GW1--06800_Well Construction - GW1_20241114

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WELL.tONSTitUCTION.RiCORD . ForIttotnal thoDili.V.-
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This' form oast bo:oscd fOr.•,singlo(.tc.MtNilklW.Ci4.
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I.Welktniittnfor Inftiptiittlitti;• • I ,
S.11:AVATEItrZOINES'. - .,• ..'L . ' • • •
• Tyler Brown •. ... - TO. • OMiCalPtiOri . . .
06.11i4til#01;allit ' A.-
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4625-A • . ' . . J 1 •
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NC.kVcil Contractor Codification Murkier . . ,
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SAEDACCO
Conipony Nome- , ' . .
, • -418:1NNER CASIIWONT_IIELAsp_NG..
. • .. . • .,_.PRom• . le ' . DIAMETER TilICKIVESS• 51.41ERIAL - . , ,
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• 2.'N'ell•Canitr.uetiett Perna fk -• - , • .0 "' •ft, 30 • ft. 2" .. ' lit. scs-4 0 . PVC
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- • ,Lfst oft;:pyitig.114E iMI primit*(i,:k,,Cpw!ty;Sfole.;:yorigrrce,,.476r$LIAA"c1c..). .-tk, . . . . •
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iiVCII 14Pc:(001f:ill use)rt . - • ,
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- - -- - - --- -• - - - •- - FROM... .. ...10 :WA;Wenn SLOT SIZE. . IDIOM eSs TdArnaMr.
Water Supply Welli• -• ' -
- 30 ft.' 4 0 • fli 2" - li. .010'. SCH-4 0 PVC
. ' 11Agitettltuml• . . ., . Clt.loni--cipaligoblic. - " .• . .,
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1:1Giothemtal(Heating/Cooling Sapply) . 10Resickntiol Water Sunply(single) . •, Ft. v;
. ' DIndustdaliCoottitercial. C3Residcntiai..Woter Supply(sbastl)
'...1F811;Olit.-- -. T-O-7 ' •"'-'1UAT.E.-Iii .- • 't iiiTPIACE-NIP.....NTN.1E1110D,i AlS10.1...h4T
. . Oinfiatiati, • , ... 0 • 1t. 23 - it: Portland Pour
143 OD-Water$U pp tymot:.. - . . . .
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159,14opitoting . • - _ •-011c.cavety . . . • : . .
. • '• Itletinta Well:•••• , i '• " ' • . •• • . ' . . • • . . . , ..ft.:: .Hi. •• ' ': -. ' • .. • • .•
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• ' DAquifccRCefitifgt " - .bOrountlutiCt RdtnettfatiOn-." : I19',;SAND1GRAVEL,PACI0f,2.tniliiiitilvV:- --.• -. ,7-7_7._ 7-7'7:. •-.7.--:-
. - •FOONI• - TO ' ..' • .MATRRIAL . . EMPLiCrAli:Nr mrrtiOn.
. . CIAiluifiStiinfO.Mtil"..t-in*O' ;-; ,.•
12&i.liaity rattitict
. .... .. . . . .. "• 28 -. ft.. •4 0 - ft Sand: .. #2
-.. CI Ailltife F-Tq• t.. • ' . . . ...., . .,
1:11ionitiVater brlittiov:. • . . .
R. • ft. - -• ; . ' ' '
• , 1Axitctinicatal 1.7col 10 utOlogy 7qubsitiOncOtootrol: • • •
• , g20.,,DRIELINGTXVISAItocti.'additimililitiiitilf,liccissarra...•--- --• .-...-- ---_. _, • -
• tIctqpiltennal.00setfl.90.0. Crtrocer.. , . • „ :FRost - • .TO. ., DESeltiPT1014 tailor.!ninny:N.:,swIriirch Otir,.-rro.Ia'stro,kir.1 ' ,
LIGeotitenital(ileatingCtioliug•ROluttn. .1:iother( plain under#21 Reuiatis)
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4,,pi&*ott6-)'ciliniiirdibitiv.11-1-2029 .•‘,1411,iimMW-01. - • • ' ' ' • , .
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50.Well LoCation:. it See Gem'a Notes• V•••"..':-"'',- 11----,t,•.i. f..._...., . .•;
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'Former Ridgewood Furniture It. -. Ai.
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FacitilyAthuterNagio - -Facility 1Dk Of applimble) - - - - - I -. -_ - NOV-4-.4-2024 .
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• . 42 E. .Hudgins St.,.Marion, NC, 28752 ' . . • • . • . . .11,-. ft.• .. ' :* , info,-,...;-.,...,,,,-,1.1.7.7.1 ',.,'...r,..,.....5r,,z.:....?..,,;,,,„i„,,. ,•.
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-PIPIsill AO.!5',tiri.:110 Zip
McDowell . Bentonite seal from 23=28'
c•000te . , PameltitcnotiCaion Na:(PiN)
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li..•/*RV*and 14Vflitle iti 00gree-Oliti.tutelliiiiitidqr decimal deg, . 22.,certif-ttliti'oil':. I
fifiivit it-...1(.1,:oh":•Liti1a4ts'soffiCie.nn - ,''- - '' • " " •
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5/2024
iltXtd p.CcitifctfWcli VaazorI Dale
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6.Is(are)tbe.well(s): Iereritianent or -Efetittuitn4.. ' • '
i.510/4,this.jer:rm,.1 filine0y ere*.#14 1hr.irel61 war.4'14,04 cr.,r4inter54 Ili iii.sy-uhilcr
Ida'/54 JVCACOC.0/q0 or til NeetC,02C-009 11'4/C6.as-traction Sratkionfr end rim;ti
7.Is iftiS iii ile00ittu.ati4bitik;well . pYrfif- tfr KI,No , . 4.*:•.•of Mkword iskrillihq pTiiiiffd iiiiiieim ii.Mrarr, , •'.
., if apisit a riptilti'fill oat kmiviivr41corrolor,(9O,Iqfprosolloo.a:ort c.01oh.t the All[Ore of rile - ' --• '- ' I '•
ripariit&,r Ail.imiarkstlikin Or On the back di"thes fotitr. .23:S Etc.dingrantOr additional itd!details:. .
' •Yon tpay use the Pack of this"pitie to,prOvide iulthtionat•Weil site details of welt •8.Nuattherof mills coittntcted: 1 consttuction details.-You may*.alSO.attachadditfonal pages•if.utcesary.
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For itiOlrlpfiklocilon.or noilirger vpply iroi ..ONLy w,101 aje ftly. c.iyi!srructiort,;m4 CM - •.-- _
. . ialmilf.tv!i forr.i.. . - . ' - . .1$ StiBMITTA.I.INSTLICTIONS.; •
9.1otiii Itelt depth IteitarlUnd Mrifireel• , 4 0,• ", V.i„) :21a..Ptir All %‘`Iiitt Siibinii.thisj.fOrm Within ilft tiai of:cotopiefitni of Well
FOr atipk welklisr off riekthr 616iivir(toroOk-3@2W ard.2€,WO) - • eonstototton ilie.fo to llowing;: 1 . .
19.$tatie water Llevel below top of casing:. . . (ft.) lgiiiitin of Water Resonrees,Inform:ation Prdeesiing Roil, . ..
/inviter h'v'el bi-Oitoly..r.usiye we'+" - • . •1617.1%Liit.Serviee.Cetrieri Raleighi.NC.176.99-1617 '
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IL Borehole dianicter .6" lin.) 24b.for"lOicethr Wells ONLY,: In addition to.Semi*the fomt.to die.atldress-in
242A.VoVe..filsO submit a copy of this faun within.30-dais olcOnipletiOn Of.welt
12,Well eOttstettetioD;Method: Sonic •colistnietton to the following:: '1 ;
(i.c,p.t.tr.yolaii,,.c,41&;bliieci.posILF(c..) •
" • • Pi-VWifill of Water Reiou rock,Underground fttiqiion Control rragrant,
• FORMATERspipLYWELL5•ONLYf' . ,1636 Midi Servicetenier,Raleigh.-NC 27609-1636
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• tfe.For Water'Sneply&IrtjectirintWelfs: • -- • •
1.3tt,Veld Miro) • Arkthoil if test: - .
Also submit one c6ii. of this Pun:Within.30 daySOf ijoinpletion of •
/3b.fliOoft.tdoil kyllet, . Antonin: . Avell•oonsiroction-.to AM'primly healtit(16parttoint•Qt Ole etrenty wbete
. CO.nsIntetetl.
FOnu OW-1 .Nanh Cppalina Deisuritteni.of MIVIMILRICAIL apd Manual ftesoureas-Divis Ion Of WomfROcutm- Fievised Atgust2ot3L