GW1--03727_Well Construction - GW1_20240621

WELL CONSTRUCTION RECORD For[mental Use ONLY:
The form can be used for single or multiple wells
1.Well Contractor Information:
II.WATER ZONES
Brian Ewing viwsi to MINIRIPtION
'\'r•ll Contractor N:mk• O. 1 ft,
4240-B ft. I fl.
N( Well(onlclCalt(cni(i.akr,Niilob,:r IS.OUTER CASING(for nw,Ni-cairn nellsi OR LINFR lif&likable)
►iosi 7, TO j Dl t\I1TFR TIIICIN\FN. NI NTtet%l
SAEDACCO II. II. 'N
CO114;im N.nik `f•INNERCASING_OR TUBING 1lpulhenaal closed-loop) ,
IrRQN TO D.A.%IF wit ] rttl(I.NF". M.lTERIAL.
2.Wig Construction Permit rt: rya ft, in.
lot all app1L able well permits(i.r.County.Stair.Variance.h!Acba[es.; l - -
ft. ft. wr.
3.Well Use icI tLwelluse):
17.S('REEN
Water Supply Vicll: ►Rust to DIAMPTT.R .1.(nNvs Tint-I:NON% ; statxNI.I.
°Agricultural ❑Municipal;Publk ft. ft is j
OGeothennal(IleatingiCooling Supply) OResidential Water Supply(singlet 2 ft. in
J 1
ObtdusttiatiComrercial °Residential Water Supply(shared) IR. OUT
OM TO MATERIAL.-- EMPLACEMENT METHOD a AMOUNT
❑Img:limn ft R.
Non-Water Supply Well:
°Monn n onne ❑Rccovc ft ft. .
Infection Well: re. ft.
°Aquifer Recharge ❑Gmltndw'atcr Rcntcdia uion 11.SAND/GRAVEL PACKlit alLtlkabki
' r'ROM TO St%TYRO NI. PMM.*(TNFNT N)TU(0P
°Aquifer Storage and Recovery: ❑Salinity Barrier R. ft.
°Aquifer Test ❑Stomw'ater Drainage •
ft. ft.
OExpenmental Technology. ❑Subsidence Comm!
j 20.DRQ.IJNG LOG(attach additional sheets if nemwan t
OGeothennal(Closed Loop) ❑Trust nost TO PF.cRIPTIuNI,..br,fordo...,,..il'nnI.t.p,r.o•rw,bet,dt.)
OGeothennal(HeatingC'ooling Return) ®(Ater(explain ulster 021 Remarks; ft. IL
I ft. ft.
4.Date W N(O,Completed: 4-24-24 well 1DNIP-D-2-26 (EVENS) , y`,a. `t�i i�W
Sa Well Location: rt. I
JUNS 't�O�`
Rays Grocery fl. rt.
Facilm'tlw net Naar Fac,bv.IDk(ifapplicable. ft. ft. -re
�ii�
(` JI 1[r(v:TA ",'•
1674 E. Main St., Sylva, NC, 28779 E R I fl 01,i ilT ''
Ph,shot \ddnnss.(its.aid Tip i 21.REINARts
Jackson DPT INSITU INJECTION; INTERVALS 6-12'
Coon/) Isrncl ldclatfrcarku N. !PlNi
5h.Latitude and longitude in deirreesiminutcsiseennds or decimal degrees: 22.(.ertificatton•
C ii
tl oc .Id rim tat lone r.,ldfuxull `
N W Brian Ewing; 5/8/2024
Sisnatine of Certified Well Contracltl Date
6.1atare)the walls): ❑Pernranent ut %`fcmplrrar'' gr signing this form,1 kerrb'crrsifr•tent the wear,war lwerrl cYn nmis-ted so accordance
WO 114 NCAC 02C.01110 or 1 SA NCAC 02 C.0200 Well Consort;non Suordords um!that a
7.Is this a repair to an existing well: l-es or END raps of this record has hers provided to Ow well owner.
If this ri a/rlklit,Ni”eit(n„wn w r'l l,0I1,:'i,1 71,,I,7111.Iros,r71,1<UN/rrplaal tar/swore r f tltr
repair walrr 121,rsna,*s section or on the bo.'L of this pent. 23.Site diagram or additional well details:
You ma% use Ilk back of this pogo to provide additional well site details or well
S.Number of was cOnslttcted: 13 consttuc(ton details. You may also attach addmoual pages If necessary.
for multiple infertlO o Or man-iOl rr rapid)wells ONLY„7di ow some rowsrrarnow ,.':n<,1„
reboot.me fom. S II.IBMITTAI,(NSTUCTIONS
9.Total wdl depth below land sontacm 12 (ry-1 24a. For Al Well(: Submit this fomr within 10 days of completion of well
For multiple wells list all depths ifdi rent text:mph-?W200'soul 2Ee1fkt') construction to the following
ii.Static water keel below top of easlnv (ry.1 Division of Water Resources,Information Processing[nit.
//noire level is(rir nor casing.ass"+" 1617 Mail Service('eater,Raleigh,N( 27699-1617
II.Borehole diameter:2.25" (la.) 24b.For luicetlott Wells ONLY: In addition to sending the form to the address in
24aabore. also submit a cop} of this form Nithm 30 tins of completion of well
12.Well construction method:DRIVEN coustniction to the folbwing.
Ii c.auger.rotary.cable direct push.tic.)
Division of Water Resources.Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Sc,-'.ice Center.Raleigh.NC'27619-1636
13a 1"irid Minn/ Method of test: 24e.ForWater Soppli A.Injection Wells:
Also submit one cope of this form within) 110 days of completion of
IJb_Disinfection n pe: Amount: construction to the corms county health depanmcnl of the co where
constnictcd
Form GW-1 Nonh Carolina t)q xinawiu of Ens uonarnr and Natural Resources-Do spa of Watcs Rsotna Rt.reed Acgrsl2(tI1