GW1--04164_Well Construction - GW1_20230623

. , •-
. . ,
. . . .
WELL CONSTRUCTION RECORD Fur Immo!tire PNLy: ,
TKO form can be used for:sitigle cr.multiple wells:
. .
•
i.waliointrattoeinfOr.inaliqu:
LL"WATER-20N
Stefan Smith . 11111=111•101MMEEZI41111
. Well Cou1n-41or Norm--•:',. ft. ,
3576A •1111•111111i1
-IS.OUTER CASING,fforinulti-&56.1*-ells OR LINER WI' UtabIc) ', ' •--'
NC Well Contmdor Certification Number ''..11CMIMilMiliMil= ainigiiMiliineffiriril
SAEDACCO Inc 0 ft..,VW 1" i'it. SCH-40
! PVC
Commimt Nome- ' '''UlaNNER CASING OR TUBING L.eothenrull clused-look '- -'' '' " ''''-- l'•'
FROM 1 TO DIAMETER' THICKNESS' iiiMThliiiiii.
2;Well",COHEIntiiiii Iri•iiiii-4; WM0301280 ity al ,itt..
1441'4 appl.kilizri!tot#ixintitljEc,'Cinenry;-.5V.I6-irritiarrce,Irlecticna0:
.,3,lAjOI 1.1134,(oltreliziV011.iiSt);, ; yr-SCREEN.
'; FROM TO DIAMETER ,SLOT SIZE THICKNESS I,MATERIAL
Water Supply.woit:
. . • . 8 ' It: ' 18 IL. 1" ' IP; . di o SCR-46 PVC
El Agalcultti nil 1:71MattidipaliPublie,
' .
. ' -
inCwtheimat(HdatingiCooling-Supily), °Residential Water Supply.(sin ft. ril iii.gle). I
- GR .: , ; . , : .. .;1;', . . ' .. .; '. ; •
DIndustrialtedniniercial °Residential Water Supply(strata) A& OUT riiom
TO. NIATERIAL i ENIPLACEMMET METHOD&AMOUNT
LI IiiiOntion .1l. ft. ' 1
Non-IN:tier Supjtly Well:•
. IEMonitoring 1:11ectivety . - . . , • „ _
Injection Well:: 'rt. ft. 1
laAtptiterlieC,hiirgi EZIOrnitridniiter Rentedialien 19i SANWGICAVEL I.ACK filaiiiilleabfer,. - : ,..,„ .-,,•,''..`" -"..."
,Paom TO ' ' MATERIAI.," ' FAIPLACEMENT Mt:TOOD ,
ClAtittifer,StOin,gi:and-Reeinve4.' 11Snlinity Okirkict . . . .
. o.
.... .
p!1,.qt!trr Tvii. )=10iinicatet11)fittta. :
ft•. tl.
bENIN"-TiTcrill111)7121100SY °Sobsi4ackfintrol: . .. • . . ..
20...DRILLING-LOG(attach additional sliectslineCessarv) '• .. . -' : -,,- - .
iliPeloIiin.141,(00'4 Lorp). •OTtaper, . ‘.F.7051' .70 PESCRIPTION hiroar.;liarkitii,A4,,tiiirritcli 611.e.'•utioiriit„.de.1
°Gbothennal 0-leatittprootinc Retun0, °Oilier(em:dant tinder ii2i-Retitailis)- 0 -ft. 14 4., Silty clay
---' 14 •(1.•, - 18 ft. )Silt
r'. fr.i:-‘,.'t .
4.bate-WOO).conipleted: 4/24/23 Well iritiT144-3 •rf-
itt-,.-.14: • . I ,&4.....LO 1....i klf r-'j '
A i JUN ? .`-; 2023 n,NYLOEtinaticiTi .r' • .ft. t •' f .
•••••-. • , -... :. ,. ,, ,
Ferti Technologies It. ft. .
F,ctlityOtiittqrThttu , FacUthYi*di7411P4ilk. . ,
IL: •
It. , bitg.41;34;:sZ!•0 Prt7C:55.11:,;:-.4 Uri
n#10,77;cx
ill McNess Rd., Statesville, NC, 28677 , -it.,, it
Phyileal-..4idr-4S.C..iii:-.Mliii4ji
Iredell Temp well installed thru DPT rods.
Colutty• ' INitul I5101OrtliiOn-No,jTIN) 1
511,it.,•ifilfiftle."-aiiiiiinkinidein'ilegiattititifiSisCiindSor ii:Ceiniald4rtileiii: .12 0,,,,t,- .f.,,.. m- ,,.. .
11:-;a1r.ltri;It.t:eile.liitiliaiilii,$iiillelelio ; '';' - '---' - ;' ; • ' ' '--- — -'
35.758011 N 80.79491 t .2 ,
" 447- 5/9/2023
Si.Elati. inlet fied*.ell Coribirter Date
• ,...
6.Is Otr41thc-WCW.:'13Pertilallient or- •XrreiniKalq• itr.vieling ihislirrni,../iterii,...K re etif; s rha lilni ireiti.O.L.:Ta O,irri;I contrue:at irraveoniance
.. . . ,.. ,.
. • . with'!II NCAC 02C-,Pf09 or 1"...C4 Ncetc.'9C;0209:11`.d/Coastiracricur Starattanfl.wid Mar ri
7.foitl:i'e i)ei):.iii,.iit•iine.4.tiigiVcii,, pvi*-•
or 00 44:'911-rhisfw4-tylii.6.-ha rut 4TI4d4416:*WV ouarer,
4frOs:ka re*t?r,.fiii OrriiyoUit ur'Itcoorrrartiorr iofm-qmilkoi arid explakrlie;natare of rfle ''
repaiiiiriikr#2.1 iv:Atititki'iieriiiiiihkeln ihe.hral:rphisicrnr. :23.Site diagratniw additional Ira details: -
- • • •. .. , . . , • . .. • • ., -
'you may itse the Wet of this P'00.In Diori&e.addiliorial Ire]]site details OF*ell
8.Nurptberpr itills eonstructed: 1 eonsitnetion'tieiitiisi-You inay alstidliaelt'adilonal pais;if tiei::esary.
Fat,'itamir,..k kityitivi.ornomi7*Ater sapptyler4ONLy irk!'rile same const,ruertwioWkoro ; . -• • , ;-, . . ..:,. ,, .
,SlilithlITTAL INS11ICTIONS-
9;,Total well*pip lielon--jand Sarfacci 18 fft)'o 21a..fior Alt Welk StibMil this fann A6thin itt days of'cnittpleticiO•of•Well
Far ii?lelisial.citcpi,'es if digiTevii(rxamiple=,361217,0'win',2@ Win construction to thnInliriairig-;-. l
10.Static water.lecel below ittp-of casiii (ft.) Dh'imion at Water Re.4aiiitts,Information Praeesiing Unit,-
1,61;iyei.tepof is aiiiiei'al.ieng;am'+ ." • 1611.Mitif ServiO1C.'erirei,italeigh,,NC 2760-1617
• ..- , , ... ,
11:Borehole diameter:2-25" '(•irl..) ' 2-lb For Tiilecttoti Wells-ONLY:"In addition to sending the form to the adress•in
244 abOVO„ also submit a coO,of Fins for-II within 30 days--of.ciiinplotiati Of:well
12.Well conStructiott.itiethod:DPT Cot14111Mi Ott tit titO fOlkiititt:• -'
(4 210 i*i:',calj"1 .df.0 litisk FY-)
Pivisloit of-WatrResourres,IladerOound ItijOetiott Control Prognuit;
FORYWATERSUP1)1.Y.WELLSONLY( • -1634 Mail' e'r-vicill Centri,Itafeigh,;Ne.17499,1636'
... , - .-
. . . . 24o.For Water Sti 1)'&Irilryttiia WOK!,
14.,it,t -o4 0,.1. 10 ..i): 'WO,Kal ofteSt: •„ . • Also submit one' cops of of itti$:.ickiii,Wifilial 30:t1hYS 9't•seitaidetiOLI of
131.t well eonalinaction•to the county'health di Oar/inept or'.the,county.wla.,•=re
Disintisitine Tpe Amount y :,„ ,. „..,„. : , -
• • constrochat I
, . . .
F:oriadW,1 Nontitaiolinc Depaconeat of-Emireativin and Naiural Rerourets-la-vision or WaleiReou-c.E5 Revised august lik I