GW1--05855_Well Construction - GW1_20230912

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WELL CONSTRUCTION RECORD •
r For isaltnatUepNL :.
This fonn can,bc.uscil for Siagloor otultipin wells- l y .
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1.Well•CiintraCtot-Information: . •
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. ,14:-.WATERZONES -•;%. • •... .- -- • - . - •. • "
Chris Ruffer ' 1901N1 TO 'DE-STRIPTION
Well Conituclot tt4und D. ft, 1 ' .. .- • .
ft. ft..
9223-A . . .
";15i'.OUTEXCASING'''iffiHintlikititifiidblORLINER;81-itii tleahk)%;
NC Well Contractor Certification Nuirlter
: FROM TO - DIAMETER Tinctortss MATERIAL
SAEDACco . . ft'• - I ! ht.
Computy Nape; • ' ,•-•44:1NNEE CASING OR 1-0111NG.;frihieritill duieil-kiiiii0.V...:,..,-. -•.--
FROM TO otArnirrEtt ....TIIICKISESS MATERIAL
2..'WOirennstrUrtiiin knit li: . 0 ft. 5 ft.. 2 'in. SCH-40 PVC
List Arl appilicpbre will pertit-1(Le.County.Strap,Variance,IrjetTic4 crn.). .. . .
. • ft, ._ .ft ; 4'.. .
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3.Wcii Use(eheckif ell tisc).: . - • -17:SCREEN • - i •• •• . .- • • • ... _ ; .
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.• Water Supply Well: FROM TO DIAMETER surf-Sim 1-moo mis I MATERIAL :
, 5 : itt 15 . It. 2 ki. .010- SCH-40-. PVC
DAgricultutal plioltinicipaliPubEe-
EIGeothermat(ileatingitooling•Supply) .DResidential WaterSupply( ingle) V
... - 11 ' •ft. • . . I .
CI ludnShrialfCommocial . PResidentiai Wafer Supply(sletred) tfoGRsi 13111 ,',/t-..1.
MATERIAL EMPLACEMMTmEmion. AMOUNT
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CI Irrigation . , . . - - 0 ft. 3 :ft. -Portland Pour
Non;AVater Supply Well:. . • • .•-- ' -• - - • -
ft. ft. • . . . ..
NMonitoring • 1=1Recowly -• - . - - -
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• Injection Welt: ft.' •ft. •
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• ElAquifer Recharge , . . ClOiptindwater Reinediation ...,19::SANDIGRAVELPACKtifilliilleabter—- - .-;•---.•-•-.-•-- . . ,=- ---*--:-.. •.= -
•-FROM •TO MATERIAL •esIPLACEMENT sit:temp
" •a. :. ' -...a n...-.. .4 :.
lj AtilhiCUSIorage and iw.,,,V.r.43' IZISolinhvi3orriei. •
. . - - ...•- ' 4 R. 16 ft. Sand ;• #2" • . .. . .
I:IA(011(er Tat. 1:1Stnininatcepraionge . ft.. • ' ' . •ft. 1'
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DetperiniCotal To:ilmorogy ElSob§itlence.Contral - .
,WDRILLIINIGILOG:izittailiaddlikiiiral iheihr It ireeinaiNI; • • -* *-• •-
•. O•GeOthennal( losed Loop) •ElTracer , most • • TO - DESCRIPTION'(olor.bardno.millfilick lo or.men sim,tita
OGatthenital(HeatingiCoolitte Return) 171611ter(etplain under#21 Retinas) .ft. ft, 1 :
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ft: ft. I 1. •
.1.Date Well(s)Couipleted: 8-14-2023 Well mgMr.4-4 SR ;
It. See GOO'•,, Notes
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Sa.Weil Location: .
, ; •4- ft,
p H ,rt ii..”.••
; olcomb Creosote Site . . .., . - IL. . .. R..• • i. t`4"."- #it:.i. V e:
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Facility,Owner•Nrutic • Facility 117#0,f applio• li
hie) • • • .., -----:-----
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, 5016 US•Hwy 601, ,Yadkinville, NC, 27005 - • MIIIINMMIINIIIIMIIIIIPIIIIIMIIIIIESIIIII •
Plq-Sbd AddMss,City...MIL-1p ' :.mREI4AREs , . .. , - , . - .4,(•,-4:1.2 n t•rn.,... • '
Yadkin • • Bentonite seal from 3 t. .,i-4!, DANCYCOG'
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Parcel trienaticalion No.(PIN) l'
56,Littitude.nllit Longitude in dcgtus/mintnestseconds or-dceintal krexs: 2L Certification:- • 1!
(ttil-en rwhi,ow ia.but is.suirik.ii)
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N• W Chris-I:tuff' er. 8/20/2023
&gnat=ofCcatficti Well Cu Mosta r i• Doc '
6.Is(are)thelvell(s}t mPermanent or oTemporary .. . .
By airibrg ihkr ferim.1 hereby eerfify x)u)i Ibe wrigv)P.xty(14r.1:)ettnprifered burneeorcheire
. . ii,i)ir 15A JvCitc 02C.0100 dr LTA NCete.02C..0200 iveu etnrsapetian Standards and rimo a
7.Is this a rejialr fir an 0fisting will: %Wes or pNto •ce4;e.of rfik record 1MS been prradded to rit;:e well awrier,
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If ridiii a readr.fill(yr Anonii led!eansintertati ll(foratati a on nd 6pf mor ahr the e of the- ,,
itimiir redo'021reaturb‘Aintall or ilu rim hiid of this form 23:Site diagram or additional well:details:
You may.use die,back of this page lo•provide'additioinl well Site.derails;or Well
8.Nuuther Of Wells coustrueted: I . • constntction details; You inay also attach additional Page.s if ticcessairy. •
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For Jildiftiple hike:ion or owl-warer supp.ty undls ONLY with tiresome constertegorr,you om
moat c,,;.e farm. - SUBMITTAL INSTUCTIONS• 1:
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$,Totalivelt depth below hind stirfikei 16 • . . (lf.) •21a..For Alt Wink: Submit ibis'form within 30.days of-cOutptctiOn of well
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For Multiple irellsitsr oil depdis ff diliTear(eirmnple-3@209'and.2631100) construction to the following:
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10.Static water lei-el below top,of easing': • . 014 • • Difishin tif Water ReSpurees,Information Processing Unit,.
If weVet id,,ei is&are aasfeke,irsa"÷" 1617 Mail Seifiee Centrist,Raleigh,NC 27691)4617
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11,borehole tliameter:6" Onj 7:411:Tor Injection Wells ONLY: In addition to.sending the form to ibe address in
. 24a:ab&e,also submit a..copy of thisl faun within 30'days of completion of well
12.Well construction method: Sonic COR.ADUCILDO to-Ike kill:Minx•
(Lc.oilger:rotary,0.41c;&Rd push,ste.)' , . .. ..
DIfision of Water.Resou roe's,Underground Injection Control PrOgrant,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Sallee Center,Raleigh.NC27699-1636
•.2.4c..FOE Water Supply&Injection Welk:
13a,•Yield(gpm) Method of test:
Also sobniit one"c•Opy of this:friiinl Within 30:days of cenunletiOn of
• 1311. nfection tS-pe: Amimutt
: Drcil coiLMIDEI1011 to the county health!deport:cut Of the county where-
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constnitted.
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Fern]GW-I North Carolina DcpanntentofErwironnw and Natural Re93111CCS-Division of Water Remo=i
•Retired'August 2013
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