GW1--06427_Well Construction - GW1_20241025

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WELL CONSTRUCTION RECORD For ltQ.nutlUseONLY: .
Ms fonn can be used Cox single or multiple wells .
1.We�ll.Contntctor Inforotation: .
f.t411VATERZONES- - '
• Josh Holt . . . . FROM TO DESCRIPTION . '
WdiCor4rUtofNante ft. . ft. !
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4698A -. ft. ft. 1 i •
NC Well Contractor CaratCoitionNuiubcr • ' ':IS OUTER CASiNG(for hill ea4r I Ctis)'OR LUNER(tt:ait lieabky• '-
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FROU TO DFAdtQBTFR THICKNESS ' HATEnLit."
SAEDACCO 0 ft. 5 ft. 2 i la. SCH-40 PVC
Cut uryNonq :I6.INNER'CASiNG'ORTVBING' oolkcrmalelnscd-Ioo•). '
FROM TO DIAMETER THICKNESS . 8Li7ERIAL
2.Well Construction Permit#: ' R. It hi. •
' • Lust an applicable Wtdl peiieits(Le.County.Slate,,Variance.Irfecti l,Or:) .
- 'ft. ft. In
• 3.Wcl1 Use(chcel:Well usc):: FL SCREEN .
Wiser Suit*Well; -
-- FIWM . '• TO . . Dt%METHR.i•St.OT.S17t: . TIItC'KNl S I-MMATRKIAt.
IDAgticuftural . i iMuuicipakPublie 5 R. 20 ft: 2 /n, 010 • SCH-40 PVC
DGeothemial(1eatinglCooting Supply} . OResideniiat Water Supply(single) ft. ' fL tn, I
©iudustrialiConuttcrcial L . . ©Residential Water Supply(Owed/ 'Y9:GRot}T. -
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FR03f' TO biATB1rPAI. E\IPF.ACEIefEVT METH"'
S.LNO[tNr
Dkitpntian . 0 it. 3 • ft. Portland Pour '
' Non-WaterSupply,Well:, ft {
I10Monitoiing • - .-.ORecomrty . . '
- Injection-Well:
ClAgnifcrReciiarge ' . EIGiouodwatcrRcntcdiation i9 SANDIGRAVELPACK(iifuiipIKahtpl` ,-
_ FROM TO " ' I bIATHRtst: ' tOIPLAct:{IKNTwatIO l
l7Aquifcr Storage and ttccov'ety. flSalinily Hamer. 4 ft. •20 ft.' Sand 2 '
. 0AgpifcrT4t ❑5torlmratcr lrtinagq •
ft. ft, i,
❑hxpedmcnlal leclltiotog}' 17StdiSidCriccControl )•io DRILLING:LOG(attach additional sticdcifirrcenarv1 •
❑Geolltetitnl(ClosedLoop) _ OTracer FROM TO DESCRIPTION tiubr.hanrnca.wR',+nkttne grab eue.dc:t
- .. LiGeotltettnal(licatiing/Cooliu> Return} ' 170iker(e plaits miler#21 Restocks) D : ft. 10 ,ft. brown silt - •
- - -10 ft 20 ft.. saprolite, •
•- 4.Date Well(i)CoutpleIcd: 10/15/24 Writ 1DtlEtw-3R. • r __
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. R.. fL k -.< > ,
$:1.WCII Locating:.. ft.: ft. 7•- ••�.` )A`•,••, _.
King Fuel Oil Company- - ft. ft. UC,, I 2 'a 2024. .
Fw:tbi}'Oiviicr Nmt_w realty lDk{f-niliticubie),
R. • ft,
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. 125 Meadowbrook Dr., King, 'NC,• 27021 It _ ` �'r r ?! ;_
'131q'sicai Addrss;Coi-.ani Zip• '�2t'1t ttARKS',. - '' - _ .
Stokes - '. ' ' front
Bentonite' seal.: om 3 a 4.. '
Coatdy - Parcel IJaiiificIlion No:(t' -j •- -
Sb.'lattitads'and 1,oagitpde ill'tic /tninuttls+ecnnd i nr detitttut degrees; . 22;.Ccrtiftc01111er,;
{t'Soli'ftrd,rW _ililvtr3•tst lfiele til • • 3.4. •.W 44 . . . 10/15/2024
• Sig0 d r1lCanirrctor` • ' Date
. f.'is(are)Yhe.-well(s) itteennuttcnt or DTengrorou.
' dy.s{b-riruq:01.iJtmt+,rhereiv eCrliJv,rdarJ slit dirP.[�J kits,tpirakJ:xarutni��ir!dirx�y�,mLrmr
With,I3/C RCAC fd'C 000 ar d5rl NCr1C a2C O2O1 Tr_fI Coirstrtrcnw1 Srarkidn#trlld Her1.4r •
•7.IatltiiaiNpitir-to an.existingwd11 • DYe_9 or ECM, tnpy-ofrd4'rraeiy1..da,4itri mrul,.rd.;:iiWvdlmrikc
lf!iWs.dronrxxtir.fig rwftrianiitilcoa mcc7ivn'dttfo 'a h ,rim icfidahrihrrulrllreofcfit . ;••
repair wititer63l.r r,r,1;.0kifitiri Or iyi te'bcc(ofrhiS flan,. 23.Site dlupririt or atldiiional Well*tolls:, '
You nta}'-use'llto back'of this i ge;to•pro lde'addiliotiiit;di'ell site details'or Well
8 I notherof dills eottstntetesl: 1 'constinctiun deinils, 'Vou nta?•aLs attach 4Iiljottat pages'if nNesstif}.
Forriiaiiiidk Ink.rldtnstrtttr+t-uiiter.IIuppdervrf OVLY with rhe:RmrertutsrrtrrtiNf,cohrlrir • i
iaMi.taom facia:. ' ' ' 'SUBMiTTALINSTUCTIQNS 1
• 9.'11'o it drjitli heftily land auifuce 20 ' . - or,,) 'gas-l nr-All Welts:.•Sitbtitit th 61-Wis thou Within:30 dags-of-campteiion Well Il
hbriirithus!riiy14lisgaldifoptdrvffdditaro'rrlarttrrtyfr? ?.00..'f.Put 2(r•I711'►' - •Constnictiontotitt:foItotFing: 1' I
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. tU.Statitiyater level beliine tap ofursiug (ft.) • Diviseun of Water R•esource t,Infi rnritinn Processing Doh,
iflioierleui�!di uburr cvrsin,;;tisr +" .IG17 Mall Scri'ie '',Center:IIalefgh;NC27699=I617'
.11.•Borclwfedisnwlr:8.2p" .au. 24li.j rr..fujl,lit Welt.ONL• Y.: jhi,actdition to sending Ilk lotto to thedddtess:in .
24aab-o a also submit a.'copy:'f this fonts icitlnn jO•dais'of completion of well
1a.Well,cot'stntctton method: RSA coitsttuctipn Co tIcefolloiyinL
(ix.mtFcr tni try,wb1 dim,i push ctca i)ivislnu of Water Reset.trces;;Qnitergr uund I jection Control Prograw,
FOR WATERSUPPLY WELLS ONLY: 1636 Malt Serilce'Center;Ralcidli;vC 27091.1636
13:i Yield(Om) Rlctllnd of tr sf; •
?4e.'Far Watei,Suppb'I.%i9jccfon Welts: •
•Also subiiut one copy-of this-loini:rcithut 30 day's;of completion of
13h.flitinfectiun ty-poi Ainquntir well consunctiun to the county licph d ltciruimm rnt or tile-county whim
-' - .conitniaccd.
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. FunuGW-1 „''glilt Carolina D.,pafsemofEnvInnut a and Natural ltc¢otuccs-Diviiiimof\VatdrFl tttm Rcc-tsed.41112UL4
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