GW1--03740_Well Construction - GW1_20240621

WELL CONSTRUCTION RECORD For Inernal Use ONLY:
This form can be used for singk or molt ink.reds
I. Well elintractar Information:
14.WATER ZONES
Brian Ewing IROM TO 1 P!S('RIITION
Well t'ttlnci,r N:,nw ft. ft.
4240-B ft. ft.
NC Wen Contractor Certification Number IS.OUTER CASING tfnr multi-cased nelhl OR LINER Id apE ksblr)
Il1ost TO PtyMETFR THICKNESS 1 MkTEN141
SAEDACCO ft. ft. is.
Cannon)lame Ir.INNER CASING OR TL'SING lxemhrrinal closed-leap)
ROM TO DIA METER TIRI('A\FSS MATERIAL -�i
2.Well cosatttrct(Dn Perl)*a: WI0100715 ft. ft, in.
lilt aiappli,nbke wolf pens,/,ti.r.Court.Sralr,Variance.Inje tint etc.I ft. n M
3_Will 1"s,Riled:well use): 17.S('Rlt N
W atcr Supph W chic MOM TO DIAMETER SLOT WE 1Hl(T(t4I1C!I M.\TRRtAI.
ft. A. In,
Agtt.ulnual DMuncipal.Public
IGeolhemtal(Heating,C'oolim:supply) °Residential WaterSupph'(single)
R. R. In.
ilndustriallContmercial ❑Residential Water Supph Ishtred) Isom
ntOM TO , MyTERIAl. EMPLACEMENT MET110DA.\MOUNT
❑hnpatton f. ft.
Non-Water Supply Well: R. R.
❑Monnonnt ❑Recover' -,
Wet-lion Well: n. n.
❑Aquifer Recharge OCiroundw:atcr Rentcdiation IA RAND/GRAVEL FACIE lif app1icahlel
°Aquifer Stooge and Recovery °Satinets Hamer rrtspM TO M yrr xr I% rsln.sLrMryr METHOD
R. ft.
❑Aquifer Test ❑Stomps:Rer Drainage ft. ft.
❑Eysenntcntal Technology ❑Subsidence Comm! - -
—
U.DRILLING LOG(attach additional shads d uecessanl
OGeothcnnal(Closed Loop) ❑Tracer INos, j TO IleSCRImOS,toter,h,ran,•..,wil'n,.l apt. ya ..n.010
OGeothcmnal(Heating.+C'oolittg Return) Elthher(explain under#21 Rentalla) n
R. ft.
4.Date W'erht)Completed: 4-17-24 Well IDNIP-B-2-26 (EVENS) _ _
5a.WdI Ltocation: ft. ft �L?i,.: : L
Rays Grocery n J
. ft. UN 2 1 2024
Facilit Ow net Name Facility ID#(if applicable) rt. •—'
Intsv a r,s 19.0E -
1674 E. Main St., Sylva, NC, 28779 rt.] h.
Physical A boss City.amid Zip dA Cd'�L v
2L REMARKS
Jackson DPT INSITU INJECTION; INTERVALS 6-12'
(cowry l'.ne l Idc,d it c,4bu NO.0P1N i
Sb.Latitude and Longitude in Iktrmsiminutcslsecnndc or decimal de-grees: ,,.( ,.,tilt,.ati,,,,
•11 aa.i:had ,tit hat h.n_r r.,tdltr,c,l 1 .-
N W Brian Ewing 5/8/2024
Sid:.air.•of Cenified Well Contractor Dakc
6.Is tare)the wellls): .:Permanent or %Temflrrran Dr.IliSning Nair jdsn,I hereby certify that the wdl(xl In./(inrl e.mrtrarted in accordance.
with I SA NCAC 02C.0100 or 15A NCAC 02C•02(0 Well Construction Standards and that a
7.is this a repair to an existing well: :.. \es or A No rope of Ai,'ward has been pmeided to the well ouster.
if rho n 0/t•/xrrr,Jill,aH(r„wa wall..",.pn..hewn n17•'.ou.r..o ;ual r.pif,pl tic'IMrr,,r of the
repair under 121 remarks sv riun or(MI rho hark of this form. 23.Site diagram or additional or l details:
lbs.this use the bake of ibis page to pros ale additional sse11 site details or welt
S.Number of wells constructed: 13 construction details. You mas also attach additional pages if 1lesessan.
for mah,ple+Accra#1.N rr,w-wwte,rwppl.wells ONLI with the ruse crinllnpcho.'wa,.m
sabnin,,,r font. SL!IIMI1TAL INSTUCTIONS
9.Total well depth below land surface 12 (fit,) 24a. For AR Wdhg Submit this form within 'Ut days of completion of well
For malrrple w,.1$tut oil depth,rjdderent icranpfe-3@200'and 2D 100'V constmctlon to the following•
10.Stalk water kscl below top of casing (ft.) Dis-isiun of Water Resources,Information Processing I nit.
lr no,r.L•,rl n rh..,r.; .,:,< ;, 1617 Mail Service('enter,Raleigh,N('2 7699-16 1 7
I I.Borchok diameter 2.25" Oa) 241).Fur Injedon Wdb ONLY: In addition to sending the form to the address in
24a abose. also submit a cops of this form within 30 days of completion of well
12.Well construction method: DRIVEN constriction to the following.
,,c auger.rotan,cable.direct push Act
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Scr.ice Center.Raleigh.Ni 27699-163t.
Wells:
13a Yield I1Sfrot) ‘Irchad of rest: 24c.For W ate,.Suppl% 8.Injertiu�n
Also suborn one cops of this four withm UI days of completion of
13b.l)isinintiun type: t mount_ well conetmcnon to the countshealth department of the comas where
constructed
Form OW-1 North(-militia Ckptuonem of Ea Inolulrm WA Natural Resources-Diynbo of Water Re Olftl s Re.iced Au ust 20I?