GW1--05854_Well Construction - GW1_20230912

WELL CONSTRUCTION RECORD
• FOr!mental Eke UNLY:.This form can ha ma to siligle,c1 InllItiplc WelW
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I.Weit..Ciintractorinformation: . • • • . .- . . . : ; . • . ' ".
. . • .WATERZONES "• -. • . '•
. Chris Huffer 1/1401 0 TO dTs$ERIPTION '
Well Coromolor Nome, ' • ft. ft, J
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9223-A .- ASAHITER-CASING`tfiiiiiiiiltkined-netgrOR LINEgliflin-Roble): ...
NC Well Contractor Certification tillithef
FROM ' 'I ID . • • PIAMETElt TMCKNEZ-• MATERIAL i
S . . L-I ..ft.• •
AEDACco ' . ' 1 . • . • ,
'• Convoy-Nowt: • . 16aNNEH CASING'ORTM9Aeoiliniatial eitOetl.lonOp--' -_,. ,- •
- . roma TO DIAMETER TRICE:NESS MATERIAL
2.Well'Construction Porrnit : . . 0 ft. 13 ft.- 2 , ''in, SCH-40 PVC
. ., Lit-14111 anilicabio will pri7e.14(iic.:County,strhi,Variance,Irealic44 'ic
, - 14.- ' ft. irt.
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3..Wcil Use(e6cdc.well use); • - - -,17.:-SCREEN • '
Water Supply Well:
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_-... - roo atTE st TO DIAER 'SLOT SIM 111 icxxr st ss I Artritttr,•
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13 ft. 23 It. 2 " 10; 010, SCH-4 0 PVC
LIAO:cultural . ClMtiiiicipalAhli
1:10eatitennat(Heating/Cod ng.Supply). .C3Resideittial Water Supply(single) .ft' . ft' . '•
1:11Lnlostrialt Comnwrcial GIResidential WaterSuppb:(slimed) .'Illi'GRoluri",--- • -- _-_,.. ....... --2,-.
• FROM •TO. MATERIAL -ENIPLACEMMT METHOD&AMOUNT
ID Irrigation- . . . . . - . 0 ft. 10 'ft. Portland Triemie
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- , NquAVater Supply Welk .
' . ' • 11,' ' - ' ft.•
Ithlonitoring . - •PRcoovcry . .
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Injection Well: • . ft.' . ft.
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QAquifcrItcetrarge . . • CIGibundwalcr Reincdiation -192SA.NnicitAvEL•PACKfi1ainarcabter-..,-;------ --., •..- .. -- .-- - -
• "FRO'AI - -TO IONTERIAl. .- ENIPLkIINIENT mtrtion = - -
clAtivilfer-St Ong and ftccoVery EISnlin113;Bairice. • 12 ft. 24 It. sand !. - #2 .
1J AnnitetTest . DSloiniviatci Drtilitiagp
tt.. .
. . Cletpetirocntal Teehnotou 13SubSittence:Control • " • • .
. '-flo.DIIILLINGLOGfattiachiddltioniii Streets':ifirceis5a1Vt• • - • - -
. tiCieothennal(Citikti Loop) :lTrAcer ' . FROM -to • ' DESCRIP110)1(coar.!.a rtneti rtoGnrattn SW.tit.) . .
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EIGeothemial dieatingitoolingRetund • DOilier fekplain under 1,i21 Retuatlis) .ft. ft.
ft. ' IL . 1
4:Rafe NYPE(s).COutpleted: 8-16-2023 iNell ipp1441-25R — •
'ft. See-Getn' Noted '
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1 2 2023
54.weu 1.10eathni: •It. ft, -
Holcomb Creosote Site . - . . - - . ft..., - SEPit.' , 1. -
- Pacilityithvacr1Nam • Faciliti•IDI(ieappiieable). .
4, ti.
. • . . infoura;:.i•c.31 .te..4.F.$7 UNI
• -, .5016 US Hwy 601, Yadhinyille, NC, 27005 , • ' ft. • ri— .. , Mb'Crii't 0,:::.;
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P10-00.01 i:01:05,CitY-.i10 ZIP "1.k2L-RENIARKS-• - • • • '• -. : • • . , • . . •
.Yadkin • 'Bentonite seal from 10-12' '
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• Cooly Parcel 1tleittir=1101)Nia:(11014) •
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561..Latlinde.and-Longlinde in dcgrcesftninutestsceonds Or decimal degrees: 21 cenin. utit'n,,,,
(trued fiekt;onn lationAls'wdflelonn I.
I
. ' Chri's Re-" er. l .
N %V 8/20/2023
Stgentace arCertified Well Ce ntrada r 1, bafe
6.Is(are)the-well* 16Pentrattent or -OTentporary th.signing lirlifaine;.1 hereby cerrify Ora*trellis-)vary(vtirv)arnybilard in.trev..anfance . .
- Ofilt/54 NcAC 02C.0100 or 114 motcoac.02an War Courtin:don Srandarris mid Mar a
treOaii"*an ekintiott well:: Yin. or big° 'r,r0.3•.of Vt.iorOdi laid been provided raft'tn.rii limier.
If thi.sliv repair,.fill oar&Otos ti4.•11 conspuerion liCrorrnadon awl iivplobr the r wore of tA e
repair rind&02 I rernrirks seam Pi-LVI MC bilik of Mix form. -23.4Ite dlagnim or addition*well details:
You may use the back of this page to providiaddiOonal well site details or*en
S.Numberof Wells Construeted: 1 - - . • • construction details. You inlay also-attach additional Pages if necessary.
For Maid&kiecrion or non-warer supply tve(4 ONLY alrft r/ht.stralq eons freerlon,you coin .
.4.ruir en form.. ' . SUBMITTAL INSTITUTIONS
9.Total Well depth be/oil-land stirface:: 24 (nt.) 244.Por All Wctic *mil this form%rigida.30 days'of icOmpletion'of well
For nada/plc iVelis-lisr all depart'ifd ,reop Forturipfe-3€52110'arid.20109) • contrition to the foltoning: ' :'.•
10.State Water-level below top.of easing: (ft.) Division of-Water Resources,Information Processing Unit,
If miler ivVel is Oiove casing,Me-"+" 1617 Atail.Service Center,Ball•Cigh,NC 27699-1617
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El.Borehole diametem6" (in.) 216.For litigant;Weil ONLY: In audition to sending the form to the address in
24a Obove..also submit a-.copy of this roan within 30 days-of completion of tvell
12.Well'construction method: sonic • . •construction to the following '
{Le..arisr;lorary,ca6te,r direct lash,cre:} 1'
. Diviiiiou of Water Resources,Underground Injection ContrOlPrOgram, -
FOR WATER SUPPLY WELLS ONLY: 1636 Mill Service Center,Raleigh,NC 27699-1636
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'24e.For Water Supply St Injection Weill
13a,Yield(g Pm) Method of test: • •' •Also snbnitt.1060 copy of this:Rain',irithiii 30:day of cOmPletiOtt of
well cortlinction to the county health department of the,county where-
•136 d ..
.Disinfeeun type: Amount:' •
• constructed.
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FarinGW-1 Noah Carolina rkparimentofEsciwinnxia atte114araral Repaurees-Division of Water limauti2cs Revised Atgust 2013
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