GW1--06307_Well Construction - GW1_20230926

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WELL_CONSTRUCTION RECORD R/ir Titcrpl Us.,0 pNLY: • •
114 form caii ba.uscil fa.sited or multip3a was• ,Ue/k
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l.,WellContrattor Infarmatiour
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'-'14:11TATERIONES . - ': . " • •
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Brian Ewinq FROM TO DK.SCREPTURN
i.V011 Co tinttl0 Oa mo ft. ft. I
I. rt.424 0 • ' •
NC Well Contrdctorr Certifigniint Mutter tSOUThRCAS1NGiroiqiiiillkiiiiii-niltNVORLINERII9ti)tinibiti.:.
FROM - TO ' PIAIWETER - TRICIMESS 'MATERIAL
SAEDACCO (It, _ 14. Ina..
Computy•Name,. •;14..-INNER CASINGORTUBING,(0netitaktuktI4LiiipiR!:?.....,-. -
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• . FROM To ' prANVETRIR THICKNESS MATERIAL
2..WeliConstmetioir Perri*6.: . 0 ft •23 ft,.: 2 , :111.. SCH-4 0 PVC •
1,..in 41 appilictible 3.9,4 pc-Ay:firs,(41.Cfninty...Tiree,Variance,infeeticfri eic.)-
11,.• , 11. : ' i • ti.'.. ,
3...WC:i.1-1/5 (01,1Ccli..{1.01 use).':
Wnto,r StiOply Well:' . . ' FROM- TO •MANIRTILE. SLOT Sin: Ill lekri MS 1 MAURO,*If, '_
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11Agtculitttal Elfi.liinicipaliPahlie. ' 23 . ft, 33 ' 1'17. 2 ' :1,11 ..010 SCH-40 PVC
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1Genthennal(Fileatingtooting•SUpply) 1:11itsfdential•Water•SupPly(single) ft' tm
-48,GROUTi ., • ' .•.• .
OluduStrtiliCommtereial ClResidential Water•Suppl)."(sluiced) •-
FRONI. ' •TO. ' • :M-A-TER-L'AL i E-N.R;LA.'CV.. !MiTIMM-CID&Aidii.ONT1 -
I:Irrigation- .. - . . . . . . . . . , • . • • 0 'ft. 19 ft;-- Portland Poured - .
No nAVnter Supply Well: . . . .- - - •.ft ft
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" IIIMoniftiring • nitcovcry _ - - _-- -. .Injection Welt: IL ,ft: , •
°Aquifer Reeliargi 1;3Orbundwateir Refitcdiation :49:SAN110311AVEL•PACH:tildpinkat&r---- - . -.----,..*-7 •7-:7--f .-.. -:,:.-.,- -
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, .. .. • , .•• FROM •TO, . MATREtrAt. .• •Rmrutermsofr mrrno 9,
PArtuifeit Storage and Recoirery IliSahn*liatre -
• , ,.. .. . - 21: ft.. .33 ft, . Filter Sand # 2
El Aquifer Tcif • 1:1SterniWate(Orairirtge . ft ft
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LIctfnicntal TeChootga.. 1:1Sub5ittence.toa4rol
. . . 1.20.zDRIt.LINGLOGlitiadf a.ddlitoigil 4MCU,if neCiscri01. - • •
'Os Oro thCnitai Tlosed Lrrop) 1:1Tracer. -roost To . - DESCIRPTION(Wan handiwm.wilViticR trot..00lo!Ate.do.1
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EIGeotlientral•MeatintoreolingRetwO ['Other ftv.plairt under:#21 RetuarLs. ) 0 .11. 10 ft. Fill silt sand clay
. 10 . ft.. 20 , fL Silty sand clay stiff
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4.•Drite Well(s)completed:.825'23 • Welt MtimE4-19 . .
-20 .It. •33 -- ft; Stiff'clay pwr
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5n
f,Well1.4cation: . .ft.. • ft. I
• . . 1:72t 7.,i-.7 El 3 1. r-N.
Speedway 7994 • ft. fc,• rt.i'...-1....r L..;• V P...-.L.' .
FichOnoccuue• Fac0ity 11:i# .iftsppika,hte)..
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2325 v " '
s-52 N., Albemarle, NC, 20001 ft- SEP 2- 2023.
PIK4ii101;M*55CitY;iir'013 • 321:IIEMARKS" ' ''.. ' , I nf3;,74,--4.:i -. ,:9 1,111:i
Stanly " . - . 'Bentonite Seal 19 to 21' -D'11:;10311 0.G
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Coml. Parcel icklioneation No.(PIN} .
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511..Latitude anil.Lringitiride in deOccilnrinotesisCCtindsrir.ticeiribildegeecir 21,...cirgifz. katil-mr .•.
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tit nett 0gte,one iaraoritti•suitio-idnu
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• IC' :%* 13,,rta,_n Ewing .9/7/2023
Sigintun..4Ceitincd Via.Contr:atot. • -• Date
6.Is(.0)tho:wIll(s)t"Vet-Mon:tit ge 1:Temporary 6 Aiinbri)trir Adm)Irerelg cerrif,rr1ftif ihr wel)(si iwtY(14x40.„1 tkulyttifetc-4 inscorieflance
• . . . till/5.4 ArcAC 02d 1.0100 or ISA AreetC 02c.;72t;10 We it C*Ottionericr.Srar4errifs and llorr<I
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7.11s.this•a repair-tir au.Orlitiago el4- DYes or 81N0 •coirrof MIT emir('beti 1;i•en pwridoliii-Oe qv,/tiltvier,
ftigs:ft 17 Fiptifr,fili rot k-..00w ird1tonciloo btfowlion aOil trptohr rfte..ograre of rite
ripotir under‘02,1frorocirres ociion or on Thelma:4:4 this form. • • ' -23:4tte.014rant.or additional well detriihn
. . You may use the ba;k of this page tolpro'videradditional well Site derails or Well
S.Nuattberof Wells Constructed: 1 • •construction details: You May:rise afia'clt additional,pages if tiecesSary.
For iitneolge ihjeollonilf oonovarer sill/ply-'yelp ONL.Y it qr.('the.sffIAT atilltrifetran: -;ellt.e<117
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.elbntir rine farm. - SfiltitITTAL INSTLICTIONS,.
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0.Tntal twit depth beloirland stirface: 3P . . • - (ft.) .24a. Fin'Alt Wells:: Sfilnuit this form within 30 dit3s.of completion of well
For ityloWpk.led tall tleprizi If diffi!rivit le.rmipfe-30200'nod.2@ AV) • constnittion to'the folloni og: „ ,
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10.Static water levet(claw top of casing: (ft•) Ilivisitin of Water Reset'rces,Information Processing Unit,
if wake ki.el J.s above eadog;Ohl"+" ..161.7,1fail ServicCfr.titer,Raleigh,NC 27699.-/017.
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Al.Borehole diameter:8" lio.) 241K For frilgerjou'Wells ONLY: :hi addition to.sendingthe.farm to the address in
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24aabeive...also subtiiit a-copy 6e this fans within-.0 days-of completion of irell
t2.Wellcoustrvction method:Bored construction tothe following - I i
(i.e.auger,i,olary;cahle,:airect pitslk.dc.} 1 I ;
. DiviSlott of Water RSourst1Tiitterground futeri
. tion Control.PrOgrant,
FOR-WATER SUPPLY WELLS ONLY; . 1636 lqitilServiceFeenter Raleigh,NC 27699-1636
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24e,For Wata'Supply&lineet(on.Wells:,
Oat Vieldiftinr) Method of tat: _ .
' Also submit one CO3p of this Ifertri.within ;it)..itaysof completion of•
13b.Disinfection
well.;Obstruction to the carroty heirldr department of the canary where ' •
type: _ Amount:, ,
. . cOnstructed. I
film GW-1 North Catalina IllaRment.ofF.roviconment and Nattoal Resources-Iftvisloo of Miler Hottl: Revised August 2013.
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