GW1--06278_Well Construction - GW1_20230926

WELL.CONSTRUCTION RECORD
Fca Gttcr»al Use.ONLY;.
.17i:•form can be used for single or multiple wells., •
I.Wcll.Cairtrnctor Information: ,
'1 %'ATIIRZ,ONES. • • .
Brian Ewing FROM. • 10 DESCRIPTION
Will CoutraaorWm. - ft: it.
4240-B ft. f[
NC Well CowactorCcrtifiamitionNunllcf 115.OUTER'CASiNG(fur mutii4Med-WetIsl'OR L1NERftf.ati Ocabk)l ..
FROM .. ' TD . ' DIAMETER• THICKNESS MATERIAL
SAEDACCO • t4 ft. I, le,. ,
(onlla uy NanaC• •
;16.INN_ER CASING OR'TUIIING'{I;i'atberin:iletuseda_64'1,,�
PROM . To DIAMETER TH1CKNE.SS MATERIAL
2,Wr11Constivctinn Fount#: 0 . •ft. 5 ft.• 2 1, . 1.11. SCH-40 PVC
400a pr?ha leivellpetnI (Lc:Gmrnh::Sta!•r.,.Vnriah e.fife b:CO err_.i'
. ft.. • ft. tn.
3:Well.iiso(check R'elI use 17:SC Rft EN -
^
W;iecrStinply Weill'. ?ow To RIAMETER SLOT SIZE Ti1CHNMSS MATERIAL
•t2Agniculntlai • C1liiii:uoipaii ublic; 5 ft.- 15 f1: 2 in oio sex-4o PVC •
• EiGeoiltennal(Heating/Cooling Supply); DResidentiat Watei-Supply(single) ri. 'IL. ' in.
®dudus(riallCoumtercial, ©Residential Water-Supply(slia[ed) T85GROUT
PROM' TO. MATERIAL EMPLAC'EMENTMEi1IOD&.4MOUNT
19Iniptition . . . . . . . fG
En=Witter Supply Well . . . .. .ft ft.
ItMenitorilig PRO 0CW
Injection Welt: ft, ft:
DAnuifcf Recharge' • l d atcr Rcnlcdiaion 4I9YSANDlGILtVIIL'CACK7inij 1illpDter - -. :
• -PROM To MATERIAL. • ESIPiACTAI;NT MITr10O
37A1)nifcr.Storagc and Reco%ery -DSalinity Hairier• 3 ft.: 15 ft. . FILTER' SAND $ 2
l7AgnifciTest DStoerimatcrthii(iri R- tt.
bEtpetioteittal'GcelrnOlo 1:15itbsi¢cncc;Coigtol (iDRILLINGILOG(atlaeh addllional sheeis if ncecssn'rr•)•
ClGeethenwit(Closed Loop) DTracer Eu031• TO . nrscRft'TIONtcour.uaroner:wn'tnctinn.-arran,in:de.1
DCreotltelinal(IlealingiCaoliae Retutn) DOtiter(explain uader•.#21 Retuaiks) 0 ft.... 5 ft. • FILL SILT:AND SAND ",
' • 5 ••Rf.. 10 IL SILTY SAND
4(.Date Well(9)Canipleted: 8-15-23 Well mgtTMW-3 • 10 'ft. 15 re. SILT CLAY MOIST.TO WET
So.WA1 L,eatbid:• .14 ft.
•
Former 3M Bernhardt Mill f.- ft: N 1^7'C -� f JZ .)
Fticpit)•*mrNarue Facillij•WI(iCappUebble), 'R, ft, c C p
1201 Steel Street SW, , Lenoir, NC, 28645. . ' ft. . ft. JCr '2 6 2023
• Physical Addiess:.Cit}•..uiid Zip {21;RF:1tIARK.4" °
Caldwell s BENTONITE SEAL 2' TO 3' itli:.., ti:: h�1�.7;-fib (t •
Convey ' Parcel ItknlinealionNo;(sip)
ih Latitudeani'Longitudeindegrees/tninuteslscctindsnr:decimal-degrees: .22,Certiteeaition:- i
prom freed,ore Iatticug is strtGckra) .
■
IC • W. • Br a.ry __Ewing, 8/24/2023
. " Sigmture of Certified Vlcll Cool rctdr` . Date
6.Is(dCe)the well(y)t DPernlanent or ZTemporaryity xi nin thin him.?herebycert(r'quit rdl4 t thr, .l war Fine, coarTnrcted In tn<•onlimcr
. twi i I NCat 02C.0100 o I fA NGIC 02C„0200 Well Constr.traitur Srarulards Lind*az a
7.Is this at re(iairto ad oxistmmgwell: DYct :or ®No `cojn ofrhii record liusbeca iirovidrd roiiw Stall(Artier, -
if this.h a rrpirir,fill Or knrnnn in dl enturnrctlaai lrrfgrrtuailoar imrl t'Ap(ain Mo.aware of did -
ieprir toiler p2l'rcvnarks.xrrtima or r n the brut of this form. 23:Site dhtgi am or additional Well details:
. You may.use thie,baek of Otis page tolprogideadditional well site details..or bell.
. ft.Numberof itelis`constntcted: 1 • •cousuuctiou details. You May:Ilse attach additional pages ifra.'Cessary.
For tirnhiple Injection Or oral-water supply we*. a Jdi th starre constrtiiriotr,you wart
subunit one form. - SUBMITTAL iNSTUCTiONS
•
9.Total Well depth hetow land stirfacei- 15 ((b,) 24 a..Fur All Wing Submit this.farm within 30 days of-comptctioii'of well
For magpies ii•rils'Nst cal deprhsifdiftrant(cxaeuptc=.l@'2A7'atul:201100) - construction tothefollowing, :. - -
11.Static Water level below top of casing ) Ilh•
• (ftisiiin of Water Reroarcey,Information Fri ecssing(hilt,
Orator lave/is abate,casint,rote'•+" 1617 M sil.Savice Ccuter,Raleigh,NC27699-16 L7
1.1:Borehole diameter:8:25" _ tin.) 246.j;or Infection Wells ONLY: -In addition to sending the fomr to the address in
24#agora,also submit a•copy of this faun within 30'dacs of completion of Will
12.Well construction method:BORED - • . coiistiuctiau to the following: i .
• (Lc.augcc iulaiy,cable,:dircct push.ctd} (.
llivisloh of Water.Resources,Underground Injection Control Progsapti,
FOR WATER SUPPLY WELLS ONLY:* 1636 Mail Service iCenter,Raleigh,NC 27699-1636
13a,Yield(grim) Method of test: 24c.For Water Supply&Injection Wells:
• Also subnut one eopy of this'fonp Within 30 clays of completion of
131i.Disinfection type: Amount: well,cbilstnrction to the county health'department-of the county where.
. consinicted.
Form OW-1 Nonlit:arolina Dcpannmm.of Encirorunetn coil Natural Resources-Divisloo oi'Watcr Rewu:cs %wised august 1013-