GW1--06407_Well Construction - GW1_20241025

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WELL CONSTRUCTION.RECORD
. Fat[tacntnl Use ONLY:
' Tbis,farm en be nisei for single or nudtipk wells• .
1.Well Contractorfnfcruiation:
' • :t.rrtYATER ZONES -
Josh Holt FROM to I)CRtt?ION
. . WellCortitactorName R. R,
ft. ft. I
4698A 1 ,
NC Well CoNmetara`cnifrcntionNruobet ',ES:OUTER CASING(fer.-c utIPessed"tscitsl'ORLINERilf:anhflcabk):
in0\E TO • DIMIETKR. ' virettNyss' \TATEMAL
SAEDACCO 0 ft. 15 ft,. 2 l f Is, SCH-40 . PVC
Ceinan.Naete -IC:INNER CASING ORT)HtNG(euthenist dosed-loop' .
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EROM TO DLAAIETER THICKNESS MATERIAL
2.Wdt Construction Pertuit t: •
ft. ft.
List tr$appticable urll pe►ireits(Le..County.Stw'r,.Variamrr,IRkelicr4 etc.)
. - •R, ft, in.
3.Wdt Use(chccic nrll Toolr . . 17_sc N
Water.Supply Well: — FROM . 10 DIAME'r'RR S OTStn. TNIC:RNLSS i \IATRRt'AG •
'15 ft. 30' .R. 2 in. .010 SCE-40- PVC
InAgticulturai . ClMunicipallPttblic . •
DGeotiteTntat.(HeatingiCooling Supply) ClResidential\VaterSupply(single) . f* f. iti
- ®tndusiriaUConmiercial DResidential.Water Supply(stated) ,-tB:GROUT. . - .-. . •
ilaOM TO 1rATBRtAL EMPLACEMENTMEiUOD&AMOONT
❑ltri titian 0 ft. 11 ft.: Portland Pour .. .
Non-Water Supply Wen; - .
R. rt.
�INonitoring • . • . . . °Recovery ,
Injection'Welt: •
0 Aquifer Rcciaarte ClGtotindt cr-Rcnicdiation 't9:SANDfGRAVEL PACK rtfutrpticnhtei' - .. . -
FRo\i - .TO . MATRR[AI; E\IPIAC:I:t11:NT MI:TNOS
ElArtnifer Storage and ltccovcty . 17Salinity Barrier 13 ft. 30 . ft. Sand • . ' 2
ElAr{niferTest ❑Storm atcr.p ainage -
ft. ' ft:
• ElEnic ilncnhal Tcchnotouy t7Subsidcncc Condor' .
'30 DRiLLING'LOG(Math adifitierial Sheet s if itecesmn'l- .
DGeodtenmal(ClosedLoop) DTricer . - . .inoNt- to DESCRErT1ON(toMr.dardnct+,uuRWrckhnt MF
D . enAge.dea•
Geotitettnal{HeatinelCooliug Return) . DOAter(explain under 421 Retuati s) 0 ft.. 10 :.ft, brown silt
10 ft. .20 . ft, light,-brown silt
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4.Date Wells)Completed:' 1 l iDft 0/14/24.. We MW-1
20 ; ft, 30 ft, saprolite
Sa.Well Location: ft. ft. • -
. • , 'c....:�i.....,,-;1._.. , `t' 1,,.'• . •
Turner Oil Station #4 • 11; ' ft,
Feci14;Yliyti i14,1 Malty IDN(ifajrpfi able) e
.R. ft, `'
. 332 E.-Main St., Wilkesboro, •NC, 28697
• 'Plg3icnl Aitdicsss Cites,and Zih ,%at;:RE ttARtt1,. - -. _ _ is ra,.,:__.�:
Wilkes bentonite chips'£ram 11-13'
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conoty - ?nee ltritvu No;(PI } ` • 1•
• Sb: Il.atiludeatirl ongitude hi deer es/mitiut s citicct}iiaiordecinial dcgrct»s 22,Certitic:atiim:.
N .W 1,,,,,rdA:a. L L. 10/14/2024
• • Si§igneniDfCM19#1.0E�ll Can-atter i pale
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• 6•Is(are)thetcell(s): SiPern anent or...DTemtiorarp-
rt1••skinias:rhuJirrn,1.hetr,.iro erenfy;rhat tlrr riYlif,iI g-rtt:.(wrae)xarutrnrr:ed JR hystor encr
nitiY I3A IrC4C(PC WOO or!SA NCAC U1C;d410 IYr(l.Coltafretc(fon Sr rd err((.t errid•tiiax er
7.Is this.i r.pair to nn existietgwelli. CJY S •Or ISINti. crpr'oJ'rhiO rrmwr.h rs iw n prorkdi i rv'ifia iirlf miner:
- If Ws it a rrp..1lr.jit!Agtrtaurt Wilt onor-mirifrrn!Monde Ih r illy/ticptabl ihr lttmere of(At
r vtedrreitikr4?9 r,iaiF., irtlrmi Serra 1:heliakt i fhii jarne. 23.Site diagram or additional well ddaltr;
You ttia}use the back'of.this page'to proude addiiiouut well site'details'or Well
S:Tutuber'ofwells constructed: 1 cou ttucnon details You ma}also•attach addititntal pages if IIecessar,l
Fortin{!ige.h;Jr:etlioi!II rh8r-timrer,trl0 tr ii 1ltOh'fitwithrilr:Hri0eRitortriItrtr,Yontear • •
a ibnu7+riw far,:: .SCIDMEflke. NSTUCTIOT1S.+'
9.Tatul:'arlldejrtli nervily-lanitaurfac 30 - (ft.) 24a: Nnr:All Wells:-. Siibtitit this form within-30 days of.Completion of Well
Fir nrals#ple w•rilrliur all 41Vrixr f/dljlnror:0Ctiwplr T©v0ir annl220PlWD')' construction to 14c follottit'0: '
. IU.Static water.let•et below top of easing (ft;) - Die•isitin cif Water Resqutces Infortuatiaa Processing Unit4
tf crinierlerrl tr abara easing'tiara +" E617.Mail Smiec-Centeri It aleigh','NC27699-EGt7
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II Intonate diameter:8.25" ;(is) 24b Ftir Cinicctinrt Wstts.©NLY: Li addition to sending ilk;foul id the addira?:ID
24aaboe:also submit 4-copy of.this form tsrtliin 30 days'of cotu(}Ienron of well
12:Well.00ntauct(ou tfaethod:ESA - oustiucrioutothc..followitti: -
(i.c:uttecr,retaiy,Table'ditty t prrsti etc:} .DEvi-koit of Water Resuttrecai Uudc rgiuuud n it ctni Control Pin tvin,
FOR WATERSIIPPLY WELLS ONLY; . I636 mail Sc%lee Center;Rilleigh;NC 2769Q-1636
13a yield(glint) ;4lcti�ad'nF fc9t: Ile.Ear Watct"Supttlt�&.litjectton Welty:
Also submit one coil* of tnis.foilii.within 30 day .of completion of
1311.111sinti ction types Aiut(unt: hood cgnstioction to the enmity health depot :pent of tits.connty where.
coostdtcted.
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Fartu GW-1 Npialt Cam110 pe,putmciu of.EDvirimund R awl Nana!Rerourir'cs-Divi;iuu of\VAIu RipatTetn Revise!Attguwilit 1