GW1-2023-02458_Well Construction - GW1_20230404

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Feb 1619 05:43p CiearwaterWell Drilling • 82$-622-i241 ' P.1
WELL C
O!N¢'!l'�itFCTIUN RECORD!GW-11 (�Far lnteimar$ae t5nry:
1. ell*intrados information: (}
W J 4 WAt 7d1N136
pp 'ra nastturtwtl
welt Canada Moe rR D.
ia
Nc Well O nttsettn CetkCetiea Weber �16 OUTER CASING gOr wrerlcllt (ittl 1
ale cd- - We-u tin „o • � �A �
r
to
fiL
I.
Pvc
Glalpaloy NNP4 - 0 L( kit)
INNER LING OR p ci iron pop) ___Au
J
��4 ` 1'�► DgOf
z.win coalttrsetioR remit& � � . � in.
idrt rill agt/tllmhle crlhmtuntetlonpetmUr(Le.INC C01440:Srafn YaNaarec eta:j'. -
!t '
3.Well line(check trdl use): - _ - - 1
"4 17.SCRMIN
Waters KO Weil: p TO _MAlmttr�rt ' SA TttrRla0:111 TQRiA6-
A icukur l • ;a unlcipoi/Pubile 0 tt e. b.
GoothcmtSl(HeitingiCa diimSupply) •T. ' -. ,-,dal WON SWOP(single) ft. {s. in.
Induakial/Co axial .11 Residential Water Supply(shared) teem, �� A ¢otrt�rcpNr±�rrslttr�t DbAlrintlnn
irrigation ��Y
Non Witter Supply Well: l tt-a t) !ti, �? 1 11�
Monitoring CIRccmery O. fr.
njecao111Vcil: m R
Aquifer Recharge CiQrontrdwatcrltcmcdislinn "it SAVD/GRAVRL PACK
(t( Ike ranniaan
we
Aquifer Storage and Rococo, fl.Salinity Bon ier "now TO Ii7A
AquiferTtst DStrrmwnterDrainage _ ft. .1
Experimental Teeltnoloay aSubsidence Control ft. R.
Geothermal(Closed Loop) D'Ilracet 20()Blank WO W atb
elelnikarnat(rteatinpjVooUng Rsmm) nOdter(explain ondcr#21 Remarks) yam TO p r vain nto aw►
A.date Wants)Completed: 2-2 23WelI'DP ( f tr.
werrirtreanna: �jS`(�X�t� SYIlLp C11 y` f, 1� 1 . ____,
1 n ;,) . •rLm ,
FaeildsiNtsertram �I��iFs
Fad*Inil(ifappiic*bie) 0. it, •
Mo.ur .t ewe. �.l rit.ov i i. ,� L .T .__
1 t1 Aitken%My,end7rp 1 - -."'.
AR •
t .
aW Parcel idandilealion Pio P _
5b.Wltitudanal longitude in degtealmimiterfsecouds&decimaldegre� In;G;� ' � 9"' t
(ir'wa11lictd.ota !SisIminMert) Li ,�'v') a
65` 31 \OD 31 83 b • Ili w x� ear
6.Marie)the wdt(s) PempnxM or ©17'sariloTery Sign orC if-rod tud1Catrawor Dare
Sp 91078 NNr forte,t hetrhytamr fy chit Or weir(s4 was(Worm)t otwisu yt in o hardener
7-In Ut is a repair-to an existing well: Dyes or WIYo with ISA!CAC 42t:.0100 orISA NCAC 02C 4WD Weil Coartrxrxkngreit ardemat that it
Mho ixarspafr.,fPaarbtawn well maximum hearmmtoramutrtprptn the WNW(Pk enpye.(thisreehtr!/ro 4ersiPhw agint1Y:Wl1'Iwetz
molt ender 421 ream&serjMt tract Mc hake MIR fora. 23.Site diagram or adtlifklm!Weil daffida:
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ft.For GeoprohdjpT or Cl rip Gedieraa!Wells having the same You may use the bnek.of Ibis page to provide addiliaoal well Lie derails or well
canciltuctian,only I GW-1 is needed. 1'ndlisate TOTAL NUMBER of was construction details. You tgayalsa Mitch allint nal pages Iftteeessety.
drilled! SLIDMITTAL.INKTRUrMONS
Total will depth halal/lent Salo= - 0S7. (°) 244 y'or All WM: Submit this Aunt tiilUun 30 days of completion of well FarnalUprc wea,'Pia oUdepr/at ifdfferam reramp/a-302Qtrmtd 20100') construction to the following:.
le.Stade water level below top of usage •. (ft) Division of Water Resources,loibrmatlan Processing Unit,
fjsnrcrrturd lr Rhos caning me p t` 1617 Mail 3arviee Center,Malik NC 27499-1611
1 i_Bon:holedrsaeter: {1./�� (la) • 24b.Pnr Ialectioq)Wens- in addition to sending the fort to the addrot in ZM
12'WWall eolultesetian mmethod:. 1�''^ �!,
'( Q/�.-� above.also Submit one copy of tub form within 30 days of completion of well
consl ndxidm to the following ,
(te.ange-,realty.cable.throatpink.ate.)
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I Division of Writer Resources'Undergiound Walton Control Program.
FOR WATER S1;PPLit WEI38 ONLY: n � l� 1636 Map Service Center,Ra .NC 276994636
I3a.Yield(gpm) Metlwd of test: /`— ` 24r.liar Waler Sonain&imieetlon Mlle to addition to minding the Item to
the edduss(es) above,also submit one copy of Ibis fotrn wdhin 30 days of
rib.Disinfection type: . ,Amount: -- completion of well consttudaion to the county health department of the county
Mime conalracted.
sameGW-i North Carolina Daportmoatoft:n+9ruindi lQuality.-DivisionofWautritasaares Rembea222d016

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Wall Driller Seifut Cordfication
Owner: New Well:
Addreac aIA)
Penult S ISSt,0
I certify that the above referenced well w grouted in appearance,in accordance with
all County Well rules.
wen Driller_Vlex Mea d L91w
Certificate*: Z 1k?7 7* _ Date Grouted 2_- -4 .-2,3
Construction: Grout
Total Depih; OS `i'Yp e
Caging : P\e--- Thickness: YY1t to C'1 - . _
Depth:Casing , q D
ter
: ( B -
Drive Shoe:
GPM: S