GW1-2023-00833_Well Construction - GW1_20230113

WELL CONSTRUCTION RECORD IGW-11 For Intcmal Use Only
I.Well Contractor Information:
Kelly Grant 1 14.WATER ZONES
FRMI 10 D[xCAlI110V
Well Contractor
2730-A ---
See Wen(:on"o.(mdlwtnn Nrnnnn - r �(I�n Is,OUTER CASING Ifer mam-re.ed wNh OR I.IN[R
l "/ i11M1 Tfi nl.MIF THICK Vf.\S N.TT.RIAL
Cascade Drill no I P n. n. I..
romps,,.N..., _.. IL INNER CASING OR TIRING tisraad
2.wro(omtructiospetmlto: PEREPAAPPROVAL RtIMi To nIAMiTn /NICI(Vfes MATEIt1AL
Inroll ulPL.nld. rdl,nwrmunm/v..rrn n. (Ie.(.+ran.y'rw.lYdsn M.l n' n' la.
n. n. i..
' 3.Well Lee(check well steel:
Winer Supply Well: I .SC'REEN
PP Y FROM I to I MANRTRP I MWO!'N ITTIICR`I[M wAT.R1AL
n Agneu uiral nMunicipaVixublic /L R. la.
OCicceh ul lHeatingiCoolmg Supply$ ❑Residemial Water Supply(singk) is. n, la.
OI•d:Wnal'Commccial ClRnidmtial Wales Supply(shared) ILGROVr
Dirt( Lion ❑Wdls>IN1.011I Off) rRMI TO I WATIPURIAL I "F7MR.MR'R m[iRWiAMd1'rf
fL h CA
Non-Wier SUPPh'Well: 7 r w,r,Ar TIZ L 01 TC
AMrmunrin i:IRecosRy n. n.
Injection well,
n. (L
7Aquifv Rech&Mc DGtuundwaler Raadiatim
DAqu,fcr Anragc and Ra.I.m nsalmn ma Vr MCrIMO y Banner N.LANWCMYEL SACK _ _
IIIOM TO MAi L rMOAr INL
C]Aquifcr lnl OSlormwaltT Dramatic
C)Fzpenmrnwl Ie.'hm.logy IlSubsideoce Control n. n.
f7Gea6crrall "osnl Loop) I.1Traccr 20.DRII.IANG LOG attack seAd"M sluice if
a..e. �rer.ra Aw.
fHitauhmnxl(Iluiin 'ooli RcNml ❑OIM(explain undcr a21 KrnmrkV FROM to.
M nrACvI .(r.M, n.
a.time Weu(e)Completed: L /6 )> wen iDE S4 D- I g h h
5a.Well Location: n. A.
Fortner Battery Ted+ n. ft.
I.CIII 'Ow N...,c faclliry IDI nf.pplirabk) n• IL
705 E US Highway 64,Lexington.NC
It. R.
ITy.kal Addn.S(-.y..nd 7 r It. 1t.
Davidson 21..�1111E1,110 KR
Couury V.rcel Idemdnauon�o.IVisit '+ �a rNLr
5b.Latitude and Iwgimde 1•degrees/minmw,u"nds or decimal degrees:
Id well fNIQ oa Y4[mg b wil&Nwl 22.Certification:
?(,,0/ (r s-9 N 3vbir of W
6.1gare)Ihewen(s): L1Permenenl or biTernperery, S."..of Cenified Well Canuclx Cabe
�� 9..ip,ine Wir/nrw.lhne(ry rniiJy AYIM.eQnl rum h[n/dal ax�[rr&A
7,in this repair to to existing well: OYw or f < IJA A'CAC 02C.0100 ae,13A NCAC 0X'Olp/Ref(Cem•acdw Js•aan��I due a sqr
I I/rAk e o rrpai�.lilt r.v 4no.�.ell rnn.mrn,w iu/w.,•rion mN rrykin IA[nafurc ofrhe �l(Air rcm.d Aa Ann I+•ovrM ro rM xrfl u.wn.
rr/Nv xMn a`I,mini.wumr rr r.uAr but o/rAtr(,urn V.Sile diagram or addillorui weil detans:
K.Far GtaprobefDEl or Close&Loop Ge•mermal Weld having the same You may uac the hock of(his page to provide ad. nual wdl ttKNtucacm Imo
eorstrucmnl.only I(iW I ll n('eded. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box),t'cc may atsn wla h A.WaKioal pugs If n ic,•
drilird 24.SCIBMM'AI.INSTRUCTIONS
f.Told well depth below land surface' 7 0 (R.)
fr.ra.brpk.efh 0.....rnwwplr-14y200'eM 2lpi0Pl
Sabmlt this GW-1 within 30 days of wall completion(xr the folluwiag:
Im rl drprlu✓dr
10.Slade water keel brow top of"Sing: (fl.) 242. for All Wells, (kiglal ham to Distscai of Walm Rw W e. rce IURL
9 rwv.lord,.ui.,.r �rrnr .•r - Inlimnwiun l'nrvlxsing line,I617 M%C•Rakich,NCC27t, NIbl7
11.Borehole diameter: (e, (la.) 24h. for Injection Welk:Copy br t)W'R, Undxigmm�l Nlatxm Ccmmd IILCI
Program 1616 NISC.Kaltigh,NC !looN-Ihyb
12.W'e0 construction method: Searle 24a.For 1\olrr Su,d unl/r wa•1 rw (:wrl►r.nul(leis.\1 ell.:(1,pymlhc
(r a su[d,Msq,bhk,dvM pun na'i Counts alimIlollCnlJ'. IC.,I CIu11nYM1 a 1 'Cwlth n c uleta Ni
FOk%%ATLR St)rPLl W ELLN ONLY: 11d • vial \Cull. rmlluda also(ip.. ._Si�l'opym DWR CXPCUA
Ibnnit mgraot ,, I \IS(, a 'Ig N(e�b
IJa.lldd Igpml Method of Iwo:
IJIL DiWrted"type: Amount:
1 rrnn GW i Nunlr 1 ur.n..Ixlw raw ul Pnrerxwvn W(1..bb.U....uxt ul W xrn NrV Mr.m Ra neew it 6lfl 1 x

20.DRILLING LOG(anvah addisio.I sheets if neve m y)
FROM TO DESCRIPTION(color,hardness,soiltrock type,grain size,etc.)
0.0 ft. 0.5 ft. Red brown silty fine sand,medium dense,moist
0.5 ft. 11.5 ft. Red brown silt,trace fine sand,medium dense,wet, ,
11.5 ft. 59.5 ft. Gray brown silt,trace fine sand,hard,wet
59.5 ft. 70.0 ff. Black and white Gneiss
ft. ft.
ft. ft.
ft. ft.
ft. ft.
i