GW1--00042_Well Construction - GW1_20231218

.., WELL CONSTRUCTION-REeORD Rir iticrnalt1F pNi-Y:
Thi.s-formcnibuscif kr-singfe or triallipls wells.
I.'4Ve1teontraetoir!animation: • '
-14:.AvA-titazoNts. • . • • .
John Eisenman FROM: To DESCRIPTION
NVOI Contractor Kling- R. ft.
ft. . ff.
4439
AISAHITERCASINGIffirinutit=disietlitillif OR LINERfiraff titsible1::: ,_ . _
NC Welt Contoctor Cenifootion limbo'
FRONT 'i TO '' , DIAMETER'. THICKNESS'' MATEILTAL
f.Lfr I I 1,17 •
SAEDACCO . . .
CalEtlany Name- ' '46';INNER'CASING'OR;TVIIINGIOotkiintial elokil-loitinp.,' -
FROM TO . DuotETER - Tates:ass , MATERIAL
2.WelirCnnitivction Permit i: . .0 R. 47 ft.- 2 I:, ' :ill- SCH-40 •PVC
,
. Lief a artilicOte we'll petaii:s(Le.-Comfy.qbaa.Alithllree,trek-0'0i oc.t .
11.• . - ft'.
• ...
3.''$1111:MO(k1F;I:wF,It Itsc): . • -,-17:SCREEN
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, ..
VVRIEESITITT/ly Well:• . FRONT- • TO - DIAMETER corsin TIIICIOIFSs I MATERIAL.
47 EL, 57 ft: !' 2 iri!,' .016 SCH7 4 0 PVC
ClAgriculiumi EiMiniidipalifttidic•
. . . , ;- %
. . .
DOentitermal(HeatingICOoling.Supply) .CIResidentiat Water•SupPly(single) :IL' fit• . ;, . .
,..,,.,
.... ...;"
OindustritContatercial. °Residential WatetStipPlY(shared) . '-' - ' • ••,
it ,...To. . MATERIAL ENIPLACENTE'iTMETHOD&ANTOLINI'
.0
- .Irrigation• ,. . . .
. . . . - 0 ft. 41 ft. Portland Tremie
Nutt-Water Supply Weill . . . .• - • ' • " - ' '
. ,
' idivIonitotiog °Rec. °very . -. .' • ft, ' . '' '' tt. —1 '
- , .. . , •
Injection Welt: ft. ft. , • .
•
.... .
' ElAtillikr Recharge i ClOinundwatcr Re*dialiOn '.49'...'SAN D1GRAVEL-PACKTil'appliLWAW-
FROM TO' MATERIAL EMPIACEMENT METHOD
. . . °A.iniitcr-S.10rage and Ree003' °Salinity Riiittce 45 11.• 57 IL sand - • #2 ''' . •
Ehidiniteitest EISIotnitateeDialOar..A ,
. . . . .
. - • ,,-• • .... ft.- - . It .. . . . .
ItieVCritttFillal TrOntotroa 1:1*11,4ittatCc.Contral 11;
4DRILLINGLOGItiltach additional ill&ti'ir rttiSsirvf
1=0:ititentrid(Closed Loup) DTrdcer• . - . FROM, ID . : DEscRIPTION Tixibr.hardEtti,..stillinick type:zrain Om.de.1
' EIGeothennat(HeatihtelCooliniRetun) Obther(eltplain under#21-Retnarks) 0 .tt., 40- ti, Silysand/clay
40 ft.- 57 IL . rock'
-.!,--7-, -.--.
4.:Date Well(s).Completed: 11-10-23 *ell monnt-124R .
... 'ft. . ft. 1:
7• :.''!t'i.f ii!;.-^- 1.--.),
Sa;Well Liwititint ' .ft. •ft.
4
General Electric Company . . . - 'ft. i • A & 'In.,
I. ve3 .• ,
FacatlyoThyuct-Namc - Facilk-iphl Oappiknbk).,
rt,
--;.....1,:cil....1 r..:-•
• •••:1",`Z.TT.,'"
3010 Spartanburg.Hwy., East.Flat Rock, NC, 28726
. .
Plo-iki f.Aitdrtss,City.:au Zip - . . .
,21:RENIANICS", . .- - '. . , , ' • .• - • • ,
Henderson . . 'Bentonite Seal from 41'745'
. . • .
Cu utuy P4Ircl lAintifkation No;(PIN)
1. .
Lntitinie ant linglintlit in dcgrcainiinutesispin!is Oilfociinal&Oro: .22.certifieatim,. I,
• (itnen hem,omlationE,hsotriehnt)
I.
N W ---- 2-1------ 11/22/2023
6.IS WO die:Wai(s): EIPetrittaitpt or nTemporpry
iv:.nutircied la.acraniance
. with/5.4 WOW 02C..11. 1:..7. .r.A..-:qii;,000 Well CossiSocricon kanoiarris lend rIkr cr
7.I tfit a repair 1n aneilitiogwelh, XVc, or °No. .cop:r..of rhi.:iorvirri bdio:bem iIi.infolai i'o.Me siriffinlicr,
If t1s a riprit.jiff ev Anthyb Si'll cosmisuction ininmation and oispight thoiitorare of the
repair wider 02.1"reillarith sraiara oi,.iv]she bail oPhivfornt. 23i Site:Dow-Om or addition:1i Welt details:
You may use the back.Of this page itd,providiadditional well site details:or Well
8..Nmuherof Welts Cou,strneted: 1 . - • oonsinictiondelaiL. You inns itl..6,01,1c1iiddilional pages if neceOly.'
.to r sitailsip!oe hefearoVii or P0iFittosiT sloppily lolls ONLY ultli dir.safrif eturstrti 0 ction,Olt 511
submit a4e tom. SI IBNIITTAL INSTUCTiON§I;
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9.70titi welt depth heft*latid stirfaCP.' 57 (ft) 2.13. Par Alt Wells: Submit tills,fano withitt 30 days*of annplenao'of welt-
For infirTpfc /hits,oft depths Ifdifferalot(exampte-3@2(143'oottod.20 700) constroction to Mc toltooing: r, -' '
!I .
ta.StadcWater leVethelow top.of easing: . - (lt.) ,Divisiiita ot Water Re.Smirc6,totormatitinFrocessing Unit,
Ovgier Wel is above&sofas;me"+" 1017 Atil.S.Silice!CFiltd.,Raleigh,NO709.9-16 t7 '
El.Borchotc iliamcfrn 1°•25"/6" _ 24b;Far 110jWititt Wells ONLY: •In addition tosending.the form to the address in
24ainfive,also submit a:Copy of this bait within 30-class"of completion of Well
12.Well eousteuettoo method:.HSA/AIR • Consintctioit to-the folloWine:. I 1
(ix.gag+,tally.callic.ilircrt yuslt..cti.)
. . - Division of Water Resourcesiindergortitd inieettou control Program,
FOR WATER SUPPLY WELLS ONLY; " 1636 Mail Servicer6nter,RaleigliiNC 27699-1636
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24.For%Vat&Supply.&iniection Welts:
13a,•Yield(ditn) Method of test:
Also submit on6'copy of this'form within-30'.clays of cOuiplehon of
13bAlisinfectiun types Amount: . well:einotniction to the county hcitith department of the colony where.
Constructed. •
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Form GW,t NoniCatolina EN.--panracatof Euvirontuent and Nonni]itesaurces,-DvisionoilVnte 8C:tut:es Revised August 2013.
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