GW1-2022-09186_Well Construction - GW1_20220930

WELL CONsrRUCTION RECORD For hicnuitU-CONLY:
This foamcan be used for sinrk or nuthiplc wdis
1.Well Contractor Information:
tl.WATER ZONES
John Eisenman I FROM to ormvPttON
%Veil Corttrtrun Manic ti• tt• i
fl, ft.
4439
NC Well Comrtcior-Ccnification Nontcr 0111,1 T-IR CASING(formuttPessid 4-05)OR L11�FR N'a llcabk
FRosi so mANttTFR Tine FEss �t.+ttelni,
SAEDACCO Inc ft, ft.
I
CAngrnn-Nana lti INHtt CA5INC.OR 7l?B[l�G eoiAcrmal tlusid loop)
1 FROM TO pL�NtFTF.R T}Il('t�\ESS MAIT.RLf.L
2.Well Canstructinn Permit 9: 0 h. 31 tt. 2 u► SCt340 PVC
Gpr nil rlyhrrohh•rrrll pertri.i(i.e.Count:',Sare,Voriontq/rveriM1 eir.) -
fl.
3.Well lice(check well usc): i7.tit RFtSN
Water Supply%Yell:
+ FROM 1 TO DIAAIVTFR ;1.0VK I>1 TmcKsf s I MATERIAL
ClAgricydtural Oktunicip:il:1'ttblic 31 tI. 41 p. 2 ire OSO I SCH40 PVC
t IGeothema d(HcatinglCooting Supph) 01tesidential�l altcr Supph•(single) ft. ft. iti.
0IndustriaUC:onunercial OResidential Witer Supply is wed) 18.GROUT i
FROM 1 TO 1 MATFRLAI. I ENIPIACOIFNT NIFTHOD A AMOUNT
❑irri ation 24 ft. 0 ft. Portland Pour
Non-%Stater Supply Well:
®htonitorin ORccoyen
injcrtlan%Yell: ft. n.
QAquifcr Recharge 00mundwatcr Rcowdimion '_19.SANWGRAVEL PACK(if tl(cahle
FROM TO I %1,TrHt%I. P.MPLAUFAWNT%0-1`6t91)
DAquifer Storage and Rcco%vn• OSalinin-Harder 141 ft. 28 A. I Sand #2
DAgnifer Test OSc ;
DEwcrmcna l'ccMtoto(n OSuhsidocc Control „DRAf,tU. \G LOG atitt.
M addltios
'
al axefi if ncc4mmn:
❑G.wthemul(Cltrsed Loop) C)Traicm FROM TO DESCRIPTIO\'tinbr.hrttdrw. ar+illn kitpe. oa.wrcw.I
DGeothennal(11catioe-Cooliue Rcium) DOther(explain under#21 Reularks) 0 ft. 10 fr. Silt/sand/clay
10 it. 41 t1. PWR
4,pate%Well(sl Completed: 8-5-22 Well IpdMN-201
ft. ft.
5a.'AMI Location:
facili»iCr+'nr Nanlc Facility iD>'firtppli:7nlc) ��'� ft. t1.
FP n
293 NC-740 Badin, NC 28009 Stanly County, , p, ft. -
2022
Pin si td Addr.^ss.Cit .and Zip 31.t2E1NAR1►ti it vi r,i R!i
bentonite seal from 28-24ft .>:JQv V
Coanb Parcel ILknlfftC:ttintiNo.tP1N4
Sb.Latitude and IAmgitudc in d gm-csiminute_c/scomils or decimal dcXnrxc: 22.Certification:
6f'%%clt fiw1d,ow lal'Iowg ix%tdfkww)
N %%' �� -� 8/12/2022
St intur,of i r Date
6.Is(am)the wCQ(S): x1Pernanent or oTemliorary Hr sitnit. r!-vy fon..`'�r1 f •. tf. .. � 1.irG<✓I.u4rbnr)rrl in rszcralrrnrc
j.1.r t...`...
o-ahi5AA ACIfX dt7Ntnit
7.Ls this a repair to an existing well: DVcs (or ENti rr�+�t rhii tt rash hr...ln•.�pnirid+.;m iM ,rvl!as^nr r.
!f fhi't it ft tf p4r r(li.far (arrnn+sill ferrb7th 7i'.rtr Art rnfy7fifm tota r-t'(dohl the nJwgi'r f tilt^ -
rrldtir-ttrulrr 921 r,tnodcs.+r-iao or cm the hf.4-k of?his fnnr. 23.Site diagram or additional well details:
You may use fire back of this page:lo provide additional well site details or well
S.Number of wells constructed- 1 cuusttuaion details. You men also attach additiolcd pages if ui tessan'.
l'LOt mtrlt/`tint ilj(rtiiPli fur n1Nr-n'rrtt't f)gtlhrti n'rth nvl.}'with thin Mtut to°srruelhl+4 t-aai e<rr)
+..unit furr farm- S'UBMIYJAL INS7•UMONS
9.Total well depth bclow land surface: 41 (ff.) 24a. For All Well,: Subnut this,fonn within 30 days of completiou of well
For rttal7iple n'etlt!w rtfl dep)hc ij rltfi rroq(.:+tvnplt•7G?ik?'ut¢120 1!X)•r construction to the following:
10.Static water keel below top of casing: (Pt.) Division of Water Resonnes,Information Prucessing Unit.
!f mint level ii ahr•re rmfog,oar-"+" 1617 bail So-vice f.Cnter,Raleigh,NC 27699-1617
11.Borelmiediameter:l0/6 (in.) 24b.For itljl on Well cONIL.V: ;lo addition to sending Il1e form to the addum in
24a above. also submit a cop} of this form within 10 days of completion of well
12.Wcil construction method: HSA/AIR coustmction to the following:
fix.anger.rotas.c-iblc,dirca push.cic.t
pir•lston of Water Resources,lindct'gt'tirnd Injection ContrN Prr►grarn,
FOR WATER SUPPL%'WELLS ONLY: 1636 Mail Sen•ice Ce i nter.Raleigh,NC 276rr)-1636
t3a }'field(gp►m) �letfind of test 24c.For Water Supply A InjcetiortJwells:
Also submit one colo, of this futm within .10 days of conrplelion of
13b.Di.infation type:, •:n_ „ Amount _V- -„ es'cll coustmction to the counh' lre:+lth department of the couniv cylicrr
consinicictl
i
Fonu OW-1 North Catolau i -1xinnicnt of Eu+uau mot and Natural Rewuiccs-Div i:hm of\t'atcr Rr otrces RC%tsed august Mr 13