GW1--05843_Well Construction - GW1_20230912

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WELL coNstRucriON-liEtORD- - For humid UO:!',iNLY.:
This form canb:uscd for single or touliiplc WC%I-' .
ff:Wei1,e4/41raC;0-r.liitorini0141):' — - - -- - " - • — "-- - . ' -- - ..
•LE-WATER ZON ES•'',.'.. ,- ,z,.. '., , - .
Robert Miller ,. FROM'. .70 - DESCRIPTION
1VOf Cppitoc(Or Nam, 0. ' ft,
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2675
NC Well CoratuClorrenifttai ion Mutter IS.OUTER CASING(for inulli-cosed wells)OR LINER tif an Ikablel • .
FROSE.. I 70 :DIAMETER.). -' 17IICKNF.SS: -.SARDACCO MATERIAL.-
0 fit. 27' IL 4" .)ii SCE 40 J PVC
6nitpuity.ttame" -.- 16.INNER CASING OR TUBING(grolherroal ciosed4obg .. - '•-- •':•'--. - '
. • FRO,74 70 DIAMETER. TIIICKNESS MATERIAL
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2:Will,:cOnstrottio'n Permit#:- ;ft." -ft,' ' - ,IrIL
fill ay kei6,11 pern10;.(fr.County,,Stmr:Yariatrce,Ir,YertiopLeial . - , .
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3,'Wel I AlsO(rkork utl I rist):
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Water Supply W4.41:: FROM -TO; . DIAMETER 'SLOT SIZE 7111t1iNINS- L MATERIAL
27' II. 57' .ft. 4 " ,hi ' :020 SCR 40 PVC
Agriculiti la! °Mtiojcipcilthiblic:
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°Geothermal 01600nel:tooling SupPO, OResitiential Water Sim*(singte) I
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GROUT
• 0 Intlustrial1Conintercial ' ' °Residential Water SUPPly(sbared) " - . ' •
. EROM .- •TOyTsius1. ESIPLACESIENT AfE7110D&A1101INT
Okrieatioti , • 0 0.. 23' IL Portland i pour
Non-Water SupPly.Well:
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1:110aniioiiiig °RecoretY. 1 .
• Injqt1100 NVg11:, . to, II4 , .
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CIAtitiircrI3eckitge P113I9lindn'Otr RentediatiOn 719.SAND/GRAVEL PACK lit opplitabtia,-'• . •
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-' ••••• •-.- .--..--'- _, • -. 11411-131 . -TO MATERIAL. . ENLA IPL:TACENT A1E1.' 011 11 • .
0AijitiftrtiintO mil Rrc ovaly cfShlini Bariir 25 O. 57' A.- Silica sand 6/20
1:1Ailitifer TO pstoimwatcr Diiiikoc
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• bkvcOpteni51 TtVhntilogy. 13StihsitIcncei 631'091:
. - .. , .. . .•• .: - 10.DRILLING LOG(attach additional shreds"if airtswarv) - .
(Igeothonnal(Closed Loop), iTracer -most- TO OFSCRIrTION lob r.Inirdarrt.t6IPttick 0 ist.oFsin iior.OM
EIGe011iennal(Ilating/CoolfoiReloto). adoiliei(yip-jintlikit,on 1..ketuali ), - 0 - -.It.. 23''- IL Brown silt
-23' .(1., 57' It. Rock ;
4.DOM-A'Cil(s)Completed: 7-26-2023 Well lilt/DW-6
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ft. It. I i'., ...c:;"""''"'"% •
Rcf .i-,-..:114....
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5.:,..11`.cl!Ltieationt It., . I. I, ' .4.'r it.."4 V 1:0
FOcilifyffy(if app*blc). .,:„..._.:_..... _ SEP L.2_2032.
Facikity-,9U-nor.Nfiroo_. ' .
Irik."'rr, ;,; • 11
1420.Concord Parkway. South. , Concord, N.C., 28027 . ;ft. 4 ,. 1
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• RI.15*111/94!rss.:-C4;ntui iin
---- •'•-21.REMARKS: ' • . . •'- . -
ea..4Pet-fai..-S 2' bentonite seal from 23' to 25' -
Coottly,.. No-411(ino-ifioilon No.(PIN)
50;-:);:ifiliid0..0(01--I!Ongitud in'Ileg*i/01111016*00(ls 0r decimal degreest 22;Certificationt•
(itoOlt rwILL-tow,litItilig iiillki•iiii)
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‘V --'- : ' - ''''. --'-,..-.", : y/.._,,!. 1. . . ,7/23/2023
Sigruour ori;'.:...k.:;.4:4,2.vr.!.."•_,..??r,-...g..„;,•• • --- - .Oat
6:Is(are)theellftp:-144mo:toad or OTentpOrary, .../ti 4igni4.1hb foi,ti.•I ilitOy.ecitify ikitl,sk trciktr)itha'fiverj.,I eikrpritt.iticiiiirecivrOti"
'OA)5A NC IC 02C.0/10 or 1.r4 NCACO2C.:0200 We Consouerim-Skindlirdi.oWit rbiii a
7;Isibii a iviviie'0)an Oxiii(4.*elif Ell'oi-•-.-6i. '.011N.o-. i*J...-of-iidi'retool has..,r:;-ri praphled ro014..:;riltpirner,
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11:1116,Is O.friMil;j1,7 let::kqe+04 mi-i.1 c;m6:ntalors'i!ifolmothoi aid.explahuil*oriare of the
repair u6.67-021.rerniirla Aee'lioti Or en 4w hack-of&Li form. 23 Site diagranforad ditional well details:
lOu May tise-",the bad,of this Page,to:pit!ide additional itill site details-Ufirel
8:/iiititber of!ells eitititrikted: 1 . cotistitietielit iletaiLS:.;-.You:inayitlso'aita0.atklitiiiiial pages if iii-CeSSary.
kofiitutdpre!OA-eke!!ei:ro-ou:II:iltir..frpY'n'p.PO4y.LIu.101-thr taturconstriretion_.j.,•ou'cio . - ---.-- - -., —
Atenpit my form: .' ' SUBRIITT AI;INSTIICTIONS,
9.-Totalitili,depth,belatt-4titid'surface 57. (1,),,.,24a.::Fni'All Waist---Suluitit:this"fori:-...tyithirt 30-i_lays..utCoinplctian:of well:
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poi,;;Wiiik 6.1 I i Iiii all 447011 if dwil,(eAthiPie4.36-P20,9!and 26P*9) :Consliiition to.the fcillintinig:- .I,
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10:Static water level below hip-of easingt:;1'. - - - (fr.) Divisiati-of Water Resources,Information iirdiessisip.Unit.
If iyi,;ei 10*1 is,dio'vy .,.1+.0"4,.". 1617:Maii$esiiCc'ecilior;Raleigh,NO769944171-
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Ilt-torehole diatneter:8" (iii.) .211),For litieetintiyielluONLY: In-addition to sentliagsthelonu 10 the address in
24aaboi•e:also--subittit a.c'oPY of titisfonii.0:111in 30-60;of:completiOn'of nil!-•
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lIWelleonstructinwinetkod:'Air construtiloin to the foilotitine:.. I '
(i.e.'auger.ipilit':Cabie,diliarii.:Ftc:)
Divilston of NViter.Reiou recs.;Untlei-46tind Injection Control trogratti:-
FOR WATER SUPPLY'WEL1LS-ONLY:, • • 4636Mitil Serrice tenter,ialeigli:Xci76991#3 . -
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24e.:.tiii Watt;Stitipt Ac:Injeitien Wellsr
130'ielii(gPm):„ MCilsdri itflest: .
AlSo'Snbatit one cops of.titiS"forni"...Within'30."-;ilayS'otcOmpletiortilf•
ty t3k Disitifetitiun pe r.„, Atiunint -tyill.erittstruction tb.the:.rtninty hoolitiI drintrItneOl•of the count''whkrc
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• FOTO:OW-1- . .f.X.-wrip0(..ofEtivirotuneni art4 Naomi 46sourocs L-piiiiion Of'*oicr Restoi,rom. .0cy4ed.Aigust-'20,1
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