GW1--05804_Well Construction - GW1_20230912

WELL CONSTRUCTION RECORD Furth rml tlsc ONLY;
']'his font]can be used fua siaglc.er tmlltipk wells - •
1.We1LCOntrai tar Information:- _ ' .
'1J;.WATERZONVS . - .
Chris Ruffer FROM- 10 DEsCRIP?ION
Well Corttr;iuor Nant4• . ft: ft. I
9223-A ft. fr. I.
NC.Nc11 ConuaclorCcrtift itionNumkrer 1S.Ot1TER CASiNG oi�mi11114 d'iietMMYOR LiNER.4111 ji illcabk)- "
FROM • TO • - • DIAMETER ' THICKNESS- 'MATERIAL.
SAEDACCO 14 ft.. 1a
(;ontlrurylautc. ,.re,;`-INNERCASINGORRTVHLNG•tgeelkeimnlcluscil-loiipi- -,'-__-:-
• ,FROM. TO DIAMETER THICKNESS -' SLLIERUAL •-
2.Wclt•Constiuetirin Perrintri: 0 ft. 36 ft.• 2 •'f>L SCH-40 PVC
Lig off aplilianble tsdlrpCiyikS(ir..County,St+r1r,Variance.lr)rEY fdl.err..) It.• ft, in.
3..Wshl list(ebecliWcll rise):- t7 SCRr:E,N - .
•
Water Supply-Welk:• - FROM TO utARIETRR SLOT SIZE TIMERILSS IDATuat.I.
[]Agticulttttal - C11+i1tlltielpahr rltblie 36 it. 41 fr. 2 ita .010 SCH-40 PVC
EIGeothena tt(Heating/CoolingSupply) . ISResiidential-Water Supply(single) fi' ft i -'1°' . •
D kidusiri.allContmercial ®Residential Writer-Supply"(shared) •- "GROUT ..._.. _.. ., . .--- -.- - . . :.• _
FIlOSr TO MATERIAL EMPf.ACEMILNT METHOD&A110UNT
Olrrigation 0 -ft.. 33 it; Portland Triemie_
• N in-Water Supply Well: _ ft. ft:
ttdlwicnitgring gl3ct:pilelp '
.-
Inject lon Welt: • ft. ft. '
ClAnnifefRecharge • C1GloundonterRetncdiatiou =19:SANDIGR,iVEL.TACR'(if+grlrlica0telx=--- =-- f-:-_.. _
• .. - ,FR01VI• do . RIATRIDAI., ' -RRIYirtiCktiINTMEItIOn -
l7Ailuifcr.Swr.jgc and Rccovcty !]Salinity Harrier 35 R. 41 ft. sand ( #2
CI Aquifer Test CIStonnraterDiiiinage • fa. ft.
DE petinicutal Teghno(o y ID SubsirIcncc.Canitvl •
211:DRiLL_INGLOGYartachiidditiurial'Aliteis if uteeswM
• OCeothennal(closed Loop) YTnn:er FROM TO • DESCRIPTiONmolar.huronca..it+rl,4n f n
ckc.Srrin�to.dci
CiGeodtennal(FIeating'CooWlg Return) OOther(esplriitl mtder.#21 Retnniks) •ft. ft. I, 1
4.Date Welt(s)Completed: 8-15-2023 vat m 5W-26R .-,r i' �� 1 ft. •See Gcfp Notes ,
54;We1l Location: .ft. fy . SEP 1 2 2023
Holcomb Creosote.Site 14- ft,
FacilitylDwocrMune Facility flit ifappli b1b1cl... IfiOr ms;1^,-Laf-.'Ps
5016 US-Hwy 601, ,Yadkinville, NC; 27005 ' ft, ft.-
rlty3ical•Aihits,City.andZip. '21:RRM1lARKS-. • . • • .• -• ' . . - .
Yadkin Bentonite seal from 33-35'
Comity Patee3 identiReatlonNo.(PIN)
`b..L ittitudcant)Longitude in tlegrcc&lminutcs/seconds or-decimal degrees: 22:Certifications
(if n elt Held,u1ic latneug is stdflek+a) //��
N ��+ Chris' Ruffer- : 8/20/2023
Sigrutitre of Ccnlf ed Wcl Canuacior Vitae
6.is(are)the'well(s): XiPerinattent ;or °Temporary •!tr signing this jarm;.l lrcreb}•rerriJe fhrii the melJ(sJ Ma(µree)tWrsuircrerl Lr;rxv'onfirncr
•Wei 154 NCICOTC A1(k7 or 154NCet0;02C;0200 Weil Corrstivrriar Srarxlarris and r,urrd
7.LF this a repair to an eu'tin;;wvelli 93IYcS rir ElNo ccjprofMir a turd Irakfr rn fimriled rathr.,n:ll miner,
Ifrh(s:lrnre,(xrir..filltRiriooiwii d!cam-rnrctfanhilirtnrrlar end c:tf+faln the#snareofthe - - I.
repair undo tr21'remarks"sc'clion or on tin bail edify foray. .23:Site diagram or additional w'ell,details:
You may,use the back of this page lo.prosideaddilotlal well site.details or Well
S.Numberof wells constructed: 1 construction details. You stay also attach udditiotml pages if necessary.
For+nalripk ltrfeaer,on or'0(111-wafer arpply taros ONLY ivJdi rho.samecxararrlterlat,Wit OM I
s:+(7mir one fom+. SUBMITTAL,,INST[TCTiON3
•
9.Total itielf depth below land strti we 41 - - - (fit.) 24a..Fnr Alt Weds]- Submit this form within 30 days'of cotnptedon of well
For irralr,ple ioclls'liar all depths ifilifft rent(exoroprt'-3@200'mi(12 @ rnoj 'consttrrctton to the foltoning: i' -
10.Static water leVet below top of casing: M.) Division of Water Retio feel. ,Tnfurmatian Processing Unit,
if numi level Js irbrlvu easing.iise"+" 1617 hlttif.Scr s ice Ce ter,Raleigh,NC 27699-I6 t7
11.Borehole diameter.67 - (in,) 24h.For Iiiicctiott Welly ONLY: in addition to-sending the form to the address in.
24aaboee,also submit a-copy of tliisi,fortu ]Within 30'days of completion of well
12.Well'constntctiou method: Sonic - constnlc(fon to-die foI1owiftgs•
(Lc.auger ret4ry,cable,direct push.etc). I
. - . Division of Water Resources,Underground Injection Control,Progtalu,
FOR WATER SUPPLY WELLS ONLY: 1636 Malt Service Center,Raleigh,NC 27699-1636
t Ia,Vicki(gjini) Method of test: 24e.For Water SItPl.!V&IJection Wcllst
Also submit Co*copy of this foriu Within 30.days of completion of
13h.Disinfection type: Amount: well ccirstniction to the county health department of the county where
constituted.
Fans GW-I Nome Carolina Ik�pann ita.of Envlt stuela and Natural Itcmurces-Dixlsloo of WaterRmattIties Revised August 2013