GW1--03561_Well Construction - GW1_20230522

WELL.CONSTRUC rION RECORD For lacnial Usc ONLY:
Tabs form can be uscil Coe singly or multipk wells
1.Weli.Coutractor Information:
`'Id:.tYATERZONirS .
Stefan Smith FRON1. 10 MIC,RIPt1O\
W01 Comractot N:rrnu ft. rt.
3576A . tt:
NC�VcIICoNrularCcnificslionNmnc�r '`MOUTER CASING(6nrtu61a-mk'tI'oc1hfORCINER'fit,,b icabk11 •-.
FROM TO PTAbtE7F.R TRI 'FSS 4-I TRtAL
SAEDACCO Inc 0 t4 1 15 IL 1" In. SCH-40 PVC
f m,gr;un Naurc. 16 INNER CASING OR TI.IHING,1'�ft,iherroatl'.ckned-1u911,, '
FROM I TO DIAME'rER THICIvNESS MATERIAL
2.Welt Constl'pctirinPcrnlit*: WM0301280 R, ft. bL
Lisi till r,}pallcable erlpei"r tsOx.CY,rnro,Sur!c,.Eariurxe.(tr1gOC!�pL ri, in
3.WdI llso(chcckw•ell rise)•: t7'SCMN
Water Supply Well: - FRONT I t0 I ut.\MMI I sr.Ot51ar. I 7111000tis I uArrnrAl,
Mgdculttlrul Cl1Gllinicipalrl'ubJic 15 ft. 25 ft. 1" iru .010 SCH-40 PVC
OC,eotitermat(ReatiniVCoolin Supply} pRcsidential Wi ter 5uppl}'(single) fly fL ir''
QludustriaUContntercial OResidentiat Water Supph-(shared) lB GROUT, -
FROdI TO. AtATrRL•%L I EN{PLACEWNT IMMOD 4.01OUNi'
Olni pion tL It.
Nou=%Vater Supply Well: fl. ft.
6dhlpni(orinG pRccsT►•ctg,
Injection Well:
QAquifcr Recharge, QGioum atcr Rcowdiatiola L4 S UVDIGIL�\EL BACK'Gf l diiabtc!°' -
'b•RON] 10 1fArF,RtA1, F:\1PI�tCr:V6:V'1'S1L-CHOn
QrtRlt(CF:Stvnigc and Rccovrly QSalfnftyy Bairice ft. ft.
❑Ar)nifcrTcst Q5toeniw ltcrfirtina3c
fL ft,
Qs yYerinlentalTcchnoingr QSltbsidcncct,atNrol All.,DRILLING,LOG7ai16chidditiaitit1sheelsifilcecssaiitil
1:30eelliernnd(Closed Loup) QTraur FROM tU DFSrR1PTlO\ L rkar.huntuc r sYr0.Mre4rt x," "n ii c,cic t
QCr othennal(HeatinglCooling Retmu) 170ther(explain under 421 Retuaihs) 0 fL 15 ft. Silty clay
15 ft. 25 (L Silt
l:Date Wells)Completed: 4/24/23 Nell iDMT1IW-2 ft. It. _ -•
5a1,Well b1cation: fL tt
e
Premier Tech it. ft, MAY "92023
Facility,Cl�ncrNuna Facl4IDB(if applimble) p, ft.
111 McNess Rd., Statesville NC 28677 ft. fc In
y•,,,; IfYS
Plgskid Add
rass.Citr.and Zip 2t_RENIARK.S'
Iredell Temp well installed thru DPT rods.
Cc,uu1} IL,,"] No.(PIN)
5b.1.14titudc'anif Lo cgr ngitude in degtcc�lminutcs/secrinds as,dccimal d '�a: 2S CclTitiradon:
(itwcll t":Gld,vtte l:Iti1vug is Srdlickrd}
35.758011 Ii 80.79491 W ! �. _ 5/9/2023
Sieckificd�4'cIlCanttacwr - -- Dale -- -- -a
G.is(Are)lhNiYell(s): aPerntalheRt or zTCtl{poYut}' !t,•sicni„p thin jOflrr„111CrCr11'L'CrI1fL'fl,L7 1J1Y 11'[!lt!"l N7lS'(StCILJ C'QT_1Ir1,CIGY1 llr fY'd'O,YIIRILT
,i•irh l f;t NGtC O6G,arrx��;•rst avcrlc n:C•it,YpO 11 i•fr C•rnrsrrar:;true Su,rxr'ards and rLar a
7.Lv tkb a rejuair fu ad ailiting%yell: o Vest or ENll L'(prnj"frl%Y rffrirYr rtrrs"by EA prorifrfrl ferule.,IY:rf Me/Ifr,
!f thfs.ri!✓fYyLkTJY.fit!<�ar krroi,vi Tarll�wru�rareth�n hrfgnnul�n azarl,irp!r'aJn the rarrrue of die
rrl,afr tardcrO21 remarks se Alan or rm the back ojdirxlnnm 23;Site diagram or additional well details.
You may use thi:back of this page to provide additional well site details.or%cell
S.Nuetherof wells cottatructed: 1 coustluction details. You itmy ally atlaeft addiliotmi pages if mcessmy-
Fvr malfi ale hoeerlon of rate-nwrer s„pplyua'ffs ONLY n'irh rhe.sa,rteLk,trstrurtrou,you ow
sa imiroa farm. SUBMITTAL INST UC.TiONS
9,Totait welt depth bcloi\land sutiuec 25 (ft.) 24a. For All Wilts. Submit this funu within 3U days of cdmpteii6n of well
For nra,lrlple ircUs list all deprhs ifdljlerou Mvtwjpk--.?@2W1 atal-20 Ak)) construction to the following:
10,Static water level below to of easing. Di\'Isidn of Water Rvquurces,Information Processing Unit,
liuwter level Is above nasfrag,rase"+" 1617 NiAil.Srn'ice Ccntcr,Raleigh,NC 27699-I617
11,Barclta►1c diamcfen 2.25" (in.) 24b.Ffir it i V l v,ONLY,: in addition to sending lk fomt to live address in
24; abo�' also submit a.copv of this fania within 30 days of.completion of iwffl
12.%VC11 coostructiol method: DPT construction to the foflow°ing!
(i-e.auger,hAary,cable direct rush-c(c.}
Division of Witter K001I ces,Utidergt'oupd Injection Coutrol_Program,
FOR WATER SUPPLY WELLS ONLY: 1636 MAH Service i enter,Ralei)th,K 27699.1636
13a,Vicki m Mli.cllod of tcsr 21c.For Watcr Supply&fRicclion,.Wclls:
�T ) Also submit one eopy of this fdrni within 30 day'sofcompletiouof
13h.Disinfection I)PC: Amount: well construction to rite calmly Flerilth department or the coitnty where
cons nmcd.
Fanu GtY-i Nonh Carolina EK-Almnera of Eaeirotunew and Vatur- Resources-Division of 1Yaicr Rcsotrc-m- Revised August:V II