GW1--02130_Well Construction - GW1_20240409

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-WELL CONSTRUCTION RECORD 63'cs
For Internal Use DN.LY:,- . •
This form can be used for iinglo et tmiltiple wills' • - A. .
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I.Welleintractor Information:
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II.%%TER ZONES. ,.
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Brian Ewing . " ' FRONI TO -DESCRIPTION
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Well CororactotNante ft, ft. .- I I • .
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4240-B . ' IL. . . .
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-z IS,OUTER CASING trOtinutti.6stilliiillst-ORLINERftfilti fifabkL ' -
NC Weil ConitacIot Ccitiftcatiotilittubtier ' ' .
• • • PtioNt 'RI , .- DIAMETRIC IIIICKNESS- MATERIAL•
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' SAEDACCO • ' ' • . IL. • ft• . n.• I.I '
Company.Nam ' ,t6.1NNER'CASINGOR TUBING...Wallin:mai efoscd-loop).-..-
PROm • TO . . DtAmETER I MUCKINESS hIATERIAL
2.Weil Cdnitruction Perruit fi: .
•. . • . . 0 ft. 25 • ft: 2 ' I-DI. SCH-40 ' • PVC • - •
,Listall apyilickede wet t pennik(i.e.County.Strdi;Variarcr(. ;liVecticfletc.)' .ft,. , . ft.: - •;. . . • •
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3,We.11-.1.ise(cheek wdl use): • - ' ' • I7:SCREEN. ,
FROM. . TO -MAMETER st,Ort MEE 711IC1047,$$ 1 MATERIAL
Water Supply Will' - . • - • 25• R. 40- ft, 2 "Pi• I'.010 SCH-40 PVC
tlAgricultural . , . . alsfunidipal/Public '
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h . -I. . I 1:1Geothettnal(Ileatingrtooling Supply) . CIResidelnial Water Supply(single) . , ft
' tft:GWOUT • ,'-I -- ' . ' •
' ' .121Edusttial/Comnicrcial . - . CIResidential‘141-ater Supply(sharer!) - '-vi4'01 . TO . ..-.'
MATCREAL I - ' EMPLACE- SIENITMETII OD.Q.A.MOMNT'
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Ellaieation . •• . 0 ft. 23, •It. PORTLAND TREMIE
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Non-Water SupplY
WI. Went. ' . - _.•. .- . • - ft f
Mctitottg . . RMQVCri . .. , I
Inipcliett.WEIII- • . . • (4 - ..I' • . . .
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• ClAquifer Recharge . EIGiourichiater Reincdfution . •-19:SAND/GRAVEL-PACK 07 applleotikr' • ...-- -,..; . — '
TO - slut:Rut.I• ' Emil.AEEM)._sr sarrnon
1:1ArpiifcrISSIorage and Recoyet}' • 1:1Salinity Hairie7 . - , 23 ft. 40 ft. FILTER I SAND • # 2
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' ClAtinifer Test 13Stomtivatcrffiraina ' . . • "
• R. , 0.1 -. .-. ,1.1 - ' ... .•• . .-
Elyxperimentd Technol4 • . 0Subsidcnce ottirol - -
f'.2IIV DRILLING'LOG Littakh•nddi florin!-sheet tracccssan-1 - ` . .
• 130eorkennal(Closed Loop) •tiTracer. .FRONI.. TO . -• DESCRIPTION robr.lnirdnets.wiTtock eve:even 4/e.•cie.1
LIGeodtettual(14eatingtool1ne Retuml Eimer tetplaiit under.If21-Retnatbi) .° 'ft*. 5 ft, -FILL SIILT AND SAND -. :. • . '
- • • 5 ' •IL- 15 ft. SILTY SAND
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4.Hate WeU(s)Completed:.3-9-24 •• Well mii140-14 . - - '
15 . rr, 20 rt.,• MOIST SILTY SAND. .• - . .• -•. . . . • . •
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Sa.Well Locathini " 20 r .rt.' 30 ft .. SILTY SAND MOIST TO WET
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• City Food . . 30 . It.- 40 ft, WETCLAy)i•PWR
• Facility;thimorNalue • ' Facility iDF(ifapplicable)
ft, - . ft.- - • - !' f r.:7;,... .7( --,--:1‘ ri'....' . •
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' 70 N. Main.St.,.Marion, NC, 28752 . . • • • :IL - ft.- "v..IN...".
. Ph)iitial Adds.A.City:and Zip• ,.2L iirlitutics• • I • APR.° -F., 202!r
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' McDowell .. '
ENTONITE SEAL 21 TO 23 i
County . ' - Nivol Ideolificatiou No.(PIN) . 1.
InfC.CiT,•:.4 .11 , .7:,•-;..:;I..!:,:-,.:
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56.I,Dtilii tletid Longitude ID rIegrcesiminutesfseconds or deeitital rIcgtees: 2L Certifleatiutif.. .'" 1.)Vii‘.;:i...Y....'ki
(if*on fV41d,On.i.10.0341s'sisfncicin) • •
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' ' N • • - W • ' EItia,,,rt EW in . . 3/13/2024
. . . Signatuto of cc-aired WeliConttactor• ' 1 • • ' Dale •- -
6.Is(are)the well(S):.laPertnanent or 113TemporarY . -11y:signing 1.1r4 fantrii Iretrby certley gun'tire ra(s)15TLY Oirre)constructed knecordonce
irlet 15A NCAC 02C.0100 or.154 NCAC01C.0200 WO Conitaretion Standards and that a
7.is this a repair to aa.tvisfing well; DYe, or No :cogr.of Mir refOrd 111175 Meta PR/Yid&OM 4!ilrii fillaler. •
iiripts'is a irpair:,(111 oat knoiciJ writ congnrction Inform and e.vidabr the nature of the • .
repair tinder 421 ietruirks:Sectikin.oi-nrt the bad:of this farm - - 23.Site diogrant or additional WO details; • . . - . •
Y'ou may use the hail of this page id.'proside.additional well site details or.ivelt .
8,Natal!crof wells constrricted: 1 . .• • construction dettirs. You-may also attactradditional page's if necessary.
For ninitlit1e Infeeilon ir non- tre,r.51,ppt.i.welts ONLY WA the sortie conitrudion,non 4 eon . ,. . .. ..
sabndfong forrn.- ritim-ET78L INSTETMONS_
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9:Tntal,well.depth below land surface 40 . ov.) Silo;For All Wells: 'Submit tins login within-30-days of completion of nett
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. For marl&siells liar all tiepin irdWirem(example-3@200'and 2€400) - construction to the follaning: - ! •
10.Static water level below top of casing: • • • • •(ft) . DiviSiOn of Water Restarces,InfurmatiotiPoneessing Unit, ..
• If water kid Is above cm*use"+" - • • - •, 1617 Mail Service Center;Raleigh,NC 27604617
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11,Borehole diameter:8•25" ••'On4 • 24b.For hifeellott 3V011ONLY: In addition to sending the fomi to the address in
.24a above..alio.submit a copy of[lc form within 30 days of.completion of well
12.Well construction truethodI NSA cousiluclion to the follosSiog:
(i.c:auger:roloy,tabIe,arca;esti,etc.) • , I •
' 'Division of Water Resources;Uutierground Injection•Control Progratm '
FOR WATER SUPPLY WELLS ONLY: ' • • • 1636 Mail Serske Center.Raleigh.NC 27699-1636
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. 24e.-For-Water Sopplv&tsjer.tion Welts:
13a,Yield(gpm) . Method of test: . . , • • • •.• •
- • AlSo submit qua cnpy of'tins form•Svithin 30 days of cotufilitiowof
13h.Disinfeit ,iontype: - Amount: . . M:cII.'construction to the county ltddltli dep;irintent of die:county.0.1xre
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Farm GW-t North Catalliu DFpananent of Envirolunetit and Moira]Resources-Division ofWaier ft crow • Rik:iSed August:NM
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