GW1-2022-10500_Well Construction - GW1_20221118

%
• WELL CONSTRUCTION RECORD For li9cmilusc.ONLY:.
T1irs Win cart bo'nscd fiii.single or rmillipk wells
1.Well.Cuntr tctor Information:
-`UMATER LONLS.
John Eisenman FROM 101 bFi(MIPrlOti
W01 Col r(ador N lrrw n• R,
4439 Tt, fi
NC Well CorrlraclorCcrtifmation Nun to &OUTER CASING(ru"r'raulti erred�ellsl'OR LINER'(if.'a" %]cable
FROM TO PTXMFITCR TfltCi-.4. �rATe[tr.%t.
SAEDACCO Inc 0 14. 30 fL 211 la SCH-40 PVC
ConsplurrNaulc. [6.lNNERCASINGORTIJBING'(Lkiifieriil:d"e6uud-lair► `-- �. .
FROM To DUMF.TCR I TMCRVF.SS I NINWR1AL
2.We11 Conitr•uctinn Powit#:
f iftaill rppr7i(ulrle vrcll prirmitx(r_r..C.aunty.:Srahr,.t•�rinrrcr•�r fdbCll e°r� l' h. h. ln.
3.Weil lisa(chccicwell uxc):
%lata Supply Well: FROM TO MANIP.TFIt 'SLOTSM TIIICKNUSS MATENW.
UAgi,knItuml 0 Nit-inicipi'Pulilic 30 rt: 45 rt: 2° in .010 SCH-40 PVC
©Geothermal(HeitinglCooiiug Stipp ly) 011csidential Water Supply(single) ft. ft: in
©ludustrial/Conmtercial ©RcsidentialWawr:Suppl}•(shared) 48.-GROTJT. . :; .. . .._
FROM. TO. NIATERML VNIPLACEMEIl'11EHIOD&MMOUNT
Dlnf tian 0 f4 25 ft. Aqua Guard pump
NoR-Water Supply well:
5d144pnitnring pRcco-cry
Inject ton Well: ft. rt
ElA,gtrifcr Recharge QG( tltWwaw Rcinciliatiou 19 SANDIGRAVEL PAc -
"PR0111 •rO MATF.RIA1. R%IPLACENIKINT MET"an
MA41Iifcr.810,1`39c area Itecowry ❑Salitiin eamce 28 fr. 45 ft. sand #2
❑Agnifer'3 est. ❑5ionlin tier 13r iinagc
ft., ft.
[7Ezperinlenfal Tbchnotogy. C751rhsictcncc t mrtrol .0.DRILLING,LOG 61IU lrad4lhionid sheets U ircccssarvl
17Geotittmwl(Clasetl Loop) OTwer FROM I TO Rri5CR6PT10\(wbn 6anlncn>nn'r+icrt n au a;m.<u.1
ElChothemmf(FIead11P Coo[Lne RetutM 0011ter.(explain.Under 921 Retuarks) 1 0 .r4 45 ft, Silt/sand/clay
rt. fL
4.Date Wcll(s)Congrle1ed4 10-14-22 Well[D#MW-3 �.F.—5�,g=p° 5-_
a
$a:•tv�l Lrrcatina: .r4 r4
Farrar's Store r4 ft
FacilNylOnrxrNanc Faoiliy It)k('ifapplrablc). R. ft. Ir1i+7S �'nD'� �P:•'?'('•"`: 1
397 Farrar Store Rd., Stokesdale, NC, 27357 ft. fl.
PlkNskal- ddrzss.City-afidZip <xl:ltlhl,tlug
Guilford Bentonite seal from 25-28ft
Cormry Nmel kkn0i&:4WvnNo,(PIN)
Latitude and"Lo etude in dt recsJminutcsJsccnntls cir decimal degrccs: 22.Certification:
(ifecllfeeld,i}ar 1ru71iugiNNidl"rck:rd)
_11/5/2022 .Siea%uireaf Datc
CIs(Ake)the well(s): XPerruanent or ElTemporen' zrY.En :fs r
llx•.rr;Grioi ihir juiiac:. r(v,, :..qfl w::.,•r.;e..;z;va7rue•ted irt,uce'tlrr.aolcr
1614"15A,kel t18C,y� -1.ir4rr,:u ti ;nIQO 11 a(1 Corrslrarrtmr Suarwtarais aar�rioter a
7.Lv this a rrjraii-to an mictim-Nvilk f]V�y or RINo icoypfMis ieehiiibas becii(iriirirled rii r;�w w11 rimier,
If rh(s'.1v n nlxrk.fill rgrr"r,-irva ivdl e+cnswi4e;baa hrforarari19a1 mid eaplahi the nu rare of rile
ri'(ri:ir nu lcr IF+�l.leal(lrI'S.TLYIIIrf7 of LVI IhC Lru'ih aftI1LY ftlr11L -23.Site diAgram or additional%reel detaity:
tibu May use Uie back of this page tq proviiti:additional%cell site derails:or%sell
8.Numberof wells construLted: 1 Cotlstmctiou details: You ina}•itiso•attach addilional paiges if tweLss ity.
For*nWriple Irdeerion ororiio-n'arer supldy 11T4S ONLY iiirfr rhvsaaegcorrstruc(iarr,.ye!a�xrra
s;.>Prniitorir.form: SUBhIITTfiA.IIUSTUCTi©NS
9:Totalwell depth betmi land stirface: 95 ((t,) .24a. For All %Wlm Suhtidf this fonn within 3U days of comptetion of well
For rrralilpfe wells list all depths ildlffereiu(exae plc-34'2(kQ•aird.2 z0s IQ)) construction to the foltoning:
10.Static water level below tall of ca sinl+: (ft.) Di�'isiun of`V'ater'lt6ources,Infilrmadi n pracessingg Unit,
l fwwer level is nbuve cas(rig,arse"+" 1617 blail Service Crater,Raleigh,NC 27699-1617
11;Borehole diameter.8.25" (ln) 24b.Fnr iroi%rtion Wclry ONLY: in addition to sending file feml to the address in
244abowe also subtuil a:copy'of this font iviihin 30 das's'of completion of%%Ul
IL Well construction Method,HSA construction to the fMlo%i'iner
{i:c.auger,.iWan•cable,direct parsls c(c.}
Dlvblou of Water R6ourcctt,Undet'grvtitid Injection Contrbl.Program,
FOR WATER SUPPLY WELLS ONLY:' 1636 AIA Service Center,Raleigh,NC 27699-1636
I3a,Yield(iryim) lvlctllod of test-
Also For Watci Suptily R(Injection Welk
Also subniit one copy of this fonn Within 30.Aqy' of completion of
13b.Disinflecdab type: Amount: well construction to the county health department of the count%•where
constalcmd.
Fpnu G%V-1 Noah Carolina Depanmcru.ef Eaviwavixta and natural Resources-Divslon of%%'aler Re w=L- Revised August 2011.