GW1--06279_Well Construction - GW1_20230926

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WELL CONSTRUCTION RECORD For,Intertal-Brc.ONLY:.
,7111-form can bettwill rotsinglcor triollip)c was'
: • 1..Wcil.eirlitilletOt InforniAllott: ,. . . ..
•14:1VATERZONES . '
Brian Ewinq • EIMI"M ' DISCHIPtION
Will CotitraclorNamO,
• 14 ft:
1 • •
424 0-B
15.OUTER CASiNaddriiiittlklised:Wellri'OR LINER:KO'Mahler. ..
NC:Well ConitglerCertiliptiontrunter
TO ' . DIAMETER' ' THICKNFSS. MATEMAI.
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SAEDACCO ' . • 04 I
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Convani-Narpo, . !-InLINNER CASINGOR•TURING.fieetheiiital efai.eit-loiip).,!•---i' -.... .,
' FROM '70 DIAMETER , TIRCKNES& MATERIAL
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2..W0 ronitroetinit eernlit lit , o -ft, 5 , It, 2 ., .'ElL scH-40 PVC
lifi oil opilicake we'll priyik;fix.Coonty..qtar..trariame,lieall0.1o1c.).
. • ft.:
0;W:el-illse(ChoelrAtell riSO• . . • 17:SCREEN . . •. ' • s• - timstv.rett• LOT Sim tinclogr.ss SIATERTAL
-WaterSupply Vieell: • FROM TO— . . 5. ft!• 15 -:ft 2 "" llit. .010 SCH-40 PVC
DAgriculintaL clMiniidipaliFtiblie-: .
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DOenthonnal aleatinitooling.Supply)' • .C3Resiilehtial Water Supjili.(Single) 16 la
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lhidustrial/Conunercial I:Residential WaterSoppiy(sluiced) DPGROUT:--' 7---0-
MATERIAL •E3TPLACENIEIThIEFIIOD&AAIOUNT
ClIrrigation . . .. . . . . •ft.- ft, . ; . -
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. . .Non-Water Supply Well: • . ,. . „ . .•_ . . .. . • • •
• . (4, - 0, . •
RINIonifOricig • . • 'PRwoyery i
1.11cilon WO: . , ft." rt;.- '
CI Aitnifcr3ccharge • • ildkomiiinolcr Rcinedlittion ‘.19SANDIGRAvELTAcKlif:alifilicanter
.. .. .,.. - -. • ' - - - -:PII0A1 'TO MATERIAL •ESIPLACEMENT MIL111011 • ••
ID Aitiolfer_Stdcogc owl RecOveiy. • E3aliniti(i3airici:
,,..-. • 3 R. 15 ft. FILTER SAND # 2 • ' •...•-..
El Minitel'TO, ' CISIonnOliter Orion:10 . •
... . ft.. (t. ' - . • •
' bE.Veriniental Teelindlog. • liSitbSidcocc:tontrOl • • -
. • . . . -,-.30,.DRILLING.LOGnittaeli inittitibitii I iheeis,if dec6stary71- •
CI OM thennal(closed.Loop) - InTracer -FROM- • TO ' • ' DESCRIPTIONbardnes,statnxii trixogrsin Ate.tira
EICeanliennal(HeatinitiCoollne.Return) 13011ier(eXplain under:041.Retuarksl 0 -I4• 5 ft, PILL:SILT AND SAND
5 ft.• 10 'ft, SILTY SAND •
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4:11iitte:Welf(s)tompleted: 8-1523 Weil m At TWR-2 •
10 "./t; 15 . ft, SILT;CLAY MOIST TO WET
54.;Well LA-tcattonf • * . .tr4• 8.. ..
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Former JM Bernhardt Mill . . ft..1.0yiC - _ . r.. F-;.•.L. t, r1
OCitYnrStae Ficl14 tiOfappiobjej '11, . - R.
1201 Steel Street SW ; Lenoir, 28645, • . --- • ft. • rt. - : . sEP 2:6 2023 . : .
Phy*k4rAti.o,P5;tity-..i3Op. '1V.REhlARKS• .- . - , . .1 pc:-..._,I.,,,...,"
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Caldwell . •BENTONITE SEAL 2' TO'3' IlliOae.....•.., •;- .,.
. CANCVAI,Ota
County Parcel IdctafteatIon No.-MIN)
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.56,Einith de,and'linglinde in degrees/origin tcsi.seciiimts Or doritnid clegreci: .22 eo. eation:•
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(irtrell-fickli one 1;10°4 is-mritICIen1)
s . . s .-
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"N• • -.W. . . .' Bri,an Ewing
8/24/2023
.SigarturiafCertipcdWell Contractor:• .--_,•• Date . •
6.Is(ore)thelvell(S)t.1.;liiientianent •or •XI Temporaiy '
• I)..tigning' iltit-friott./freed,, terrify rho'tin.leey!14-ids-.fore,!ow...wife:oil to4oc•corfhaux.
teith.15.t NPIC 02C.pipo or 1SA.NCtteT2C.p20.9 1Vel1 Conioortion Rondares mid that 0
7.1$tfals,-a re0alr"th an kihiting well: DVes ,.ity XINo . lxiiiir.Ofchly.'iecord bh,i:tool provh•ted iO:ihe in II riterier,
liihtf.ft'q 0,Ootr,AI evil 417611911e[qtotniaructiori leforoiathin arid ti.rp(a1n rim more of the
kileeir wolOr 02 tiornarUsecitera in-on the bakkofthiN form.. ' . • 13.Site thagram.or.additional well details:
You.niay..uie the bactiTof.this page ttil-provide4dilitional.well Site-ilithils:..or•Well
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.8.Ninnherof Wells Constructed: 1 • • . •. - . •constniction deird!..s. You inay also attach additional pages if Iii..vesdrit.
For iiniliiigelotecrion oroloi-water supply iveqs ONLY 616 rhn.salTiq coirstrudtim,yiort csoo • . . . . .
' sohmir OOe Aim,. . •. . •_, • SUBMITTAL lisiSTFCTIEINS
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9.*dived depth lielowland suffice:: . 15 , - . (ft.) 140..Enr All Wink- Submit this Sarni within 30 ilOys of compteriOilof well . .
Foe*hi&ivells list Oil depths frelthirou faxgropro-3@209°oOrl.201(7,9) L construction to the foltoning: " '• • -
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IQ.'Statie:witter llevel heloW top of easing (ft) DivislOn of-Water ReSottreeS,Information Protessinig Unit, .
if weItY'level li above edifto i'Lli•"4-'' . 1617 Mail Service Otiter,Raleigh,Ni:27699-/617
II:Borehole diameter:8•25" . 'On.) 211b.for Infection Welhi ONLY: twaddition to-sending.the foini to the address in
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240"abele,also submit a-copy of this fond within 30:days of completion of Well
112„Well construction method; BORED • . . COISIRIC0016 tii the follOwitg:.. I '
(i.e.:piker,tetiuy,cable direct taish,etc."4
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. OiviNion at Water Resources,Underground Fiction Contro.I.PrOgrkuit;
FOR WATER SUPPLY WELLS ONLYI .1636 MaIl Service;Center,Raleigh,NC 27699=1636
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24e.For Water Stippl St.InJectioti Wens:.
113O.'34old'(gPot) Method of test: •
Also submit one copy of this form Within'30-..days of cOmpletion.of
• 1311.•Dislnfeetiou Intet well construction to the county icalth"department•of The crawly when
, . . , Amount:
- •- C01150aleta
-Sant G VI,l Nook Candina Dqa.nmetu.afEntirolutmo and Natural Resources-Division oiWaic 11otirc itcvlsed'Augtot/013
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