GW1--04161_Well Construction - GW1_20230623

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WELL CONSTRUCTION RECORD
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For internal lise ONLY:
This‘forth Ceti tmused for single or multiple wells• _
I.Weil;COntrt tetor•Infitrrnation:
,l t.r.WATER ZONES ' '
Stefan Smith FROM TO DF-SCRIPTION
Well CorRraelor Name.: • rt. - It. I I
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ft. ft. I
• 3576A
NC Well Contractor CertiftebtioRNatiiSei ,IS.OUTER CASING(for toullt-eistilW-eilst OR LINER t if lOppiablel
FROM TO I DIAMETER.1 .- THICKNESS litATERTAL 1
SAEDACCO Inc
0 ft. 23 ft. 1" • in. SCR-40 PVC
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Coatimay.Name. 16.INNER CASING OR TVISING-(geotheratal closed-looity •
'.:FROM i.TO DIAMETER THICKNESS MATERIAL .
2.Writ CDIIME116.911 IielinH ii:WM0301280 -ft, '. 11. l'hi.
.c..ist oil vpilfrabir v.-rli prim:n.4(Eq..Cawrity..•Sare...1'arietire,4161.-ecel e,f.n)'
ft- II, ..11.,;.
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3.Well„13,§e.(e6ecleVell use):
WaferSupply Well: .." FRoNt I TO I numitETER slot SIZE I TIIICKNKSS I.MATRRIAI.
23 IL. 33 6: 1" in. '.(iio SCR-48 PVC
0Agricultural. Ohdonielpal/Public
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OGeothemtal(Heating/Cooling Stipply) 0ikesidential WaterIt. in.Supply(single) 1
18.GROUT.
0 IndustirialiCortunercial I:Residential-Water Supply(shared) .
FRom - 10 MATERIAL EMPLACEMENT METHOD&AMOUNT
El/rite:400n ft.
Nott-Water Supply Well: .
rt.
libhiglifto,ripg. 1:11itccpycw -, . . 1
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Injectitto Weit:',
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0:AatiffcrItechargO EIGrottoeltMict-Rentodiation. IS SAN n/GRAvri PACK(if'optic:031W ,
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•FRONI• I'TO ' MATE:MAL c FM PIACTMENT SIETHOII
9A.4111(4-8*11,46ai4lk0014' ElSalinityl3cirtier ft.
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0 Aqui(erTeit ' ...P$10iriliv.liwtO*Iilf0:
'ft:. it.
•DE4crinicrdul,Tcclmolog, OStibsidenccCorttrol.
'20:DRILLING LOG initneh additional Sheets'if necessaryl
Elcr*Itratal(cluaetI,Ioop). OTraqer, FROM 4 I.T0 OKSCRIPTION toonr.II:mulct+.siallnick ti k.:P*.iffrizt;ctm
EIGei.•AlienitaItHeatine,roolitte Ream}, CiOther i' eplain tinder 0.2.11:Retoarks) ° ,It 1 14 ft. Silty clay
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14 It., 27 ft. Silt
-I:Date Well4cottipleted: 4/25/23 ',Well.ID#WW-5 • 27 '4..i;' 33 ft. sandy silt ,
:,3',Welt Locatiani. .ft.: ft, -,- --.i-,t,'r:PC..-:L- V t-- '
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Ferti Technologies It. It. ,
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FaciftiffnvnerNinK • flualitylD,;.'(ifajtpli0.00., •
111 McNess Rd., Statesville, NC, 28677 4!.. R.
Inkcir.... .tc'A 13 roc..5,14-:e--g
Flpilfdi:.i.ti.f-Y-7*clii;' -'1.REMARKS
Iredell . Temp well installed-thru DPT rods.
Gnaw plimel IA.:306080c No,(PIN) '
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56.14tinide'anil 1.iiiiititte in degreeS/tnintitoSi*O:P4 iir'.dc011iM lOR1*- .22..certifielitilui:,
(11,41,liCld;one-jaHlotig-ia'stifileI.:10) • "
35.758011 - :N, 80.79491 w
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. Al&-/f0i4411i1 .
5/9/2023.
51-ret4.21;rEegilte1 Well Costal:4e Date
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6.16(are)the well(s): OPentrastent or „RiTestiparitry„
.vignEng it-Li.J'en9,.I irerei9,certif.;thei.r:dy ire:lifs I ii fiior)CUSOlyt led w tireoreLirp.x.
With/6'.4 NCiC..0.1C,01(19 tn.i 54 NC 02C,0200 Well Conititirricnt Snumtan'is'and ittar tr
7,It.this a repair to al1 eii htipg IV cii;'- pvt* or 'xi No ,,r<wx.of thif're.ninf has bird Oroi,i4,.ed ra:*1 loVi riwner.
ill41,5:,1#g eilkiii•Ai(me knOilsil let:ii conso.nte*h.htformallor raid I.:A.1*hr she rua rare oft/to
repair tilivir 01.1.iiilaitr.k.i:31.-ciiirini ciri ilte.back lirtfiii-him. -.23.Site ditioant,or additional.Welidetails: • . .. . „,.-
611 May,ttse Akblicli'of tills pa0..tiiproicfe.ldiiilional well site details or Well
8.Number-of Wells conitnteted: 1 constnictioictielaits. Ybu in also inlochadditional pageiif necessary:
For ittitiriph Iftleizlityrffroon:.11TiTitipp.11y te:e ils,ONLY.irhh r."..re.fortie.cffrstr,!odlon.,youi eon . -. . . . • . ...
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A-142niir edy.firi...1.- SUBMITTAL INSTUCTIONS. ,
9.Total well depth below land surface: 33 '014 24a. For All Wells: Submit ills faint Within 30:days pi:completion*of ti.'ell
Formhipie wells-list all depths#rfikercii.!(C,tact.te=.3@-200-antl2@ IVO ,constraction to the fo)lonirez:.
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10.Static water In bdOW to Ifor .easing:. (0) Division of Water ReSoureeS,Information Tinfeessing Unit,
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ifwgier levei(soay,'cgsi.v.:011!'+" 1617 Mail Service Cenic4Raleigh,NC 27699-1617-
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11,Borehole iliamctei-:2.25" '„lin.) 2Ib.For injection Wells ONLY: 10 addition to sending,the form to the address in
24a above,..also stitinit a.copy of this.folio within 30.days.of completion of,Uell _
11.Well construction method:DPT constnictiMi to the,followitia:.
(IC aitiger,ritiry;Cattle.:direci Omit.etc'..t
DiviSitm of Water Resources,Undervr,onnd Injection Control Program
19RWATERSUPPLY.WELLS ONLY:' .1636 Mull Scriiee Center,Raleittli,NC27699=1636
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. .. 24e.Far Water Stipplv 4Ve InjectiOn Wells:.
1 a..Yield(grim).- Method'of test.
ip:DisinfeetiontyPet, _ Amount: lAN:clstol csounballiriiitietion one.:Ca'to Ile°ef ottitittit3''llihienttiltii'41:11hcipni-;rt:'',°iLdnat3',:ti-61''tifciel),Ecuoi}ilient4)i°,.‘ftvohef:m.
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FantiGi.V-1 Nkanitarollsa DepanaKat Of Ern'IMILIIVeill no NaL12111 Resources-pivii ion of Water'Fle<arcim Revised Auguscio I i
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