HomeMy WebLinkAboutGW1--05278_Well Construction - GW1_20230814 ! ,
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WELL CONSTRUCTION RECORD Fertile:1ml Use ONLY:.
This form can Wined fer single or malt ipEc sells•
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e ' 4 I.Wellaintractot Inforutatku: • . . , . . . . . . .
-14.-.:WATERIONES . '
Chris Ruf fer most. "to OFSCItePTION
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NC-Well CoMractor Certification Number 1
FROM' ' 10 ' utAinnutv- TIIICIZNEM. ' MATERIAL
SAEDACCO .• . 0 ft. 65 fL' 6 ; In. SCH-40 PVC . • '
company Mose. /6:-1NNER CASING'ORTNBING:(egotheimat ettistif-totijty -' _•-•• .
FROM 70 DIAMETER UREIC:RES• MATERIAL
2.'Well tonitnictiiiir Permit ii: 0 ft. 81 ft. 2 ht SCH-40 PVC
Uri aft 9FIilklible l'it'S pe'mrks.(iim County..Stutti,Voliortee,flectiffloo.t.
3.'W.c.1116:0(kb:co.:IN:0 itse): • • • El:SCREEN • • '
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FROM. -TO 0•DIAMETF,ri s LOT SI71: VII CIC II R:$ M ATER IA I,
• Water-Supply Well:• •
,- • . 81 - It. 96 It. 2" iri. .-.olo SCH74 0 PVC
C' . LAg.ri;:ultural CAltinicipaliPublic- _
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Elaathennat(Heating/Cooling-Supply) OResidintial-Water-Supply(single) ir.. -'I'.it'• •
-AS:GROUT• ,
ClIndustrialoConuncrcial ORcsidential WatecSupplY(shared) -' •• -" '—- -— •.-- - - - --- -
FTIOSI • •70. . MATERIAL • I EMPLACEMENT IIETTIOD&AAIOUNT
I:irrigation . . . . • 0 .ft.• 65 ft. Portland Tremie
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Non Waiter Supply Woll:
NM. milt Oring ' ft. . . • O. .
.IZIRccovcry ' - ' - •
Injection Welt; ft. ft: . . •
0 Aquifer ilccbarge. • tiotrduatcr Reincdiation 492SAN 0/GRAVEL-PACK til'ap-plittley,'
. . RONI . TO AINTF:krA I. • •R NIP I-A:CFAIIENT MIIT1/1011
P Aquifcr Strimgc and Recovery -1:1Salinftv Harrici -
•• • • • . • • 79 R. 96 ft. Gravel pack. #2 .. . .
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0 Aquifer Tcst 1:IStOnriwatee Orninage
1t!
' LIEVerilitental Tehnotag. . .1:1Sithsirtence Celan]1
:111:,DRILLINGLOG fatiaelraddlliimil i heats'if neceissari.f. - - -
ECle,.alitennal(Closed Loop) . .titracer . . • FROM -to ' DESCRIPTION tartar.narductl,trdEructr one:train!Ate.tte,1
EIGothernial(Hearin:lin:cline Return) Dother(explain under.142 1 Retnatits) • .ft. ft. :
ft.. . IL
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. .1.DatO W611(0.co nipleted: 7-19-2023 Mien iiii#MW-1D, .
ft: See Gefo's Notes
5a:Well Lueationt .
ft. ft. RE(,...;.1...::: v E.-:.Li
Pinehurst-Plaza ,ft.• ft.'
• faciiity,Vwner Name Facility iDgtiCappjbe) f.t. ft. AUG462-3
1680 NC HWY 5, Aberdeen, NC, 28315 • ft. ft.• : 1.11§, agi V.-n Prn(i.F.4.7ii..g I.16;1-
0.1;YOCIILMICIOSS,.City-..111411.43 . ,2 t:RtritAitx.i: . D4,Ntr.r.f.A.N3 • ..
Moore • Bentonite seal from 65-79'
Calmly Parcel Idusuirillion No.(P114) 1
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Sh.,Latin]de UnitlingiOule-in degrees/minutes/seconds:or&viola'.dcgem: 22.CertifientiOn:
• (itraell Etokl;one lavloti issaftliksin •' .
Chris
N W C Ruff er, 7/18/2023
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• Sigtuture'of Cm:flied Vt ell Contractor - Date
6.Is(art.)the:well* EPermattent or .17Teinpitaiy 1_ ,• J [ ./. 1 •L• el,
itr signhq imi jun%.1 Annr411.Cerro):PC:i Itar 11.nris II Ma Nii,e)Conytmeled ift•tocconicincr
'NM'154 ArCAC 02C.01M or i A ATOtc ow..-o2oo Will Canso-N.7km Srandards(rad Ow o
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7.Is this a repair to ad 4isting well: OVia. or EN() - . 'ctiff.of chic icctini 1,1i.4bre.7.1 iirovided ra ihe%aril(in:nes.,
If ge(s:Is a Te;tkibt.fill cot koouit Weil cominviera If cr.e?rfAITIOJI mil(*fob'the aware Of the
ripoir under 021 trenctrio section or On the bar(of this form - • '23:Site diagrantor additional,weli details:
YOu may use the.bad;of this page•tolnovide.additiOnat well Site.detiils-or-Well
8.Number of Wells constructed: 1 • • . consunction details. You Mar also anch idditional iiiges if necessary.
For nrtdriple tufeerttn'or ortn-watiy sspphy ills ONLY with Msame t, renstriittiint you eon • . . - ..
sgfrriatrine form:. • • SUBMITTAL INSTUCTIONS
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1..Totat ivt4I depth below land surface: 96 at.) 241a. For All Wakt. Submit this fomi within 30 days of comptctiOri of well
For tuntfipicitTlislist ell depriLi if dejTerop.lexampte-3@200'atul.26109) . ' 'constnretion tolhe foitossing: ' '
10.Static.Water lei'el below tap.of easing: . O.) - Divisitio of Water ReSourceS,Information Prneessing Unit,
If MOLY kilo,Is abbve eaiftig;ilse"+" . • [Gil Malt Service Center,Raleigh,NC 27699-1817
if.Rarchole ilieuncter:10"/6" (in.) 14h.•ply 1latit!qt1 vi,viis oNLY: Inattrlition to-sending the form to the address in
24a abcive,also submit a•copy of this form within 30 days of completion of well
I 2.-Well construction method: Sonic consnuction to the following:
(Le.pager,rotary.cable,direct gush,etc.;
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• . Divisinit of Water idCsou nes.Underground Injection Control,Prirgrant,
FOR WATER SUPPLY WELLS ONLY: . 1636 Mail Service'Center,Raleigh,NC 27699-1636
- ..24e_.For Water Suppiy•&Injection Welts:
13a,Yield WO Method of test:
' Also sobniit one.ciapy of this form Within 30.dirys of cOmpletion of
I3h.disinfection Ante: Amount:
. .wcil:corAtruction to the county health department of the.'county'where
' constnicted
Form GAL! North Carolina EX:panmem.of Eaviromarna and Natural Resources-DWisloa of Water RL-..curtm Rcs-iscd August 240