GW1-2022-04874_Well Construction - GW1_20220525

WELL CONSTRUCTION RECORD Fer Inzwl Uec ONLY-
T16 f,1nnc3nb,.
1.Well Co"Intctor Information:
F I-LAVAT11111 ZONM'7
John Eisenman FROM to DrICIUM01%,
VV01 coleucwr ft. ft.
4439A ft. ft.
NC fill Cu irworCcaffiwilion Kindler t&'OUT M, CASING` 0 tuish ki-cillx%dMs OR LINER,fit,a
FROM 1 70 PEI,;FTKft THIM-ass I MAT"41A],
SAWAMO Inc 0 it. 1 20 CL 2- id. SCH-40 PVC
l'aa tam Nallw -16.INNER CASINQOR(
Fn0�1 yip Dt%MFTER: THICKNESS I MATERUL
7-Well Construction Permit 4:
ljjrf all iqjyliaible%eli penuies ji-e.Cowit.r.St e,lbrialwe.11,yeCdc'n eir.)
3.Well I.Ne(Cherk well itse):
41SUR KEN
Water Supply WL41: WHIM ITO DIA'-IKTF:Tt I SLOT SUT I THICK-sr-N... mAT1--,t7FA1
1JAgkultural 20 ft, 40 fi. 2- in, 1 010 ISCH-40, PVC
0GO(Itcultil 01catiog"Cooling Supply) EiRcsidential V61atcr suppky(Single)
DindustTiAlCounucirciA OR cqdcurial Warer supply(Slumd) AWGROUT
FROM MXTERDJ I
01niption 0 ft. 14 IL Portland Pour
Non-Allater Supply Well, i ft. If.
011ouiloFingr 011ccovery
ltijLclion%Vell: it. fl.
C1AtjuifcrRccharj,,c OGromridmucr Rictwulizaion 0.SAN D.-GRAVELTACK i1i-avtdirable)
0Atptifer8tori�c;uwJRccovcry O'Saliniti,ELirder FRoll I To 1 NIATrRIAt. VVH-f-%kTMF%-r".'"Mil
0 Aquifer TcM, DStormnatcr Draimigc 18 ft, 40 #2
q.
0EXPc1iwcnt:,4TcChnwogy OSubsidcticc.Caigrid
Vale.DRILLING LOG titbch additional diets if
DGeothentul(Clused Loopi 131'mcer FttOtl To DUCTUIr"ON,tmbr.bm'da"t.willFwk 11 %;M(ICA
DGeothenral itleatio%'Cooffig-,Repo) 0 it. 30 (L silt/clay
30 Q. 40 ft. mock
4.Date Wcl1(9jCumplL,t,L4: 4-27-22 Av,.ql wsw-9 IL M
Sa.'V%Idl Location: IL M
Broughton Hospital 1'j
rhd[i;y,10ivr4:r%Jaiw Facilin-ID!0f.-M"-blc3
1000 S. Ste=ljmg St-, Morganton, NC, 28655
No iical Addmss,Citt..Rndzip
,2L REMARKS',
Burke 14-181 bentonite seal
U",
PAIC0 Itknfiric4im No.1111N)
511.Latitude and Lonpudcln dcgrcm 2 Certification:
w .5/1/2022.
Dale
6.ts4;re)thcvveII(s): XlPermanent or -:37emporary
7.IN this a repair in an existing wil: UlYcs or KNo
IfIbis igeo repwk,fill vor 4ovor
23.Site diagrun or additional well details:
You otay use the bach of this page to piovidt additioird well site delails.or%veil
S.Number of welly constructed: 1 cotistnictiondetails. You rnav also
SUMNIFITTAL 11N.SFUMONS
9.Total well depth below land surface: 40 24% Far All WeUr Submit this funn within 30 days of completion of well.
ForiwililpJr wriffi li'maildepiln ifdif,1i-jyj1j 2Q,lip)) construction to I tc follwaing-
10.Static water level bclo%v top of casing. Diiisiun ufWatcr Remaircm Information Prucenim.-Unit,
i/wzoeo, it 0-4-ve. as +- 1617 M:nd Service Center.R-Acigh,NC 2709-1617
11.Borehole diameter.6 (11L) YA b.Etj r hL%ft_%V lh ONLY: to addition to s a odi tw.the Conn to t I ia address in
24a above. also subixit a copy of this funn %villfin 30&ays of completion of well
12.%VcU construction method,Air Construction to the following.
(Cc.attgzr.mmy.cable.dixcl pash,ac.I
Divisfutt-ofNN'ater Resources;Underground injection Control Program.
FOR WATER SUPPLY 119ELLS ONLY: 1636 Mail Smice Center.Raleigh,NC 27699-1636
13a.Yield(11put) Ifedlad of test: 24c.For Water Suppl.%&leicefloii Wets:
Also submit one coln, of this funn within 30 da s ofcomplefion of
weil construction to 11w county ftealoh depaninctit of the wuray Micro
constructed