GW1--02251_Well Construction - GW1_20240409

4- I1
WELL CONSTRUCPION'RECORU For,h¢crttaluscoNLY;-
' This ferment be used for single tit itudtipk wells.: '
1.Well_Cantractor Information: , , .
,1A ATERZONFS . -
Brian Ewing FROM TO I)EiCRIPt1OAf
Wol Contractor Name. • ft,: . ft... I. . , ' •
•
' 4240-B .
.ft. ft. ' • 1. '•
•
NCB'itlCardrnetarCcttiftcalionNuli:tiei ' • ,1S OUTER CASING(for'mull sect-Wels)ORLINERtitaji ticabk):
FROM "TO DIAMETER I I TRICt.MSS. MATERIAL
. SAEDACCO f[, h. MI
Compuly Mom . . . • ,16 INNER CASING OR TURING tg oiiurinal closed-loop). •
• . . ,FROM _ TO_ ' DIAMETER 1 THICKNESS - MATERIAL
2.WcRConstructinnPcrmit>r: . . •ft R; 'di. • - .
. , list oll epplicrible writ pdiwits•fce,.Cnmuv,Stoic,•Varinrrre,fleitial err,:y,
-ft: ft. in..
3.Wclt:Use(chgcleWcll use):' • r�;SCREEN
We11 • . Fnt�M.
Water Supply, _- . .TO utAatP.Ti;R •sun.SI THICKNESS. MATERIAL .:DAgliculttual - 15Municipal/Public' ft. dt: in, I'
®Gcathetmal(Iieatin Coolie Su Supply• S .
& g Supply) ' ®Residential Water (single) ' 2 1L in. .
' ©ludnsttiallConmiereial ©Residential Water Supply(shared) s:cRo[IT
FROM . . TO . MATERIAL .1' I EMPLACEMENT\IErItODSAMOONT•
Dfctipntion fl
Non-Water Supply Welk.' . . ' .
DMonitonng: _ • - . .flRecoycry• . •. ft. • • rt..
Injection:Wetl• - ' . • ' . . . • . . :h' ft. . . .• 1 . • • .
. GI'Agnifer'Recharge ®Gioundwatcr Rentcdindon ' . t9:SA.NDIGI'IAVEL PACK Iif applicable)' • . _. -.. . - '
. FROM • TO' - . 'MATERIAL 1. - EMPLACFMF:NTmutton
IDAgnifcr.Sioragc and Itceovety . " GJSalinity flariicr - 'ft.. ft. I '
D Aquifer Test 1751ommntcrRraigaoc R. ft.
D tpcdnicnlnl Technotogy . DSubsidcncc Colarol , .. .
• :'an DRILLING LOG taltach additional aka Ifncccssan'I ' . ..
' 1:1Geotlteinial{Closed Loop) ' " • DTracer. • - " . FROM TO' DESCRIPTION(tsbr.lisIa i,unnttknnevprainsiiaru•.F
- DGeotlienual(HeatingfCaoliumRetunt) Mother(e plaiuunder 2I Retnatks) o ,,f- 15 It, FILL SILT,AND SAND
F
' 15 fL 20 ft, SILT CLAY MOIST
4.Data:Wel1(s)Completer/:'3-14-24 .Well IDif IP-1-15 (Evens). 20
ft. 29 25 ft... SILT••CLAY MOIST TO WET
Sa./Nell-[atmrtinne .- .- :ft. . ft:. .
New Hope Laundry ft. ft, s "--`"''--•,n m-,7. -I
•
Facilit)',tDisncrNanie . ' Facfit)'IDa iifappliaable) . • R: tt. • ^ D •
2100..South New Hope Rd., Gastonia, NC,. 28054 ' . . .ft. - rt.: .• \Pfl '� 2G24 . .
Pingxttl.Addcess City.undZip 21.RElitARKS', tnc_r•�_.cs_,.; s,.•- :-�.'14n, ..
Gaston - . Insitu Injections Boss 200 t.,, � �
• Count/, Paivel 1de:infic tlioo No,[PIN} - l
' Sb.);atitiide Mid Lnugitnde iit'legrees/minutestSeconds or dccinull degrtxs' • -
titbit[field,one lataoog is sttftieieio - ' •
22.Ccttitiration:'
I\' W Brian,.Elwin g . 3/15/2024
Sign'tture 61 Cdtiftcd Plell Conuactar•• , - Dates e '
.. . . • 6.Is.(are)the well(s):.DPertnancnt. .or 'XITetnporar M}• F
signntg thin fotttr,f hereb��rrrrifr that rhr rre•!!{sJ tens(Fern)nonrr»rrlerP ire mrottrmre
• . . irith 1511 NC.IC 02C.0100 or ISA NCAC 02C.02(u1 Well Constradioir Srat+dards amid that tr '
•
7.Is this a repair toan-ccimtingwell; DYes or iiNo . cosh'ofriiirrmconi has N ell prmpirlAtto•NN'rn•I mnlmlrc,
If thfs•is,o,o ir.fit!cur(crania ird1 c5oostmcrkaa Informar)on oral t:tnlaln'rlte murr are oldie • I ' - ,
• - -repair tinder#21 icmarksaeriiura or an the brick afthis form. - , ' 23.Site dhtitram or additional well details:• ' ._
•Yon may use time back of this page to'provide additional well site details or Well .
8.1\untbei of Trills cousttTicted: 7 i]ousttuction details, You May also atiaclt'additionai page's if necessary. . .
For naUlple IaJecr/on or new-water supphr•we/ta ONLY with the some consirrreriat,yoai can • ; .
' su6uur'am fore./. '' - SUBM IN ITTAL STUCTIONS ,
' 9.Total well depth below landsurface; 29.25 - (ft-) 2141. 6Lr AU Wells; Subnul this farm within 30•days of completion of.welt•
• For math/ple'µroNs/rsr all deprlis ifdrffivevlt(e.rantpfe-3@100'mull@ 1OO') construction to the following-, -
j •
10.Static water level helms tap of casing• - • -(ft.) .- Division of Water Resources,Information Processing Unit,
!Ault?urer/evens tth i e easing:ale""+" - I617 Mail Service Center}R sleigh,NC 2 7699=I617_
1I,Borchnte diameter 2.25" . ''(in,) 21b.Far infection Wells ONLY: In addu-ion to sending,the form to the address in
.24a above,also.submit a copy of this'form within 30 days'of completion.of well
' 12.Well coostinction'method:DRIVEN ' construction to the following:• I • -
(Le:auger.rdarj,i nble,direct gush etc.) Division of Water Resources,Underground Injec• tion ction Control Program,
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FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 •
1lctltod of test: 221c.For Water Supply&dnjectim Wells: •
13a.Yield(gpm) - -
• Also'submit one copy of this form'Within 30.daysofcotupletionof
13h,Disinfection type: mount: well constriction to the county ltcullh dcparimrnt of the.coiirtli�.wilero .
constnicted.
. FarW-1 NNod D.p h Carolina ana mir temi of Eonn:tit and Natural Reso times Disidoo of Water Rno m G u'= Revised Atgust20I3