GW1-2021-02345_Well Construction - GW1_20210527

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WELL CONSTRUCTION RECORD F'If` rnmlU-ONLY:
This form con be a5ed f�nr 5inglr;or multiplc wells
1.Wei I6ntratctor.litformatlon: �
U.WATER 20NFS
Brian Ewing FROAf TO orcSr..Nrv(tetl'
''01 CurttrncttyrNaine ft, fl.
ft. ft.
4240-B
NC Well CommetorCcitif ellotiNionbea (5.OUTER CASUNG ror" uHi=c9geA%Yctls ORUKER(if.a ficable5
FROAf TO nr,AMETER THICKNEss A[ATLRJAL
SAEDACCO Inc 0 tL 5 ti. 2" in. SCH-40 PVC
�,nt�! - 16.1'NNER NG(iR TllFflNt`: 616 irm' Y1 tkised-liii
dam 'hanic
FROM I TO U&NIETER TItiCKNFSS MATERIAL
2,Wt4l Constructinn Permit#, R. I tt. I 6L
fra fill ag,a hraKrmr.ill rivin(i4r. Cnunrv.Sudr,Wirialive,1je:do elf.-j rt. is
3.w4i-Use(Chock well use):
Water Supphv WC4t: - FRO,rt TO 1:niAAt1KTl tt st tn'grsr; Trirt?VCNTYSS MATKNIAt,
D Agaicu titrai ONU]".icipallfflublic 5 ft. 30 (t.- 2" in .010 SCH-40 PVC
❑Geotlt rural llemuriooli Supply) ❑Residential Water it. ft in
( � n3 St� pPh'{single)
❑tndustriallConwerrial ❑Residr ntial Water sn Ia.M.0ff-
fib.(stmreda FROM TO MATEN1Afi EAfl?1A VMENT Mf;MGD B AmouN-r
❑lini ation 0 fL 3 tL PORTLAND POURED
Non-Water iSu pl)ly Well:
�1Ngnitctrin ❑ltcccrtr.• ft. tt,
Injection Well: tt
DAqu*rRccharrc Wrixindst'atcrReiucdiation (4.$AN5]GRA-%VEL1'Af-'1±O ni icslble
- m _. nfn�r►Ltttal. .._ _ ��rn,aS};tlrvTntt.tuttn---
❑AiintfCr StGTR;t'anA Recoti�ry' QSalinily Borricr ee I"4 fL. 30 ft. FILTER SAND # 2
❑r>�tnfCr Test- ❑c5ti1r11tR71teC f}rtrn;t8c
❑Experimcntal Technology ❑SnWdctwc Contral.
34::DRILt ING'LOG'(attachmddifdrrotshediifre ram- n-
❑Geodiettual(Closed Loop) oTrcer cR2af TO PUCIUMOs rlcl
❑Gbotherfnal(Rea it Cooliue Retinn) ®other(implain ander 1121 Retnatks) 0 ft. 15 tL fill Silt sand clay
15 fL 30 ft SAME
4.Date Well(s)Completed: 5/5/21 Well11 #GP-lA _ e�
5a.W t.11 Location: (L it.
McDowell County Landfill fL tt
Ftrc10y)0ra'rrer Narw- Fad1hy 1D k Cif a pplWblc)
(L f1. ►;,3 onn PC Iessif1.
3849 NC-226, Marion, NC, 28752
VkysicolAddrem City.arid Zip 1t:ltFhtAltk$ _
McDowell LANDIFLL GAS PROBE; BENTONITE SEAL 3 TO 4'
C��AtNt}' . ,: YAf��11A.=ditifiGlHRr�NO,(lrit�l ,. , ,
5h:l srk Wde'and i,nuptude in dcgrceshnimatcsliecrinds or decimal idt&=-. 22.Certiir'rraiion:
field.,*fit 1.1001V is sadtickill)
W _Bria.n._Ew n, ,, 5/12/2021
sigmwrz ofC�ertirmd Well Conttaciar Date
6.Is(are)the well(sy $Perm ment or ❑Temporaty ph:sdga ing All fiamr,t herel i.a'erf f¢'roar Me imI4-o was fl4rm.j wris r iciLd in jivronkmer
u'uh 15,1 NCAC 012C.Ofrk)or t Sat ArCAC NC,0209 Weil Consima roar Stnrnfards and Mvi a7
7.Lc this a repair in an a dstin well: ❑Yts or K No raSm ilfrNr rorconf has bem plrori*41 rlt Ar cart owner,
If INS,it 0 repTir,flit 4mrkaafom well cmrasr€icda r htforrranfion tvAd eapdotn the rieruFe of the
reWir retider Oil rem arks seafim or ran the bark r f this fornc 23.Site dWram or additional well details:
Yotf may use ilk back of(leis pay to pfo'id'e addii(ional SIelI site details or well
8.Number of yells constructed: 1 construction details. You ma+'also 11112rh additional pago s if irecessaty.
For ma Nple Ififee iaui f*nwp-urarer Akppl r wells ONLY rrtrh the mme a r4rrstrari4tlon,xw ram
AwNi dr acne fora. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 30 (n.) 24a. For All Welk- Submit thi's form within 30 dkvs of afmpletion of well
For construction to the follming:
10.Slide Water level below top of casing: ((y,) Division of Water Reim rtes,Information ihnce4sim8 Unit.
tf itvrrrr level is above tdidagt eaxr +" 1617 Mail Service Ctoter,Raleigh,NC 276"-1617
11.Bare6tiic disrnctcr 8.25 (in) 24>t,Eqr�Welk ONLY in addition to sending The form to tyre address in
24a abin'e. also submit'a copy of this form within 30 dai-s of COnfpletialt of well
12,Well constmetion nw—Abod: BORED Construction to the fralloiving:
(i.c.auger.tutor}'.cable:direct pusle etc.)
Division of Water Resources,Underground lnjectlon Control Pnoglfn,
FOR WATER SUPPLY'WELLS ONLY: 1636 Mail Service C"enter.Raleieh,YC 27699-1636
134L Yidd(gpml MC4104 of test• 24c-For Water Supply&inlc0f4n Wctas:
Also submit one copy of this faun tnilbin 30.d#s,of.coulpletionof
131f.Ditinfectirfn hp� .. _ «ell crrnslnrction to the county tucaitit departmefrt of the ccmnty whm
_ __ Amount _ ___
constructed,
Form GAT-t Noah Carolina Depaitojeni of Emvitaivaeciu and Non"lkm,mrcxs-Dh1sio0 of Wrnlo r RMLrcm Re Mit August V13