GW1-2022-09185_Well Construction - GW1_20220930

WELL CONSTRUCTION RECORD ForlrtcnNilarONl.l':
This Win can be used for single or twiltipk wdis
I
1.Well Contractor Information:
tJ.N'A7£R 7oNE5
John Eiseaman _F_R4)_%i­_T_t17 IarsCRtPnv�
Well C'olttracaa Name tt. A.
(1. `
4439 ft. I
NC\\tcli CommaorCcnifrcation Numbci 15.OUTER CASi G for anult4ca4ird sells OR L{NER Nis livable
FRONT TO MAaiT.TFR Tit/('FNF.SS MATFRtAL
SAEDACCO Inc h, h.
l:on palu%Nana 16 INNER CASING OR 9IJYR!NU!)21he rmaf elowdaimp
yFRON TO M.s1tFTFK Ttll('ti\t¢S ROTRt.1L
2.Well Construction Permit K: 0 ft. 32 ft. 2 u> SCE40 PVC
lot at.,rlyllirahb•%dt primil,(ix.Ctaolfn.Gave.1'ariatwe,11yerticn c1r.i
3.Well Use(check well usc): t7:sCRiKN
WaterSuppty Well: FROM I TO atANIKTER SLOTS17.F. I lnt('KS I MATERIAL
1 lAgticullurll i INfunicipalAlttblic th. 42 fr. 2 in• .010 (SCE40CIGeothemrd lHeatinSlCoolinw Supply) OResidential Water Supph•(single) t• fa in.
iDiodustriaUConlnlciciarl i Ikesidcntial%ViterSupply(sivired) OUT To MATr.Rtit. I eMPtAcIBtExTMmtooA.vNtor+r
❑kri vtion 25 ft. 0 (L Portland iPour
Non- ater Supply Well:
®Afonitoring ORccovcn• d
inject on Well: tr. tL I
ClAquifcr Recharge DGtniindii iter Rentediition 19.SANDW VEL PACK of u ilkable
YRONt 110 MATrAtAl' BMPlall\tEYTmiTtN)a
❑AquiferSiornFc and Rccovcn• OSalinityRanier 1 42 ft. 29 G. Sand #2
0AquifcrTest OStortmvtcrlhainngc
nEVcrimcnial Technology nSuhsideacc Control
DR '
❑Cnottrcmial(Closed Lon)) OTracer FROM TO aF.S("RIPTIO�tiubr,hwldnc«.vtA'n,'R h ,vats ,eir.i
❑Geothennal(11catinelCoolim Return) DOther(cs lain under 021 Remarks) 0 (1. 10 (1. 1 Silt/sand/clay
10 ft. 42 It. PWR
J.Date Well(al Conglletcil: 8-5-22 Will ID#MW-200
► ft. ff.
58.(Fell Location: It. h. f (( f
Y.zx,9 Yy,. �..w,i .%..
Facilits,)0i+rcr Name Facility ID-f 6farplicible) �F_PA —2
293 NC-740 Badin, NC 28009 Stanly County. . err n' tL G,;
r Inf�c,�r ,i ,-r Unii
Plivsical Addrrsa City.and lip 2t REMARKS .J 'r r.v
bentonite seal from 29-25ft
Counh Mrrer 1tletdtl'tCttiun No tPi.\1
5h.Latitude and longitude in dcgrces/minutesfsecnnds or decimal dt't;r ces: 22.Certification:
N ��' 8/12/2022
t)atc .
6.is(arc)the isetl(s): EPerinanent or OTcmlmran -+'u .i?�. �w ->'c<—o
ire xgnirg this.fun. •.d•' sr., .:a.,vs t..r::!:"'Pvsrnvled or rer<irdrmrc
t,ilh t M AVAC Off(' •.;�-.+ �'t. (,::�, .«l .+12(Y 11i47 Cwlslt tr•i(m St t/AwAlr<rn.i Akv n
7.6 this a repair to an existing well: _ves or EINO rre...Vhas th.o?prlw#110 t rn the trrll.ta'ncv.
/f lldt Is 0 f4pdr,fill t €l2m'Vt 6 rl t'nas7tn!r'In Ntf tra47dv+t t»d r-t7+G'tlq r)Je lutrra.'ref rile
.Astir rn drr 6.I nmarA.t t'rrn� or an thr hrs:E r.l this farm. 23.Site diagram or additional well details:
You may'use the back of this page,to provide additional%veil site details or well
S.Number of wells construmd: 1 colutruciion details. You i y also attach additional p igvs if nevessan.
A,#n11r1414r ittieC riP11 Ot nfkt-wmer vjwp.i trelh/):SLY with dor some roturrardmi,u:a emt
taiwurarr f,�t.m. SUKIMIJECAL INCTI]MONS
9.Total well depth hctost land surface: 42 (ft.) 24a. For All %Veils: Submit this form within 30 days of compictiou of dell
Fnv mndilth•t,efh list«fl,lePWI i;rltf,i•rtvu/arnmplP- 712-0'Y nt47 zG!10y) construction to ft following;
10.Static crater level below top of casing: (ft.) Division of Wster Resources,Information Processing Unit.
If turret level iv ahm-c rashes'.am-"»" 1617 Mail Service Center,Raleigh,N('276994617
11.Borehole diameter-10/6 (in.) 24h. for lLf%XI(;iq%Vcllc ON{.Y: .fn addition to sending the form to the addict in
24aabove. also submit a copy of this form within cp days of completion of well
12.Well con.str action method: HSA/AIR Construction to llte following:
6c.aug:r.rotary.cable,direct push.ctc.I
Division of Water Resources.Underground Injection Control Ptugraor,
FOR WATER SL:PPLV WELLS ONLY: 1636 Mail Service Canter,Raleigh.jNC.276"4636
lac.For Water SupplyA InFectionil ot,
13a.Yield(gpml Atcthnd of test: 1
Also submit one copy- of this form ivithin 30 daysofcompletionof
13b.Disinfection ty Amount: well constriction to the courtly licaIhit depann►cnt of the comity w hcrc
constmcicd
Form G\V-t North Catohtu D7 pannicat of Ein nonnrcnt and Natural Rcsomccs-Dh-ion of\\'atcr Resources Raised August?)1.1