GW1--06277_Well Construction - GW1_20230926

•
• . . - 1 .
. WELL,COMTRUtTION"..RECORM Fortiffcinoitr4c.pigim:. , .
Tliri:fernicilitbelliseil fir sftigleai multiple weits-..
P .
- - 1,W011.COntraetor Inforrantion: ,
,. • 'I.LAVATERWNES: - . . , - •
Brian Ewing PROM. - 10 DESCRIPTION i
Welt CaiirdOcit•Norne.,_ • ft. ' ft..
• ;
• 424 0-B ' . . . :•:1.'i • 16, I . ' - ' • • .
NC Well Contract&CenificationNunter AISAUTER,CASIMG-(f6,-iiiiiiikaiethieffil'OR,LINER.Oriti-Iliaki:t','.. .. _ , •
FROM' • - TO -- DIAMETER- • TRICtralIF.SS • ' MATERIAL. .
- '
. . -'..0..- 0.. In.• • - 1,- - ' -. . •
SAEDACCO . . . . . , . ,
' -
Convan)-Na,we. ...t6ANNER CAONG'0114Uft•ING;44ialliiirtal ek4d.loiiiii '.*., . .- - ,•
FROM' Ti)' • -DIAMETER 11110ENESk. MATERIAL
. _
1..Well.ConStmetion'Pertult lii • • , . . 0 'it. 5 It. 2 1, '.. tit $CH-40 • -PVC
0 i AO gpiitkaNe ip*047107(1,c.enunty.Stalp....Varlairce,frfeetici; e.). • ,
. •- ft., ••ft. T' ,' iT4 . ' • .. ' .
. . .. .., .. ., . ... ,
' .
3.Will iis.0•(V40F will 110)j. • - - • ATI:SCREEN . . .
WatarSniaply-Wal. . : ram- TO I-DtANIETER ; s[Air Sin. Tni-CKNr,qs ,10,4TERW.
040111i0P0 . . . . ' • CO4OnicipalTalic% . 5 --ft f 15 it 2 ...,' 14!' • .Old • SCH-40 PVC
• • ' • ft. • • •
'CiCre6t6mtal(HeatingtbotinE,Supply): CiResitieiniii•WatirSupiilk(Stogie) ' .' - , It.
•
. .
0 huinSttial/Conunercial • - • K. r.— • .
. 13Resideatial Water s.upos.(sIrtyctiY 1GROU
^.' --,16MATERIAL' : ---: --- - ''' - •''' - • ---'''' -.
. • -E NEEN NIPLACET IIETTIOD&AIIIOUNT
• . I:Irrigation- .. . - . . • . . . . . . . . . •It.• '- ft.. ' . , .
.. . .
• • . ,NnaWatnr Soppiy'Synii: ' . • : ., . '. . . . ... . . . . „ . ,. . .. .•
' . . .. . .
. .
'
• . 1014cluft,iiripg,: - . . 1:34ci:O.YelY • ' • _, :. - .
. ..," .
. - Injoetion Wolf; • . . . - Tt •. •ft. ' -, _- • .
•
' l:I.A.titifer-I‘ccliatge.... • • - - , .. agicitnfidalaRefrodukijou, . . IsisruinIGRAVEL'PACKlirattiilieabtty! .- ' • r.:..-1,7-_-.--'---.;.. '-'.--.-- .-J,--'
. ..
• itOM —TO • ' MATF:RPA L. - • ' -RNIPLAEEMENT METII011 . ••
'• 1:fittitiiict. lOragi'an1 ikee0eii, • 1:ialinioe0aitici.., , ' 3 . -rt., '15 W. TILTED. SAND # 2 .• ' .
- . ClAttnifeileSt - • , " ' f:ISIOntiiiitttliiainage• . .
.,. . , , . . . . •. it., ' •it; , ', - .
--- .•. •--.. - .
. . Deztptintental TOhnotog. la41111Mdtatcoton4tOt •
. . , . • 20.'DRILLING'LOGIiillidiriddiiibilit1 sbeetslitkeisarki- • ' ' ' .
' • . - tl0e6i1LOingil(clo$eii Loop) 'OTFiepr• ' '. • ' - -F13051. ,- 70 ••• PlzscRIPT107;tea*:hardliivti.$01Wmck type:-gagii*,f.,:,tit3 , • -
. . . .. _. .. . . .
• •ft., FILL SILT AND SAND
CIGZOIlle1111,11414e3IiIWCR01111dRettn) • Eltitlier(explain under.#211-Rtuaths 0 1
) • • :• 4. 5
. 5 IL. 10 -ft. SILTY SAND -'
. ,
.-i.:-Datii Well(s)Conilieledt 8-15-23 '' 'ArtidilD#7.14B-.1
- - -10 ''..'fL '15' • ft. SILT•CLAY MOIST TO WET •
. .
•
5:1:,Wlif 141C.Ifillii:.. •
. . ' - •It•- ; . 'B! ' 2
• .-,-.. .......... cm.36.1• ^...L'''''''a:
• Former OM Bernhardt Mill • - . . • .. - ' ft.- • ft,' - t . • P' t i°/E0
.. . .. . . ; • • , A...4...- ../ .,.... , •
FicftitytpivneeNinte: • • Fd.06 1.0#ifapp*.:Ibie) - .
"-,
. . . ,
• • 2 ,. 2023- . ' •
1201 Steel Street SW. , Lenoir., WC,. 28645 SEP 3. • " ft.: 14, . ' I,
Plkitiiafk4d0.s5 citY.."0 4 . :IL REIVARKS' •' . '
. . .
•
-BENTWITE 'sEA7. 2, TO.3-i'- II" ry,..,"WOG •
Caldwell, . •
" CMItily: . . .
Parcel 1cleiatifltaiion No;(i'IN) . .
•,, - . •-.. . . • • . .
Sh,..Liotucia and-.1;iiolgii*ihin ticgmesinalitt!teitsecfnitsOt*vintalite*e): '22,-.ce.rtineation:.. • .. : •
(lt6ell rt,olt1;•oist i;inioOgis•sidfiellottO . •" - '- . .. .
' •
. . . ..
' N • • Wf _.-Beria.,_ri.- -Ewhig.- . • 8/24/2023
• • . .. . sioitmroccitm,.W.0104nirqiyi;', . ,• -.:' • Daft
• • . . . . . , .
6.Is(are)the.\TOWS):.EIPennanent. .or mTemporory' •
4 ais:ning,thli feriira. irerel,ty eerrif,v Oar:Mr well(s)Pitts.01#0.I.eirretFirifiley4 Irtzavon.hrlice
. . . . iildi15.4 Ari.tc 412C.0.190 0..r.111.Ncetc,(32 .!Ina()IVO CotiMicifon Sranr(arefEryid rho d .' • '..
Ifs ttwi a rtOoit".0 atiClibiti.og ii'ellk'. ElYesr..or ENo ' I 01.0!:.Of rf 1E!-"ie.('iiirf 114 ifal itiel'ige.d foilie saithoirr,
(f rigs:ft q rAiNTOfill,Of:44iyii teen iionitruegrra lOrrarrarar oral ap(rrar the.flamer,Of the 4 •
; • . . . . . .
•
iiiirrir rradirr 02 l.'remrintrithaten rii-era the.bri&0;1'4114 form. • . . .23:4 ite.tlial,trativr aatiltional.woo.detail . .
You inay..osO the back Of,this pa&(0',Ordido'additioriativell site details or Well
S.Stanber0f Wells ivitsrtatted: 1 . .- ' . • . ' coosnuctionareiaiis: You inas aluiattaeltititlitionol edges if ttecesSaty.
foriitultiigikieeitor NO-wrter suppl,rierg(1 ONLY frith-rhe.p•ntre corrsteditiost,iet•errq • • •. • . • -..-.. ... l• .
, irifrarir 0The fOrin. . • ' -•' ' . Sill0MrITAIANSTUCTIONS
........
•
. . .
. • 9.117Inii1 Welt tiOptit betoWlanti stirfacei • 15 • • • . (ff.). .244.Par All.Wilk' Sithinit'his fonit wit biti SO days-of oatuptetiOn'of welt
For mural*4,ellslist idlrfeprks frei(reray(arrange.-.7@200'do&VD MO) -' ' •constroction'tothe foitowittg: .1" -
. ,.
. . • . . .. .. •
10:Statie.witter ievethelti*lop.tif easingi • . (ft)• . 'Ifivisioo of-Water Re.4otinteS,InfiprouttiOtt Vitieessing Unit,
*Welief le.ed it Aber!'aufai:ate'"+"' • ' ; • , . ' 1017 141Lait. iniice taint',Ralei0t,NC27699-/017 . . • -
• . - • - . .
it;borehate di:linden 8-.25". (in.) 24b; 4rjaidgitiOnlYA15 ONLy.P:: hi addition to sending the form to the address in .
• 24aalitA.e.'also submit a..eopy of this forth within,30-iia5,s-of,.completion.of well.
12..WelIconsituctiou method:BORED •
'CODSNUCIThli to the following2:
. • (Lc.;4,ei-.,iptgy,cal?le;Edincl.pusl..%:etc:J' . • • . • •. . . . rkivhion of Witter ItisaureeS,Unde.rground Injection Oiotnii.Program.
. FOR WATER.SUPPLX WELIS:ONLY1 • • 1636 Mailervice Center,Raleigli„MC2765,4636
•
• Ile...POI'Water Suit*&litik-0411 Was:-
13n,l(iFldr(glitn) Method of teSt: •
AlsO •Sobtait'pt.* copy of thus'faith within'30..tlay,'S ofcattittletiOn of•
. . . . .. ,
13b..Disinfeetiont3iet Amount:. • • .well:.cOOStoiction.to thO'Colony iicagk cicriarlinent-oe the-.00011111.,wheit
• • c0rst0ictal.
•
. . . .
1 '
FenuGW,L • Nonni Carolina fteparonent.of Envirartmaa apj Natur11 Resource g•,-Aivi$Iimi aiWaterftOgttew -• Rev.4ed August Itili
. .,