GW1--00045_Well Construction - GW1_20231218

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.- •WELL CONSTRUCTION RECORD FOr jrtemalit49 pNLY:.
Tli4-form cam betned far to of multiple was '.
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1.Wel.1fiit4Ittot"!animation: . .. .
. 1.1:.WATERIONES • . S . -
John 'Eiserunan FROM. TO DESCRIPTION
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NCR ConlnK161'N;wpo. ' tr: • it I
4 439 I I
35':OUTER.CASING tfoiluittIktiinetist OR LINERtirainifitablel'. .. . .
NC Well Cooliactor Certification Number FT4051 ' TO " - DIAMETER- TRIMNESS , MATERIAL
SAEDACCO . . - . . . .
Company Napi-- , -16',INER NT,.... , NG05_,.......iliat -Mat elsokil-lon:kit.
FROM 'TO . • DIAMETER TMCKNESR - -MATERIAL
• 2.'Weil tnnStrnetion Pernilt li: . 0 .ft. 60 ft.- 2 b ' Itt. SCH-4 0 PVC
.t.irlollirpgiticabk v.-dIpcnrolic..County4tam,.trarlarter,irialitn eic.1 ' M.' .
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3.Welitse(eherit.ridl d.m.• • • .
-17:SCREEN
. ,_ • oM of Fo . TO - mtuctu staYr t 1, 8173 T: HICKNrsS 1 MATRRIAL
Water Supply Ws.41: , . . 60 -ff. 70 - H. 2 ilt.' • .010 SCH-4 0 PVC • " - -•
ClAgricultitral . . . .' EiNfiiiipaliPubile, v ,
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1:1Peetheimat(lleatingtoolini SupPlY) ilResidential.Water.SupPlY(single) It. - it. -
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0 ludnSitial/Conunercial E3Rcsidentiat Water Supply(shared) '18'1GROUT''-- "FRONI • -.TO. . MATERIAL. - EMPLACEMLNT AIEHIOR&/MOUNT
• '0 liTipition• . .
, . . 9 It.- 54 ... .ft, Portland . Tremie• • . . _. . .
• ' NonAY:it&Supply Well: , . •" • " ' r ..- ft: ,• •
IgiDeleaitoring PRceiitveri „
Injection Welt: ft.'
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. •. DAnnifer Recliarge•. 1;10.9undwater Rentediation .-19SAND/GRAVEL-PACKtif:•implicalder ' .,r-,----:-..-..- . • . - ,,. --.- - .
. -.., .. , ... .. -- • • - - -Emoht• TO . I 'AIATP.MAI., • ,FAIPIACEMENT MIMIOu •
A ARiferSIOrage aMI Recoyety 1:1Salinny Rairice 58 •ft.: '70 ft. Sand #2 ..
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. ElAipierci Test. 1:ISIbminnter f3ntinage- • " • • '
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1:305perimentel ToArtoregy itSubSidencetentrel.• . . .
2(i.'DRILLINGIOGIaltacli'additiaiial iheetslf.neeessaiiii
.60eetlicittoIlcied Loop) . 13Tmeer •Rom• • TG , DESCRIPTION((Air.hanItictu WI/nick tylx:orsiin Anz-ork..).
OGeothennal dileasine/toolitiaRetutnit Obther(explain under;421 Remats) 0 :ft. 50 ft. .Silt(sned/clay
r\C.; ,,it 1 ii". _.,.'..) . .
. . • 50 ft.; 57 :ff.- pwr I... .
4.-.Ditti Welt(s)Completed 11-10-23. mu mont-17A
:-57 'ft. 70 ft.. Rock V.
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5a.Weil Locattint:' '. .
.ft., ft. 1
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. . . DEC'1.B .2023 •
General.Electric Company .
- - . rt.. ft. ,
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•FaOlity".thvorNtuus - Facrilitr ID#Ofapplkhble) • ft. ft..' . • - .
i, . !tyforrnVjcn 1.,!,.-c-:!..7.4..V.:-,:.-2
C'.cCr.130k,
3020 Spartanburg,Hwy., East Flat Rock,.NC, 2872 6 . . - . • ft • ft, • . ' '!' :. .
. . 0.1114:Jill'4405s;citY-:lii10*IP '•2t,REMARKS* -. • :'- • ;:' '' . • . . . .. .
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'Bentonite seal from 54- 8. •
Henderson I .
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. Cuomy0 0 Parcel Itkutict,,,ation No,(PIN) . 1
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Stf...Latitude and'lingittute la degmeiiminutcsfseOnds:it dechnaldegiec$: 224 Certification:• li
or nen rNid.,-*lie lanton0s$afttelelp ,
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• N 'W r I. ... 7......'. • 11/22/2023
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G.Is(tte)the Uell()t',Remanent .or -Erilmtporaiy "••'
ii).yiEnbig dzi,jechpigglidt(*,,iful47-7;:ti'lr ar777:`4 ear-yin:Alexi katworglancr . .
.. . Wei IMAVAC 0ie1.11. -177e;;T:iiN.;:giC..0200 Wetl Com/maim karPlarrla end thor a •
7.Is this a repafrio an .:ijiting iyelb Clittni .0-r HIND . 'icki..df Aix.irrOrd?Ai 1.1;.en pr-ided r:O'ilze sirli Maier,
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If thif.iio rAook,fill cm WOW!!moviareiloriinjor(orMon dud iwpigili the#iarore of the -
rival,roofer P2ifirriuOlik.rizthira oron An it ofthis form. ,-23:Site diagram,or additional Well details: • - . .
yoi.tuak;iii0 die.back of this Page itipt&ide'additional Well the details Of Well ft.Ntnnherof Wells cotairn -eted: 1 • - cotistniction details, you may als.epattaeft additional pages.if necesSaty.
For iitaiiride.Irdevhon o,olui-Iturer supply melts ONLY WA[homing.coosteudion,g;oltewo - . .
sOnik Oc fonw. " ' SLIBMITTAL INSTUCTEONS 1
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9.*Tetal well deptithehiw-land stirface4 70 (01„). 21a.•Fur Ail WAS: Sithtnit Otis fonu within 30 days of cOmptetiOu'of well •
For ittalalpfc iivittlin all depths((different law-4170re-3€.200*mul20100) Constifiction to!ILO Yollosting: '
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18.Staticwater Pavel Ipaltin,top.of casing:- (ft-) Division of Water RiAointeit forn Iniatiati.Pk.iessing Unit •
lf lilel/Of teiVi if ilhOre.&Wag;hie .."+" ' IG17 MaiiScInice;,Ontlir,Raleigh,NC 27699-101,7-
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H.ilorehtik diameter:19-257/6" 24b.Far rtileetion Welts ONLY: In addition to•sending the form to the address in
245'ab6a*also sahrint a•copy of Otis forth within 30 days-of completion Of Well
12:Welt construction method:HSA/AIR - •consinietion to following:: 1 • .
0.c.auger,(Mary,caljle;[(ital.pOsh,de:,. • ; ) ., - •
. . . . . - 1/1vhkiit of Wat er.ilesou nes,ildudergronild Ittlecifon Contrid.PrOgrant,
FOR WATER SUPPLY WELLS ONLY( .1636 Atli Service I'Center Raleigh,NC 27699-1636
-24e.FOE Water Sultelv.&Injection Wells:.
113u,'13.Fld"(OM) Wilted nicest:
Also submit-one copy of this fan.nithin 30.days of cotopletiOn of
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13b.Disinfection . .type: Amount: well:construction to the county health department of the connty where
-. constructed,
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Fdrm GW,1 N:oriltCatollm DepanstentofEositoomem and Natural Resources..-D-tvisloo of Waler Rpnoms Revised&gill 1013
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