GW1--05972_Well Construction - GW1_20230912

1
• s WELL CONSTRUCTION RECORD Far[eternal tlseONLY:
This font:can be trscd.for single or multiple wells. (_��
----
1,Well.Cuntrattor Information:
t A:SVATPRZONES
Stefan Smith most Trt , DESCRIPTION -
Wcll Coi*radot Name ft. ft. I
3576-A ft. ft. ! i
NC Well CamtactorCcrtifiW(ion Nturirct `',15:;ODTER CASING(fuiquidltt ca4ed nellsIOR LiNER:tit'an il?eablcl'. -
FRO\i TO DIAMETRR THICKNESS MATERiAL
•
SAEDACCO t4 fL in
Canryruty Nam. :;t64NNER CASING ORTIMING:(geatIerinat elos J4loiip n'' -
FROM TO DIAMETER THICKNESS MATERIAL
2.WelR•Coostr i ction Permit#: R. It.• i 'in:
Lainft ap iiratde will pc-twit:1(La.(smut.State,lrariarrrr,fr eeper stt7,) ;
. 3;Well Ilse(checicrsefl use): • -17:SCREEN
•
'Water Supply Well: FROM TO. DIAMETER ' st.trrstrx. Tatcros1S 1 mai-m m,
. . • El Agricultural CDMtuiicipaliPub!c It, ft, ire.
IDGeethemtat(IieatingiCooliog Supply) ®Residential Water Supply(single) fi. ft;. t}�
' , Olndustriatt•Conmtercial DRcs.[dential Writer Supply'(shared) tl0 GROUT , • -= �..' .. .- _..
ERO51 7O.•
MATERiAL i EMPLACEn:NTMETIIOO&Alinami T
Dlrripntion . n•. ft,-
Non-tYater Supply Welt: .. . ..
I:M nitoring lJR ec cry , D. ft . - .
Injection Well; ft. R.
ClRgnifcrRcchargc - • itOiout dw terRentediaU en �1.9 SAND n:RAVEL1ACKnr:ritiiin btel ' -- :-- _ _ _ _ --__
"-FROM TO MAIM/MI. -EMPLACEMENT NIL-THOR'
DAgittfCr:SIOrago and fRCco ety PSalinity Barrier' R. ft. is• •,
El Aquifer Test l7SIortnwatcr Drainago . .
• -It.. (t. •
❑Eylerintcutal Teehnoto ' IlSrtbsicicmcc.Conlml .
4n:DRILLIrGLOG7attieti adMitattal'divots'itiiecc"ssarsl' • -
OGeorltenrutl(ClosetlGuup) OTracer FROM' 1U DESCRIPTION(calor.hYMucn.miahliekhlx. n 1k%dr.1
. DGeotllewtaf(IieatingiCooline Return) D011ter(eNplaiu under Pl'21 Retuatks) ft, .
ft, ft. l
4.DatieWei(s).Conlpleted: 8/9/23_ Well.IDWIP-1 - IP-13 • _ _ _ _
1- .1
•
Sa,Well Lucatinu: .it i�
.- tt. `" L.t'
NCDOT Parcel 90 _ .rt. tt, S E P 1 2 2023
Faciliiy,'Oii'nerNmae • . . Facility ll)k(tEapplicable) • ' R.__ ft:
4509 US-311, .Sophia; NC, 27350 ft,, ft.
DV L,',1:r Jin
Plty%idalAddress_CRY-'and Zip 1t RE11rARt:S- - .
•
Randolph ' . Temporary DPT injection points -
•
Coauty Parcel I&ntiflealIou No:(PiN)
.514. .ttftudc,ind l.wigitmliio in dcgl'ceslminutcs/sceonds nr decimal degas es: 2g:emit' ea*wa: '
quell field,one!loam I''•Sartieieid) I
i �1.
IS' F� 4 9/1/2023
Signal-..ofCe.QcdWellCon-trailer Date
•
6.I8(all)lira'1\'@IR(s): LIPeridanettt Or $I lettlpOrirt} (fir signing this_Aida,2 here!}rerlifv'Aaaf the well(!way(t, rej c<rrs fired hr;nicraitlrnir
with 15.4 NC.IC 02C,01Av or 154 NCAC 02C.0200 Weil Cnrrsrrn•Nwr Sraar1ards and trtar ci
7.Is this:a repair to an a istiag well f]Yes, or KNo 'roj,_rpf:Ws ircord bas been provided ro Mai'sill mr,icr.
If thts:&a rerpalr.fir1 as krrondt teacolumkt?oni htjrrnurrlon artsd r:ti on'the mauve of the
rervairmrdar 021 rernarksscrliam orwt dm back of this form. '23:Site diagram or additional well details:
• • You may use the,back of this page'to.provide additional well site details,or Well
S.Number of Wells constructed: 13 . . cots/auction details. You May also attach additional parses if necessary.. .
• For multiple i*c'rhvr tn-ano-nerrer supply rertds ONLY with the.sinagcons(rnctlw e,you curt 1
=Nu ttw form. SUBMITTAL INSTETCTIONS 1
9.Total*volt depth beton-land stiff:ci:. 30 (ft,) .21a, For All Wells: Subunit this fonn within 30 days'of eoniptetion of well
For multiple iirUs irse a:i deprlis ifdlfi'i rpm(emanate-3@200'mal.2@s 100) construed on to the fottowin8:
10.Static water level below top of easing: - (ft). Division of Water Resources,Information Ft(messing Unit,.
1/miter level Is dare easing,Use"+" • 1617 Mail$etviee'C rater,R uleigh,NC 27699-16t7
El,Borehole diameter:2.25 . (in.) 24h.Fair itejeelR((ri Wgtls ONLY: in addition to•senditig the fort to the address in
. 24a above.also submit a copy of,this fortis within 30-days of.cornplCtioik of well.
12.Well construction method:DPT CollsttuCtiOl to the following:'
tie.auger,rotary,cable,ditcci push•etc.) .
. . ,Division of Water Resources,Underground fisjeetlon Control Program,
FOR SUPPLY WELLS ONLY: - 16''36 Mail Service Center,Raleigh,NC 2699-1636
13;o,Weld gglim) ,Method of test: • 14e.For Water Supply.&Injection.Welts:.
Also submit one copy of this Orin within 30 days ofcottipletionof
13b.Divinfititiuu type: amount: well construction to the county kohl:department of the.county where
. •constructed. . S •
FortGW-t Nenlr Carolina Department of Environment andNaturalResources-DivfsionofWaterReatrcs Revised August ND