GW1--06282_Well Construction - GW1_20230926

WELL CONSTRUCTION CONSTRUCTION RECORD. I Far Imolai tfaepNLY:
Til . .
ts fonn can ben.wd fel.siegk m or ultiple wells-
1.Wel.1.Coittre&tor Information: \Lk 'LL.WATERZONES., • - . ' - • " -
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Brian Ewing FROM. .10 DWICRIPTION
Well Corimetor.Name ft. ft.
R. . ff..
I i. . : •
424 0
qSAIITERCASING.trikfitatkliSirfneRSVOR LINER:Atari''liable)i. .:..-
NCAVell Commetor c'enificationNuwher
nom ' To . DIAMETER t ' 11111CKNESS MATERIAL
SAEDACCO . •,f-1- ft. • ,1 I I In. . .
ConepanyName. 16.-INNER,CASING'ORITIBING,Oleoillteilitil ckikil-lorifelkL--
FROM To DIAMETER - TRIMNESS MATERIAL
. 2.Vkit tOnstrtietitin Perrnit 4: . 0 R, 20 -ft. 2 . SCH-40 PVC
1.4r*i itri itpplicoble will puitntts.(i.o.County.Slam Variance,freectfrq crc...i.
. , ft.,.• --tt. • 1 • h!t.
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3.-Welt:lise(ehectr:well use)i r.17:.-SCRXEN
...
-!" Fno:ki TO WAND:TER I SLOT SI7E THICKNESS NIATERIAL
Water-Supply Well:-
•riculti 20 -ft, 30 IL-• 2 .. fe. 1 .010 SCH-40 PVC
1:Mgtrai. • phltinidipallpitbiie•
- 6 It.. ,.
ClCyeathennat(Heating/COoling'Stipply) bliesidential-Water Supply(single) in. I-; • . .
,
LlioduStrialiContotereial pitesidential WrderSopply(timed) . --"'t GRii.Qu'r'i--0 • .1 Ni-A'' "- EMPLACEMENT NIETTIOD-,a/MOUNT .•
El Irrigation" . . . , 0 ft. 16 ft- Portland . Tremie
. .
• No&Water Supply Welt: .. . • . ...
ft,. ft; , . .. .
OtMonitoring• ORceovety . . • .. .. ._
Injection Welt: ' rt.: . ft. . I. . •
LItItittircilICOUrgO - ClOitillkiWatell Rciitcriiiiiion - 492SANO/GRAVELPACkiiCujiplkatee). • - --- 7-'-... -: . ,•-.-- .:-.77''- '
. • . • .7-FROM 10 - stArttrm. , • •ItstriArtmenst me:Ttion •
ClAnnifct.StOrage--and itecoliety .OSnlinity Elitirlee - 18 -11`.. 30 ft. Filter Sand #2
El Arinif-cerest, ' . 1:1Stairtitratc.e Making° .
. .ft,.
• . '
1:38VerinientaiTeehnotoff. IZISI4idcnCe.t.olling
-..20..'DWI LliNGLOGItillieVadditiixtel iticas If neceisal3.1
OCeOthennal(-Closed.Loop) - OTtacer - • - .,
FROM,' TO • DESCRIPTION(obn hardimm,milliNtsk typt.PPAill,issic.dr.)
_.
OGeothennal(Reatine/Coolitte Retum) ClOther(explain Onder.#21 Retualks)
r----- -.,-.--7A Fr.-7) •
. ft.... See GOBI'.a Loge ' 'p
• . .4. ,
-1:Date Well(s)Co Mpletedt''8'24723 -liratifttitei-2 P .
• •ft.: ft.
Sa;Well Location: .it. ft. sEP. ci G
Granny's Bait s Tackle . ..
. . . .. IL, ft, . • .
... ' ..t.,r,11 • -s ••••
tacilitykDraxrNaree - Fielli*WA!(tt'applahle), • int.a....,.. .,..r., ,,,..• Pr,)^5.44N.t7.a 136.1
'R. . ft, . DVfitaf,,'-• .
• • '
6830 NC Highway 8, Lexington, NC, 27292. . . , .. ' ft,. ft,- , •
Oliyika141 Jcss,city,-..'atid*ip.. 32 L REmAngs.1. -. ' . . . . . .. •
•
Davidson • Bentonite seal from 16,18'. .
. . .
Comb.- • . Parcel latmlific:diou No;(PIN)
1 '
. .. . .
• Sii„1.-atitink.ant Longitude in degrecifminutts/secOnds rt'rrieeintal degrees:• .221 Certif viaticum .• •
, . .
Omen Hold,one latiloii is-$1r.Elikiii) . '
• . .
E)rian Ewing.
9/8/2023 .
. . _,,_ Sigraturief Cettilled.IVell contractor, • . - Date
6.Is(are)the-well(S):-22ermanent airigTemptirary- - - i;.„i •..
.gnIn .t fUM&1 j„C'hy• err/y,f)al h,!1.i•rm l a„v v'r.? ox.x.•xled i•kfc51•0,knC V
. -irkii 1M Ar't.1C 02C;9100 or/.5.1•JVCACO2C;tr.-'00 Weil Constrartion Standards and that a
7,Is this.a reparrtit ati e.siStingvvellf Oyes .Or giNo . , Toii.t.?f flay iectin i loiti.teen proridetl ta.th;sivii rimier,
, lf this:tv a'Oak,fill(4:At aus Weil tiiiisttitctiati Warthation calf(*lain the narare of die
iipair want#.'ZI iletnurkt section or on In bad.of this form.. .23:Site diagram oradditioual well detaiho ..
You May use the.back of this page to provide-additional well Site details-or well
S.Numb er of Wells Onstructed: 1 • .
• . • construction details, You inay alsePiattatit additional pages if iteeesSary.
For iitaltiple Irtjecrion'or aira-imier supply iiTilos ONLY Wet ritusonacCORWrXerkt,you can - .1 •
sp.611th Me PPM SUBIIIITIAL iNSTUCTIONS: •
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0.TOtal Weil depth beitiw land stirfacei 30 • • .20..Km Ali Wells: *Mit this'tarot within 30 days of completieit of welt
For aultlpfc itells list all depths if dtiprena imorrip re-3@200'and.20 WO') consintetion to Hie folloning: ' .: '
la.Static water level below tapof casing: . : ,. . OW Division of Water 4sovirc es,Information Processing Unit,
If mitre lkidIs above 011'4.itse"4- ." r 1017.1$1ail.Stivieerenter,it aleighiNC•27099-16 E7
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IL Borehole diameter:8 45" 'O.) .24h.For Refection wo ONLY: 'In addition tozeoding the form to the address in
24a-abin4.-also'subitiit a,copy of this form within 30 days-of completion of WI.
12.Well construction method:Bored . . conshuetiou(011ie following: I '
(ix.alipci-,nylat)..eal?le;ilifeet Push,d.c.)- ,
. . ,.P.ivis.ioit of Water ltesources:,Entiergroundlitroition Control Pr gram,
FOR WATER SUPPLY WELLS ONLY . - 1.636.141itil Service Center,Raleigh,NC 27699.1630;
. I- • ,
• 24e.Far Water Supply Zit.injection Was::
113a,Yield(Om) _ _ _ Method of test:
• . Also sobniit one:cepy of this-taint Within 30:days of conipletiottof•
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13b.Disinfection.q-pe: - Amount:' ' well construction to the county]health del:moment of the county where
_ I 7 conittoctcd.• .
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Fenn OW.I. Nonit Corollna DN.:palmetto(&Mt-merit!au!Natural Resources,*Won of Water Rotircts RclAsed Amps:20LI
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