GW1-2021-01040_Well Construction - GW1_20210305

WELL CONSTRUCTION RECORD n\L,
I hi.lean,an ho u N art:mgL e+muh:pl.well.
1.Well Contractor information: _
GaryJustice 1 f4.NtTERZONFii
FR,I,I t1 nFxs afPltnx
Went Se°I. 330 "• 340 "• 20 GPM
NCWC 2150-A "
\t'w 1111>Mraaarz l:rntka!>m\cmlcl IS.OI l ER('.LSIS( Ifar meYFcased w, (/R LINER R $ea1J
inuw lu_ UI_.MMA I_IIN_L\F.0 W AfEA1LL
Justice well Drillin9. INC o n "'64 61/6 S C --
Le�prn.xamr Ia.IN- C'ASIN OR ft.RENc ralbrrnal cha
SW20-0499 .Nr„t 1,-- -_MAIIIII-K 1tIRK]L51 ,IAILNL,.
2.Well Construction Permit a: ft. I. " !
L+.refril'l,(InIN, urkprnnr.arf...um Sane.rxriea.. Lrn.;,.,, ,., la -_ {
11. 11.
3.IA ell Cse(check well use): 17.SCREEN
_
INU,1 Itl I UI NIl1lN ,l(11412 Illll
Water Supply'Well: in I
if.
L'.AgnculRlml LJVumepal Public _
u(icofhcm,a IHeafingCw, hng Suppivl A(IteaWautai FA;dcr Su N pph mgeo it. tf.
LJhsdustnai Comnwrcial LJRceideropw%k JNr Supph lsharcdi IL CRMT
MINI it, V1f.RFAI. _F.,Ie1.M LSIEV,IETIII1Da AW(R\f .
utrri'adon 0 1'- 2 R. Hole plug 1 Bag Poured
Sup
\on-tion l itil: Well: 2 1 22 IL Easy- Hole Plug._I• 2 Bags Pumped og p ured
LJNonmuin. 1-iRcco„r, _ �
Injection wdl: 60 " fi4 "
LJAquitcr Rechange L'Grnundual.r R,n,cdialion 19.SAND'6RAF'EE PALK(if.pplu.blel
%, INuw In NU Lai%I E4r1_Ae'LNIl.0 4I,INW.__774
LJAquil r Slomge and Reel,,cr, L!Sulinity Huo
me I It. it.
uAquikr lest u5connuat,r ikmnage r-
IL It.
uCxperimental Technology ulubud,nc,Control
b.DRILLING LOC In"a aAdltloW Jena its m
Uticothemul l(foscd Loop, Li race, fRuw u, ok,(NIPIItI\ rvY.r beda.,....rtr+rAnw erM sae.111.1 i
U(ieothemul ille+ltin'C.wlm'Retuml LlUth,r te,+lain onda"Cl Remark,t 0 "' 12 "' Clay Rock
2/09/21 T 12 It. 60 I,. Rock with very soft breaks of dirt
4.Date WelUsl Completed: NeIIIUR_ Lot I �1
Lim.FF ell Location: 60 u. aos Granite Quarts
R.
Creston Development.LLC / John Nelson
(a dn3 OwmrSun¢ Izulm.IU �po.!whci
1851 Creston Dr.Black Mountian N.0
Yn -el lJdrc.r,l:rv.amt/!P 21.REMARKS -
McDowell 063800835260
1'IN,
3b.Latitade and Langitude in degreesrminutevseconds or decimal degrees: titication:
22. r
ul x F.:Iic J,nm In Ling a.._I:w Imo
35. 583898 N -82.233282 FF � 2/09/21
sc,n,11 1 IT talc
6.1s(arothewell(s): xemanent or Ulemporan
.,.. •I]. a „-v ,,:�, .. .,I ,di. .Y :'H.nrlrti,n.rnr.r .,amJe.n.and chine
7.Is this a repair to an misting IncU: Liles or X\o •ry r.n.::.. �;.t e:er r,,.:rn .:.r.d o.•l, r;L,.:n,:.
ry rA) , arv7.xb Al!I.,k on, r n,•nM-,, I✓W. ! _ l. .unit .•.n.
ro- rMl r a_'f n ih,"I,t,✓r r 23.Site diagram or additional well details:
1 } n,a,It,,the bud of thi, p:,µ, m pro,lde additional well site details of well
$.Number of wells constructed' eon.lmdmn Jcl:ulr. 1'eu ma, abo.mach:wdinonal pagcv d n cs's.<•lls.
I...eebgd,inn'.I................a
•xn.en.u,r h'nn ��jj 51 HAD1'l't p l.INS l C I'll/N]
9.Total well depth below land surface: 405 Ift.I 24a. For All RxW: Suhlmt th;e lone , nhm 30 days of eomPlena,of well
f.rrn..1"4"�',I/r IT"'III eh re°. v,r:4.r„a 1.nrn,rc,..I'I P." I'd t .. r, ,nn.lnmti.w w the lLllowing
W.Slade Water kvel below top of casing: 140 (if.) Di,lsion of N afer Resources.Information Processing Omit.
11:,.rrr 7r:.;n er.u.,.,.6, u, 1617)tail Service('enter.Raleigh.NC 27699-1617
6 11.Borehole diameter: (in.) 24h. For 1.cclion It'ells O%IA: In Addamn to sending the than to the address in
Rotary _.,a aka,,. al.a ,uhmit a nqn .d d:ie lnml within ill y„ of cs.nlpidion of well
12.tF ell construction method: cun>Imctlon to the IJilauinl:.
I..;.111F11 Luce euJ:.;I. ,
Uirision of Nater Resources.I.ndt•rgtuund Infection Control Program.
FOR IFA'TER Sit PPLI N EI-IS ON1.1'o 1616 NIail Sertice('enter.Raleigh.NC 27694.1636
13a.I"ield(gliml 20 Method of Lest: Air 24c.For to stir Suaoly K Inlretion 1%'e'ils:
NI"I .uhuut one Cop, at this I;mm ...thin 30 das°otcompletionof
13b.Disinfection type: Clorine 73U/cxmounC 8 OZ „dl ,onarurliun W the ,aunt, health depanmcni of the county where
.uudl u,t:.l
hxmfiW-t \enh/ Ind N,t,r.!I K:.mtr::. 1lnsinr.,.!Neer K:zour.;. Kc,i,cd Augot!(it3