GW1--05853_Well Construction - GW1_20230912

WELL.CONSTRUCTION•RECORD•• Far itacrllal Usc.ONLY:. •
This.form can be used for single or multiple was-.
1.Well:Cuutractor Information:
• '14t.WA ERZONPS .
Chris Ruffer - FROM TO DESCRIPTION
•
Well Corir..tcior Name, : rt. ft. 4 II .
4223-A D. fr. . i , •
NC.Wcll Contractor CcniftcltianNumber 1S.DATER CASiNG'0,-•ii uiti raseitsit0 l'OttLtNER'(if ap tieabtc)�•
FROM TO •• DIAMETER THICKNESS MATERIAL
SAEDACCO (4 • fL in.
Congnu1)-Nauw. 'I61NNER.CASINGORTUBING.(f",iiothefiifaletaied•IniM)d.'3'•=._ -
FROM ,-TO . DIAMETER THICKNESS MATERIAL - '
2:Wcll"Constrtictinn Permit li: - 0"• ft. 30 11. 2 .•bL SCR-40 PVC
L4iof,applicable will penrei (hr.Colony.Stale,VoriOner,fre-alleti,ric J tt 0, in. •
3:Weli.b'se(thee!:will use): AI:SCREEN . - -
•
`Water-Supply Well: .. FROM TO urA1ta nt( SLOT SIZE TiMICKN M l sMrrertrnr,
Deigricultural C11Nturicipab'Fublic- 30 ft. 35 Ft. 2' iii 010 SCH-90• PVC •
• • DG im eatheal([leating/Coeling'Supply)' IIRes'idedtiatWaterSupply(singlet' ti' f� in' .
❑iudusiriallComwtercial ❑Residential Wp[er.5ttppl}•(shatt:d) "y6iGRO(1T :.... - =.
FAOM • 70. MATERIAL EMMA.CFMEENITSILT OD 4 Arun tJiiT
❑Irrigation' 0 "ft. 27 -(t,• Portland Triemie
Aron-WvterSupply Well: II:
Ildlvloniloring • . IlRecmery - -
Injection Well: ft„ ft.
. . ClAgrtiferRecharge °IGroundwater,Reliicdiation 19:SAND!CRAVEL•PACRIifingtilikahtel" — --.- - ------ .--._-
- -
`-•PROM 10 MArERIAL. - . . - •EMrt.Ar:iMENTminimma.
❑Agoifcr.Storagc and Rccdvr)3' ❑Salinity Banter. 29. ft. 35 ft. Sand I • #2
. El Aquifer Test C]Stomiwater)tuinago It.. ft.
DE' atimcntal Teclmoto �'xp� ��. p5trhsictcncc.Cutdrol
20 DRILLIIIr G'LOG'fatiaehnddllion ul ahcets if itceeiierV'-
OGeoilietnytltClosedLtiop) ❑Tracer PRIM ' TO • DESCRlPTION(mkr.harttucrrstiMm IiOTCgFrancfr+otkt
❑Geotltennal(Fleating/Caoliug Return} ❑Outer•(explain under.#21 Retool6s) .14. ' ft. I; ' .
• ft: (L.
1:I)ote�Veli(s).Cnngileted; 8-16-2023 FVc1CIDtyMW-5OR I F-' en-A* •---.; ,
L See Gero's Notes l ?.t:t...„,j;:{ti/ .>f-1
5a,Will LOcatton: :t4• It, (�
Holcomb Creosote.Site ' .. . ft,. • f(,- SEP 1' 2 2023
• -Facfitl•,!{hvocrName - Faciit illh(ifappli:able)., ,;�
(t. tl. Ini�-rr.a.,...41 Pit%. a' lirr#
t� ,:
5016 US Hwy 601; Yadkinville; NC, 27005 f4 - ft, Cr.:,.,. .. V Li
01esie0 tiddtoss_City:viol Zip '' a2t:REMARKS' . . . ' "
Yadkin •Bentonite seal from 27-29'
Cunury Parcel i,k ititteaiIon No:(i'IN)
5b.L:ttitudeanit longitude in degrees/minutcs/scconds or decimal degrees:
Owen I Id,olio lablong lr'sidlcknt) 22:Certification:
N w Chris Ruffer I 8/20/2023
Sigtiaturi orcert lied Well Counactar Date
6•Is(are)IIICH'ell(s);,MPu-in i IeRt. or ❑Tensporary si mi 'hit forriri.1 kerOy ter&1v Plot the ivr15_( szr Iintire,1 cunoriKied lmxonlancr
rrirh't501-NCAC OW.0.1(30 or I Sit NC4(7,192C.,O20O-111(J C irsursrtftur Standards and dun a
7.Ia this,a repair:to an eustini;well: 211Ve or DNo coprofrhrr irconi/mi.Iwo provided ri.r.t %urn tilMier.
4f rhis:ix a riepalr.All our kr,onpt u'dr coy sieucilori htforourtton aril usual;rhs,h rare of the
ir1iairradar 521'h-for s serlrun or•MI the bcs L of dike fornc 23;Site diagram or additional well details: .
You may use the barb of this page to provide additional well site details•or Well
S.Nuinberof Wells coustnicted: 1 construction details. You May also-aliacli additional pages if necessary
For ritalrtple infectfhi or n nu-nnu'r supply wells ONLY liith rhe.si'RE earr5(riwf wt,you eon
A-Omit oiie form. - SUBSIITTAL iNSTUCTIONS i,
9.Total ivell depth beton-land surfoeei - 3 (Ii.) 2la. For All Wclis:' Submit this fanu within 30 days'of comptetien`of'nell
FOP rrtnitd&ivelielist all dr7xhiIfdtf''rrYnrresarapteg@2.0,0'atul?,11Mr1 cOn5tnletionto!Icfoitonins; '
l;
1,0.Static water level below top if:wing: ' (ft.) Division of Water Reriourees,-Information Processing Unit,,
if water level is above astray.life"t" • 1617 taitSei•vice Center,Raleigh,NC 27699-161T
11.Borehole diameter:6" • _(in.) 24b.For Infection Weliy ONLY: i`addition to-sending the form to the addles,in
24a above.also submit a"copy of,Ills farm within 30-days of.completion of well
12..Well construction method: sonic construction to the following!• f
(Le.augcc iutary.c01c.'ilircct push ctc.) I
. • Dlvhlnu of Water Resource's,Undergt•ouud Injection Control,Program, -
. FOR WATER SUPPLY WELLS ONLY: 1636 Malt Service Center,Raleigh,NC 27699-1636
13,t,1,'icld Wm) Method of test: 2244c..For Water Supply-fie Injection.Welts: •
Also submit one copy of this forma tirithin 30'daysofcenipletion of
Llh.Disinfection n c Amount: .well cbnstnrction CO the county health department of die calmly Whereli constructed, i
Form GIV-I Nonh Carolina fkpanment.of Environment and Natural Resources-Division of 1Vater-Racurtas Revised August 1Ol3
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