GW1-2023-02587_Well Construction - GW1_20230410

i
WELL CONSTRUCTION RECORD Far trICrnal Ua ONLY:
'nfs form Can be used fatsingle or multiple,kvells
I.Well.Contrictor Information:
MAVATUR.ZONES
Scott Hunt, Jr FRt)Nt TO 0MCRUPTIONT
«cllCornradorNamc R, f. tight' silts hard to determine
f4 fG I '
4561-A
NC Well Comm&ar Certifkation Number t&OUTER CASING Mdir�itll-c*srd ER'We110 OR IAN fif s'"8-blcl'.
FROM TC1 OL IETBR I TIUM-NESS I MATERIAL
SAEDACCO Ina 0 M. 26 fL, 2" ju; SCH-40 PVC
Coa$umy .t6 [NNHRCASING OR..TUBING 'uarkermalclased-Imt ,
FROM TO DEt\IEifGR HEii-C N'ESS I NIA7ERIAL
2.Welt Construction Prt•mit ar: ft. ft. 'm
List all cw1f able a C.Coroup,'VWx,:Yarfura-e.'r1ye en el'.1 11.
3.Welt Use(chccicwill.use): f7 s4 RreN
Water Supply Weth FROM TO MAM1rETBR SLtrrsts>r I TrtiCNMSS IsrArRRr\t.
OAgdcultutal Mfunicipalftblic 26 R. 41' R. 2" im .010 SCH-40 PVC
®kteotitetmal(Heatil gZooliug Supptyl ®Residential Water Supply(single) fL IL ire,
i3ittdusnialfConmicn:ial ®Residential Water Su ts:GRt)i}T
Pph'(sliatt d) FROM TO NG\TERE\L E\IPLACEMI iT11121IIOD&ANIOQNI'
01trigation 0 f4 20 r4 Aquaguard Tremie
Noa,V4ratcr Supply Wc11:
�hfonituring 131tccovc ' f 4
Iulection well:
flAquiku kcc.[*ge. 004ouritimicr Rci icdialion 'M S ANDIGP AVEL PACK of r iIkabW).
. . .. 'FRONT To MATRRM. C'SIPr.At:F:\rE\7H4YlIOn
13A4nittStmagcaridRcc4,,'CEY EMilinityfbitice 24 R. 41 ft,' Filter Sand #2
t3AquMi-Test 11*9nnWatcr.tin,h Tgc
AEq}crirncnW Tcchnotog\' ❑ absidencc Coulml
'20.,DRILLING'LOG(attach additiortalshca!if ncce mn•1
I7Geetiternul(Closed Loop) L3Trdcet FROM .it) DFSCRn'TIO\rwbr.haMnc�e.xtR'nrckh a c,ek}
OGeofltennal(ffeafin?_'CuoRut lketutn} 130dier(e."-plaiu under 921Retuat6s) o ft. 17 ri, _red clay fill
17 fL. 41 fL tight compacted silts
4.DateWeL1(s)Complctetl: 3-8-23 VtrC111DOW-22 41 f4 tL rock
5a.W dt lLocation:
t4 '-° ii�r•i
White Oak MSW Landfill f4 it PR 7
Facility,OntrrTfnruc F&Ufty WN Ofuppli able) 1
ft. ft.
3898 Fines.Creek Rd. Waynesville, NC, .28785
Physical AM.*City and Zip 2t.REMARKS
Haywood Bentonite seal from 20-241
County Parcel ldoilif6:;Ulot1 No,(PIN)
56,l atilude and I,tingitude in dc>;recilminutrsJScetinds or dceitn tl ttcgtres: 22:Cciztific:atitrn:
llf uclt frCid,"oite LtO7oug Is srdnicicrd)
N W / ' 3/19/2023
Signiturc afCertifird Prcll Ca tar Daze
6.Ls(are)the weU(s)- MPeniwo eta or ElTemporary Ity sigrung'this(amr,i irerel}•Cerrifs rhos thr 11e11fx)was(%rrel carsinrcred hr aceorrlmtcr.
Tyler}15A alrCAC 02C Alfk?or ISA KCAC 02C,f1300 Well Il Constrtrtrar Stamlaids and duel d
7.Isthi a repair to anexii#ug-i all: OV& or END ce>irropth/r�rrnnlhrshran,�mvirlidtntF+rri.11onrtrr.
if this It a rip tir,fill o tr kf tm yr ll cnru.ruegon hrforoicrrwr rued explaht the itarare of the
rewirrmder#2I remtarJLi swfian arcvr dre brad•of this fanrt. 23.Site diagram or additional eyed detaiLc:
You ttttny use the back of this pag to pride additional well site details or mil
S.Numberof Wells catisttucted: 1 Coustmction deiaits. Irou rtla\atsu ailac[t adtliHotrat gab s if nit essary.
For nudrlple-drderr4m ormrm-!inter supply tvi lls ONLY.rvdrh rhr sametunstrurtlim,y4m cdm
sadinrit am form. SUiiRfIM L iNSTUCTIONS
9.Total well depth betow laud surl'arcm 41 (D,) 24a. For All Walls. Subunit this furin within 30 tUys of completion of wpil
For ittaMple tceth list all deprhs if dlf,'erva(e mtp(e-3^a 200'and 2@10)), Conrilnrciion to(ite following:
10.Static water levcl helow top of casin(ra 19 A) Division of Water Re iources,Information PrucessinR Unit,
if nvttvrlevel1,above Cushtg.rise"+" tdi7 Aiai[Scnice;Center,lLdcigh,NC 276994617
11,Rorchote diameter:6° (in,) 24h.roe,•In .flan Wetty ONLY: in addition to sending ilia fomn to the address in
244abore-also subtuit a coliy of this font within 330 days of completion of well
Ii2,Well aoustruction method:Sonic construction to tine following:
(LC.atiger.rotary,cWca diieci pustc etc:)
Dl\•Lciou of Warnr Itesautce9,UnderBroand ittjcelion Control Prograur,
FOR{VATER SUPPLYY NVELLS ONLY: 1636 Mull SLmice Center,Raleigh,XC 27,699-1636
13a t ccld(gpm) tfcthod of test: idta For Water Sugt&Srfnit ctinn Wells:
Also submit one copy of this furut %kithin 10 days ofeampletion of
13h.Uisinfmtitiun typez Amount: «"eti construction to the corm¢)'k Ith department of the connh'mbere
carlstrtrcted. �
FanuGWA NoahCsra11na0.panummofEm•irottractuandblarurtlRcsautccs—DivWonafNirarcl Ri troy Revised-August 20l3