WI0100467_Well Construction Record (GW1)_20170202

I. Wall Commuter fvPormafiov Division of Water Resourr
Gary D Justice
Wen CnnlmMarly— FEB ?_ 8
9dFn_ n 2017
Water
2. Well Coessueda. Perms d: \A1
1'n oil vpPlico6lexellpermlu(i.e CormT Sblr. Ymiarrce, elw)
3. Well Use (abeckwell use): _
CAgriculhrml chhunipalMablic
CGeothermu(Henting/Cooling Supply) DRasidendel Water SWPly (single)
ClndualrinVCommareial 0Rmh1audal Wmu Supply(ahmed)
oAgrafer Rmhmge
CGraundWasho R.Il diatiw
oAquiier Storage end Recwary
Mallory Sumer
OAquisr Tan
OSmrmwatu Drainage
OEapedmmmi Technology
0Subaidence Cuohol
RuGeothermal(Cloaed L.op)
OTmcm
4.1)mawmlbs)Complem: 2-8-17 was luq
3.. W.HLneadma
Uwe F Grothe
facility/Owmr Namv FacilitylD%(Kapplicable)
2544 W Paradise Harbor Dr.Conley Springs
Plgaical AdErmr. ClrY.a°dZiP
Burke 2764471619
Costly Penal ltlemiECNipn No. UPI)
fidd. (SAID
end Longitude io degreedminuW/attends or dmimel degeem:
(Ifll fielyove hNong inaufFcievr)
35-4645.45" N 81-28'53.19" :W
Ris(me)tbewen(ab wraremoset .r OTempocery
].6thlearepdrmen egirdggweil: OYm or ON.
/ImoianrepalePlmmpnm,n xvn eammnivnryo"nmlaa rare uPlain rnenabea Ilse
repan render#Il mmorL eeenon arvn lse dad oJlnujom
8. Number mWells ennafruated: 2
Parmul%{vleiryealivv nrnorr-xnler.rlppN xaf40xZr1"'n/neramemarn-tip. yovmn
annndeanelrsn.
9.Tamlwe1dapM1el.hmdaurfnce: 360 (R.)
Formunae nrells!ul nil deplN ldB r(eranaa3Q2o0'aMI@1007
10. Stafic amer level below rap ofessing: (fL)
ljxnlerlevel uaMCn ur/ng, xm "'."
11.110reholemamesr: 61/8 (lm)
IZ Well comtrucdon method: Rotary
(i.e. auger, rotary, cable, tlire[1pxrF, ek,)
FovImIrevl Use ONLY:
I
14. WATER
ZONES
PROM
ro pFScgmrwn
R.
R.
R.
n.
19.OUTBRChUNG
FROM
A noula-ouIdwella OA WNER Ifv Ilmble
TO DMMQFER TnICQNPBQ MARpmAL
tt
h 1u
K INN SCAR
as
ORTUBWC aRerreal oaubGOO
To oLumTm xrcKNEvs mA eqw.
n
h In.
ft.
h n
I7'SCREEN
PgOM
TO
phfM11ET8R
E.M.
THICKSINI
MATER1Al.
n
n.
Ira
is. GROUT
FRnM
T
MATBRmL
QMP MRM1T OD&Me M
n.
n
a Eh
n.
360 n'
R.
Bentonite
MM
740ag Easy seal
PumP/both wells
19. SAND/GRAVEL
PROM
I—Kou.summe
TO
MATERW. QMpfACEMRNF TIEFMOD
n.
h
n.
n.
Tom pR6LINGLOC
FROM
etmcheddltlmWheea
TO
V vecesse
pEs, 1, rains nvrtive rGVm[k [h He
Dirt,Clay'Rook,sand
0 n•
63 h
63 tt
360 n
Med/Soft Granite, Quartz
!L
6
n.
fL
n.
h
tt.
tt
n.
n.
11. REMARKS
IMorloalbn rOC"a.+. y ..
12. CertlMedona ` A a"Fw z-z-zon
Sgvammoremlmd well Coxtn ve� pay
CBoYrhIM NUC 0247.0107- /M AiGIlml me xe1lolkl W
but C(xvu JruvvalmonmS,tmgyed rn ammotlrdPovnr
Copy lve mrvlAss wMr-11x
23. nae
Site diagram or additbuat.11 details:
You may.ae the back of this page to Provide addidoml well Site detvls.r well
conamtcdve desile. You may also attach additional pages ifneceemry,
24a. Far AS Wells: Submit Nis farm within 30 days of completive of well
cveatmmion to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Cause, Raleigh, NC 21699-1611
24b. For Inlmtian Welk ONLY: to addition to eaMit, the Ibm to the eddresa m
24a above, also submit a copy of Oda Save within 30 days of completive of well
consbumion to the following:
Divsion of Welter SeverceCreer, Raleigh,
NC27on Canfcet program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Cantu, Ralelgh,NC 3]699-1636
13e.Yield(apm) Mmhodoftseu Air 24c. For Water Supply& Intemor, Wells:
chlorine Ale. Submit one copy of this tone within 30 daysof on of
f
tab. Dlsinfeetlan type. Amvu.b 8 oZ well ...sumades to the cowry hmlth department a the county where
.onslmctetl.
Form GW4 Nmth Cervlim Depmmenl ofErwimnmant mW Natural Re —es -MvimnofWater Rev¢edA rzoU