ' ••R. 2 - i •',IIL SCH40 PVC - • .
14.0 41i i(it-gge t?*11 0614.14 fhk.,,Coun,ty,i-S4thr.;.Vorigisv..IlYaliell,, c) '
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3.'Well.t.t.se(eiieckw,iil use); . 7etW;SC,'RKEN." .
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Water$Upply Wel8' ' - - - •• . — ' •FROM,- - 'AO . : etaatF,Test"'.'SLOTSIZE. . 1111C100S5 .1 mArolit-Ar, .• •
20 ft. 30 •- ft: 2 'iff.: • .910 SCH40 PVC
ClAgrtcalpttat; .014tinicipaliPoblie. •
173Geotheuital illeatingeCooting•SoNlyt OResideetiat Water Supply.{stogie) . • 4, 1 ,
,Itc,-GRotrr,- - -,---• -.._-_-....-•-;4,-i- - .-,--.--,-1,., • - -._•-- -,.-,.,- _. - •-
Clfildusitial/Ckaputercial
DR4sidcfitiat W°t"'SlipplY(stiiiml) '":•FRON1 '''''TO--• - - -'Mt.ATERiAL, - -Ert'IPLA.' CE-7,N-I-LNTMETI- 10D-st--.A-.51-0CDIT '
:1:11rdpation. • • .. 0 ft,. 16 i.4• PORTLAND TREMIE
14•ItHI,Wo.ter Stippty Welt:. ' ' . •
0,14clitor1pg' . • ingc.cPY.c.IY • • • ,, .
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Itijectliot Wett.i.• . ..ft, . ft: • :
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0 Aquiferike4 fititgO oQsotoUtigiter katedltitioit'• . ..-it9::'SAN1IG10.V.E1.1•PACk'ilf;a0plteafiteV:----7- 7,-..-", -
.. - .. - . ..--- _• ..... .... • ,.. • ROM• . .TO ' .' ' NTATERIAl... ENIPLACIAIENT MEMOD .
III Alliifct 80410444 I.4.4.1.'.0 13S-tlinliv Wittier 18 ft, 30 • ft.• SAND ir . #2
CI A40ii:C1-.Tc6t.• 0$1611411-titrf Pi4 tliia&` .
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i;l4FPORIcIttln7c4!!!10•910' ill8itbsidCwotolPRH, • ' - ,.&
40.11RituttNalliOaiitheti'additiodoriliiititioectssorW'' ''''-=----"---•::.. ' -7----7-'
, Ogg:3kt*.(C.I.asedLpay) CITtacer , . ' ..tmost• • .TO. DESCRIPTION(ctilor.haitituaiotal6kk Dvc-,:ofit't'iSti.k-R0 .
• tlCuMbential.tHeatingtootiOgRetmOt. : l:lOtber(eotplaiii under.fa 1•Reusatks) • 0 ' ft., 15 • 8, ORANGE SILTYSAND •
15 ft:. 30 • ft, SAPERLITE •
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4.;Diitd wicsy coniiildied:.10-8-2024 -kirdi m#mff-6 . . .
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. . ;77.;4"r"--,,---' 5"-''•---, e 7-,
. Siti Wit LtiC49P:.. . .ft,. . -ri, : , 6 •;i.L.-C,..,0 C:•7; '44 .L)
JII FOSTER STORE " it. . ft; .
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.,_ .. .. • • aCn-1-2- 2.02,ityxi *,..,-. - - . . tookytaveica,10410 •• .
.ft. fl: '. .
7147 NC Hwy. 801 , MOCKSVILLE„ NC, 27028 ft
. - . ; r., ' . . • Irit...-Y. :4'.F...,2 mt,-4.7.-4'.;•,-7..t U•icA•s• .Ili: •
1100:r.q sc;.c1,3:-0-14i0 -?ItriltEhlARKS!-', • . V.:IN:I. •
DAVIE - BENTONITE FROM 16' TO 18'. '
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paatay• , - • . . t`,4tr.g3 Id run No.(PIN) , . . . . .• . .i . .
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I.,:4titiA40:ailfd f..Otigttodetit de;reedpiiiture4iSetiiiiils'o-r,deciinalitcrec•k: 2.2:ccritifkatioin • 1 - .
(ft'Welt field,:ono hAfIciliUltitfakii} . i
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-I- 04::.. ....0),....4......e.._ . 10/10/2024
-51seatt„arafe4'etti ....W.all'Cantiaattif
6.I.4larey the u'ellOrt.10Peririanetit or.• Erreiiiptitaky'.. . fh:,ttnitig Mit.ji.frT,.1 feirOyerf*y!big.11*iregy)ts-var.Nr.tr)-tx,i,rayinirte4 its rtiwpitkace
torn:FM.?CAC 112C.pipo or/.54 NC,3C'q2C-:0209 Weil.C6niireiiithir Skindareii-(intrgxtio
7,IsithtS af-riliati to-UO*4084;Well.• . pires-.or P2..lio coii!'r of rilii irconi 1:6!Nen prrpiidril fir WUawn
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if tfris is o r'epirfr.:0..i-xi;,Otoiskt ii:tiTcokonitl(trea.ipilioroviial twit 410in ihe ripire of ri)e
repikfriiirdir*21.ianarki slum or im iheival:of'this farm. 23.Sttediagratit oe:n888044 Well detaitst
• YOO May use the bact,t of this ili0,0"-provide additional'well'se di.igii*.•0;well
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8.Nucttherolmilli coo-Strudel!: 1 coustme.thleiatis. You ipayt,so atiaelt additiOnit pages-if is:cc-ism, •
Form illrOplOtkeallyi or non-water•supply to1.40,1,1 with rfje.Frri. consrrardlort,yortearo. •
itibmitesni form. .
9.twat Weititepth bet6W-latitt sorra-I:et''• 30 . ' • Of) Sfa.,Per AU 'Welk:, Siihniil this fornt WitbOt 30 4Oli-xi(cOloPtclio of'%*!1
For iatillialet4'ffi'fiirrdirktghs:iMijfererir(o.kimpfe-3€,200'.anti.2@l190'). COnstivcOgn to the...foltaising:: 1:
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.1u.staat water let below top'of-eashig: 22.7 • (IL) Diii4ti-u of Water Resotireis,Infornuition Prdeesibig Trait,
tivio'hy level ti;t1tot!e tiostog.aso...4-.. 161:7 lifalt.Servie.tettier;Raleighit4C 17659-16 17
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it,BOrehote diameter:8•g 3 PM 2411Y.FLir ritielafoo'4Vgllts ONLY: In addition to sending the fomt..to.itioaddress in
liaziNvO..also submit a copy of this fano within 30.days of"completion of DO
12,Welt construction titetkod;AUGERS tOtIMifict(gh to ilie folloWing:: 1,•
ii.C;•qtogcr.r6tiuri,.F.. :.q1A641itedriti,isel.
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pavkitittof Water fosourre•s,'Uodirgrotiitil fujerfion.coutrOl-PrOgram,
FORAVATERSUPPLVWELLOONI.W• - • • li636 kill Service- eider,Raleigh;NC-27699-1636 '
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• f3:0,VirldlgtiM) - NfCfiKttl.Cf test . .
Also siitinitt bite bapy of thig'fditti2Withitt.30 dayS Of 4oluidetion of.,
.138.Diiinfeetion type. . . . Amount:. welt.consiroditin to II='c'ecnO:.itc:iith ite'paroncia.of(tic comity.whets
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' ' , conslOigto.d. * 1
-' ForinGW4 Non!!Cqtallaa Ekpanatent.ofEtrunannrat apd Natural Hasa:arcs-Dtvisice of Mier ROtarcm ffeOsed Apsyst:101:
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