GW1--04165_Well Construction - GW1_20230623

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WELL CONSTRUCTION RECORD . - ' For ItacynoI Use ONLY.:
no fonit call Iv usca lot stright or malt itik,tvell5a•
I.'Wei[Contractor Infertnatiett:
LLWATER-ZONES„,
Stefan Smith FeUhl, ID orS(ItuniON
Well Cook-410r Notoo• rt. rt. i
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ft. I
3576A ft.
NC Well Coottnetor Cortiftiohtion
,'IS OUTER CASING tfoi'rnotti-iaktf:Iwells)OR LINER Ofa ationfabkY . '..... : '.
Nitabc7
, FROM. TO • 1 PTAMETER- i TIIICKNTI, MATERIAL
SAEDACCO Inc -
, 0 :It., 15 It. 1" Am. SCH-40 PVC
Coitqtain•ts'aine. , ',16.1NNER CASING ORTESINGIgeoibermal ctuF.eil•looft..' - ' - ., .-- ., :,' ,
FROM TO DIAMETER. THICKNESS MATERIAL
2,vitcli'cogistille-006 ociiii#;V; WM0301280 R. It.
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14st WI apriti'crible•willpeirrit.0...4:-Counry.-Slot Tad auct.,filleree.ft ow.).- ,
-11., ,ft, '.
3,Weil:Use(check iVell 115d: ;.I'LSCRE.F.N. . ' . - a . .•-,'„ .
... .... .„..
- Well:,Supply
'Water Su .
'''-FROM' TO DIANTETKEt- 1 $WI.sm.', irlitat.Stzlitt-•I mAuttat41,
El Agtitultit tal
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EIMieticipaliPublit 15' ft. ` 25 tlt• 1" ill. ''...010 SCR-40. PVC
. . ft. , .1e.
06eathemtal(ReatingiCoollogSupply), EIResiden(ial Water Supply(Single) ft..
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0 IndusttialtComitiercial DResideritial WaterSupPly(shared) . ' ----- — -
FROM ' TO MATERIAL ENIPLACE-NIFIN.' T-MEIRIOD&AMOUNT
EfirligRI1011. . 'Ht ft. 1
Non-Water Supi)ly NY.,011:
. .. , , 'It... IL
oillitaniti#411.3 Ogccovc.IY ,
lejs‘.ctfatt"WeLl:-.' . .1t. ft..
CIA,MitRelyellarge EIGiouncItOter ReMcd ration '19,'SANIfiGlIAVEL-I'ACK."fa itoottealito . •,..,,,•.,• , .•.t. - '-; ..",t.".'",.-' .
, ;,, •..,-..• ..• yt, , ,•sttotsc .;Ito - MATERfAL.-:- F:NIPiACCO6TNIt71-111011
10:ll.Mitrei2s:iiii;iiilaiti Rceoiii4t. rifiljp!ly lairiet -- R.: rt.
p..).qulfci-Tc4 "1:1,•StOrmWater•Otaitimge., .
A.
ft h.
itwerimental TrehoOtou. , b,4ultence"..c.Ontra I' . . ...... ., . .
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,, .. •,-. * 20.-DRLING LOG taimeh'additio IL litil 5Iittis'if ercessirvl
IDet.oithettual..(Olosett„Loop): OTreeeir. 'FROM- .TO DFSCRIETION[(obi..htird,i.at,.gm R'ciivR li pc,,'OrAin f.:iit...itit:t
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EIGeothennai ateritinprooliba-Return). Cletlitc(eplaitt dederti2.1.,Retnetts). t 0 -(1. 15 ft. Silty clay
• 15. .-ft.' 25 ft. Silt
4.Date.Wel,t(s)Crmpleterl:'•4/24/23 '.MiairDif.TMW-2 . Ili" 8. - --. ..
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. ..„ „ .. .. . ! Es —.r. 0,...; . 41 1..... .r.
, .. ,.,2 c.._.•t,....t ki
rt.
i if N 3 Z023
.;,w,,ft.1..0,..itiipik- , ... ft.- ft,
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Ferti Technologies It.;
facilitilDwpgr iiintitq. F2F-flitY 00(it*Ii,.414- "A,.
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, i .fircr,.'^. !a ... ;
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111 McNess Rd., Statesville, NC, 28677 l'1- D4.14"'Ci5Para .
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P!0*:11:'447",•k :Ci*'.7.-;!PtiiZ. #:)'' ''',2L.RERIARICS.:,
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Iredell . Temp well installed thru DPT rods.
Cgimfy Fm-41100iii0Cilion•No;f PIN}.
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51t,.tatiritriie'attai-1.6aglititte hi ttegtveitritirittriOcOlindorVcchtMittek.reti."' 22..ectlific-Atimi,
(U ,;ellfil41,;oke jiiri6„4,..hl.f.0444-.11) - ' -' - -
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35.758011 Is.;• 80.79491 5/9/2023
Si.ELTO oitt fled Well Contra...tar -Pie
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6.Is(ire)the.well(a): EiPermaitettt • Or .&Temporary. ity.:signing.:ikir furnv:1 irerikr re rfify.MO,Al,trrikvi my,t50 ecupintefeil or we•ordance•
• .Vini 15.1PICAC 02C,arm or 154 NCtie02C:0200 Well Construction§ianditas and IhWir ti
'1"...,isiiiis a repair to an eaiMifti*ei(tr.: pyi!s-: Or XlISo ''Clpy.Ortilft ftVirillf i'liTSPI"Cti Orp,iiiit'd roe'stVi?f.10141; .
ii.tPSIti.0 ripilr,fiii!Mt ktwivil writ corinntetiorrhtfpn#iiiini rod explaht Me lialldre of rile . '. • '. ' i ' - .
repair ciiike i2 I iirmizitsr:vi•es.iiia eii-irf Ille:thirkrorthiskim. :23.Site 4 ilignint,or additional well.iletOts:
. ' You ina).3.t)se..11<tk liarl:of this pig..to-prOtideadditiMitil ts'ell site details or Well
tr.Nittober ofitells ottitsttiteted: 1 - eianstuctiotr details: N'att mu-y also.tittachtadditional•pages if oecesSary.
For itat*Itijecrione'r oi;ri:11:OreiA hino:44y-14,11,s,,bNLY-tiiril ri)!..srrat.le:conm'rifetionx.yri:14 can • . - •. , .
. . . -..i-t4tiiir our/pan: ' '' ' ' " StiBMFITAL INSTITCTIOICS' .
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9.7tititt irelj.idept1t beton'lanilOrface: 25 •(00' ..21:1•. Fni-All'Wells:"'S.:abed! (Ns-f6!in Within,30 days of teottipi5tioo of,livelt
For nuittiek frettelist id/trepthr it4eret4 i••••orolOit,::3@217,9'aot12.@Mil .constiactiait to-the-1'0ton;nw...
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10.Statie water lirtt1 below tap of reaS i ng". , (ft) Olvtsiiin.0I8V;ter RmieuricII,Infermatientaicssing IF,ni4
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• if wereikiiet is iiiitiVe-,'Mitait.as.t.'Li-" ' 1617 Mail Service Center,..ltaleight,NC 27699-1617
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It Borehole diaineter:2-25" •'(in.,) 24b.For rtirectiori 11/e11.0N1..Y: In addition to sending the Term to the addms.in
244 ahave.also submit a copy of tails;Tomt within 3t datts'of eiMipletteitt of well
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12:Well constriction inothod:DPT -.'OtMinidinii to die follow hie:-
(i.e„ati.ger.retaty,-'saltle.directtusli eta.)
Division atlitVitter Reson Yetis,ITttdergronnd Likle'clion Coetrtil Pieki•eith,
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FOR WATER.SUPPLY WELIS ONLY • -1636 Mail Senice Center Raleigh NC 27699;,1636
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14e.Frit'Water'StiFf111-&Injection NVelt:
1.3.a..Yield(ititrnj - SletltatFOfte;st:
Also'subMit ott;e copy of this faint',Within,30.:tiayS6t,completion of
43b,oisinfeition tyilet _ . _. Atnount i well conistruction to the-county heollthldeparinnint 6i,'ale.cqualy:where
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constricted.
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Form tt OW-I Noah Catalina D,...-}xtritiNint of Environment and Neutral Resources-Division of Winer.ROxrcra Revised August:tit 13
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