GW1-2021-00440_Well Construction - GW1_20210201

Jones, Brent
Ffam: juiie register <[e-mail]>
Sent Thursday,January 28,2021 9:25 AM
TO: Jones, Brent
Subject RE:TERRY GEARHEART WELL
d?N SII?Edti'7Xr4,1!a t.t a s-rtttgcrtox RFC-ORD
North Carolina PepnnmfrK of F.ariwrrvecrat and Nxia ld Resources-Division of b ater t?uali1L
^Y WFIA CONTRAC7011itCERTiFLCATIO\ff 2314A
1.WELL CONTRACTOR: :d,TOP OF CASING IS-1-rj FT.Above Lard Surface
1��1V IQ L R �7t$TER 'fag of Cos"terrtgna"athrr bmax'and surface may rettutre
Well Contractor(tndivldu*Name a variance in accordance with 15A NCAC 2C R116.
l rt�TERWEt,:t<GO INC. ;a.rip(opm- KsfODOFTMtAE
Well Conitadar Company Name .1. DISINFECTION.TyPQ mJ: nt 07
1 WEST I iARITY ROAQ
Street Addrass txATER 2DNES{depstnp.
HILL NC 28458 Tom, satronr_ Tes_ __ __eoen_� _
City or Town State Code :Tqw Batorn Too Bohan_ - -
9t 1 Q r 289-317 :Tao f — Top,...... .,mouorn
Area code Phan number ThIck"imat
T.WELL INFORMATION: :7.CASING: Depth Dtamotsr Waignt Nlatortal
WELL CONSTRUCTION PERM1TaPW 24-10QW :T-OR-0__BatmmJ-6—Ft-, — -0- ,ey-c;-,,,_
OTHER ASSOCIATED PERIAfTe(ff applicable). :Top -soft—--^^--Ft-
tLortorn__
' SITE WELL Ip flit applcalrtc) -top -
3.WELL USE(Chock One Box)Monitoring 0 MwtiSIPa11ttiafrfiCk.3 =ft.GROUT Depth Ata'wial Method
tandusmaircrxr+merciatt;i Agriarihrrat Recovery fniectfpn; '.Toa-Q .__.Batom�Q,,,_.,,•.rt-HQ1 a Pt 1RFD
irrigationl►f Other fi>(90 use) ;Top —Bc'4Mat—FL�,,—
DATE DRILLED 71202
4.WELL LOCATION. ;S.SCREEN; Depth Oteencter Sias Sias Material
FR{)G IrFVEL Rom¢ :Top _B-arn, 96 FI.4 +n. _b76 ln. py '
(Sheet Name.trumEe/e„Comrwaty.Subgivislcm..iAt Ne.,PlrcCr.Zip inxlei :.Tap.,,,,,, ,an—
CITY:WINTERVIL cotwTY PITS Top Bettom FL in. I
TOPOGRAPHIC I LAND SETTING:(check apsropi we W4
LSfope OValtey GfFiat MRldge IJ0ftr__ 1tR SPAMIGRAVVILPACK.
^OMSOR iV35.530541 00 = DOpB' Sba Material
LATIT uoE 2 — 'Too !ttettom t0—FL#2_ ..CB YEL—_�_
LONGITUDE 7r _"DMS OR V1fzz.441451 DD T�
LaMude'bngbudesource: WPS 01opographiemap ;Top liotbrn Ft
(bcer+ian of tecomast be anotMr on a USGS lops map arxlarfocherf fo -
this hwm it rtof using CPS) ;11.DR ING LOG
6.FACILITY(Name of the business where the weft is located.) TW Bc6am Formation Description f
x Faality Name Farifidy=(I appScabio) „20 1,.30.�,,. ( -f� M 1
30 _t as AI'!t2 8 CLAY G .;
tAdde ss ,t`
Striae 0 ISO— CLAY
NC D J SNE"a .�' a. \r 17
City or Town State Zip code - P 7fl i?4CK 12" iL t
TERRY nogg ART 70 ('sg
Contact Name �J RACK r v'
d�42 C FVEI ROAD
Mailing Addm$$
WINTFRVt!i F NC_ 2135At) !
City or Town State 7.ir Cede 12 tiEOaARit8:
Area code Pnona number
6•WELL DETAILS: :crr ECE ry rrtwar r xltoxw�tu3 5;RrC{ n+fifi a+ra x Tn
�5rraGa+.-"t:nt:La CCxaSTR':�4=Ff3!w SiF+u^lARt1e.ANs�'rw✓_4tAGiwm"f G�'7ts5
a.TOTAL DEPTH:.
b. DOES WELL.REPLACE EXISTING WELL? Yes") NO
SIG`8A-tMEOFCVRTWIEDWELL 60INTRACTOR 1 DATEL
o.WATER LEVEL Boron Top of Casks: FT. }UL-- EMAIRTFIR.
(Use'-'it Abe"Tap of Casing) :PIZ D NAME OF PERSON CON51 RUCTING THE WELL
ForSubmit within 30 days of completion to;Division of Water QuafitgF- Information P ing, Rev.2M
1917 Mail Service Comer,Raleigh,NC 27699-1 Fr1,Phone.,4910)SOT-S DD