GW1--06544_Well Construction - GW1_20231006

WELL CONSTRUCHON.RECORD Far trampfilsc pNLY:. ,
Thks•forincanW•itscd foi dtigI6ct stallipk%yds• . 1
" - • . 1
1.Wel.LControetbi Inform;lion: •
14:.AVATER-LONES . . ,- . • •
John Eiseman . FROM. TO DESCRIPTION
Well Oititramit Nome, ft. ft. f 1 •
• •
':It. ff. i !943 9
•AS,'OUTER CASING`trirrivitilIkaitffireKOR LINER:6141f litablaL .-_
NC.Well Contractor Certification Nitoftet
FROM -- TO . . DLIMETER 1.. - THICKNESS ' 1 mATEMAI. -
SAEDACCO . -43. . .
• •
ComputyNatsc, • • -,161.NNER CASING-ORTUBING:tisikeritil 464'14DM-or';
-FROM - -TO • DIAMETER THICKNESS' - MATERIAL
•
iAlticittonstrtitiinit'Fern*4i . 0 ft. 5 II. 2 ' 'ht. SCH-40
PVC
Lfti tril qpfiliciike ire'1 1 peiFfes(Le.Cpunty.•Stroo,Aroriarar,!great c 04..elc.,P • •
. .
' 11..• ft. •
3.*Iiltis -(041:*011 use): • 47:SCREEN , - .
Wator SmiplyWoll:' • .
FROM TO' • -DIAmET)R StOT WE THICKNISS I IATERT.M.
- • 5 .ft, 20 Ti. 2 'in.' .010 SCH-40 PVC
Clitgliellli001- - PliiiiilkipaliPH141r,
EIGecithonnal(Heating/Cooling-Supply) .C2ResidentialWater Supply(single)
OltulustrialiCommorcial CIResidential Water Supply IFR8i0G:°Fr.--
TO _ MATERIAL' -ENIPIACEIIILNT METHOD&AMOUNT
El Irrication• , .
- . O. :ft.- 3 _ ft.-• Portland Pour '
. . .
10114VatEr Supply Well • • • . - -
ft
CjiktVONVIY . ,. • ft.
• OlVionitorfti .g • • ., • _ . . • — •
•
Injection Welt: • ',
-•. •-.-... , '-- . . • .
PAquiferfteeliarge L . ClOtoundnalcr ReintdiatiOn :caw SANnIGRAVELTACROAlitlieahtor -- . . ., •-... • r, , -. - „,
, . .-.soon •To MATRRIAL EMPLACEMENT'METHOD -
fiAttuirc.r.8.1.0titi..anil Rccovet; 138alinity Raitlef
- .,.... ... .. „. . 4 ft., 20 ft. sand
ID Anniki Test . . CiSitottirataf praftfago •
ft.... R.
• DEVetimental Into.tou. - 1:181tbsidcacc'C'ostiml.-
, . .10.•DRILLING•Makitad,a ddllion'al Ileitslf.nee6sitil •lCr.co. tkettoot.(clo$ed Loop) . I:tracer. FROM- - TO - DESCItIPTION Dvbr.barmier!.ikOntett Dtx..'grailm sin..‘,tie.) '
. .
CIGe.4thetotal stileatillgid0Oililg Rehm) 0011ter(explain under.#21-Retuatits) 0 .0.. 20- .ft, Silt/sand/clay . .
. . It.• ft.
. . .. . .. , • ' .
__, •
4...Ditte,Welqii.Canipleted:-9712-2 ' "Well IDPIT473 'ft. - R. 1 . • ,,,,,.......''i.:,.,...e"----",:7-7,‘•.. „...„,..
.v., r ,-,..-- •:.%.g i--.•I, ,
54.Will LArathint ft. - "!. "7 ')."
Arlington Branco.Oil Company . ' . ,ft.- n r - n--------2.
j tP
nioilhy/.0nitio.rIsituo fac110 IDP,(rapph.oblc) ----1'-------- -k' . . 023._
. ill -a:.,..;0--,-, -
,
270 N., Main St. , 'Jonesville, NC, 28642• • • „ ' ft.; ft •, • 0,...,?.- '-",-...:-;0 Ui-i,
0-16.1.1•411.41055 citY,• lti*IP -2 I:REMARK'S- •. :,k,::.3 C.1,:3'N •
• .
' -bentonite 'seal from 3 ,41 -
YadkinI'
Can* • ,
?arced kloolitioa0 on No:(01N)
. :
Mi.,..I.atilitdchnit Longitude in 110t'eviintinutOsectint1S or decimal degrees 12.,c.craft; emi00,,,_ i*
OruellilehiolielaVI6410flii.100) ! .
.• .
'
• N NV _ .7,-;.- : •- .,.----- .......---- 9/17/2023 •
Sigtuturucf,..7..5i.le.,4 -- — • Dale
• . ..:....xe--- ....,,,„ , ?,,,
6.Is(art)thoyelf(s)t 11110eintattent ok LITempotaky - it),.4.04'ikofirifi,',•-e.ir,*eq:,F,F,-,ito tiz.5.77;4:2:7,f.fri2;•*"..tif.='iv,rasiti!ciad ire;•c•earrinater
. .
• iiitli IMN('AC OiC.1.4,-,e,--;,:-.: ii1.7.:021317 We COirsitTicifoit Srarrojarrti mid Atm a
7.Is this a repair to ati•ekiStingwely Oyes. or 81N0 .1.60.ofth1.f rccoiyl kiii been pint iiirri to kre in ii riirait;r, •
If rh(s:It o riix.114*Or kqi•itsu li'd1 COW'iniellOil Nforowdivs wilt ti.rpl,oln*aware of the . . •
repair rooter 02.1'remarkif.itaiara 01,611 die bark of this farm '23:Site 0.14c9nIME,addltio,uall.will tielnifs:
• You may use the back of iltis Mike InSprovide"additiOnal well site details or Will
8.Number of Wells const meted: 1 • . •construction details. You May ali3Olitiachiddilional pages if tb.sCeSSity. -
Faiiitaliipti irdecriii.o'tv ormr-Trarr supply iv'elf.t ONLY O4tIlthe.settl?coirstiettion,yea.e49 • . •
.qui:wilt ime form ,. . . • SITBNIITTAL INST1TCY1ON§•
0.Iktsilit'ell depth liettnyhtail stirfae&.f. 20 .
. . (tt,). 21a..For Alt Wilk' Sabath this form withiti-•30 days of•cduiptetiOtt'of well
For ipiriple ire&fist oil depth'If&print(extioipre-3@ZOP'tux(.2@ Mg) . constmction to like fORDEOIl$: ' "
. . . . . . ,
ID.StaticU.ster Idel below top of easing.: . . . _(ft) ItivIsioo of Water Resottreeitanfitrtriation Fror.esshig Unit,.
1f Iroir r irrerds above cils4.1..itse" ."+" . • 161.7.NlaiISirviee,Center,Raleigh,Ni",•27699-161.7
1. i ...
11.Borehofe iliameter:8!25" . 24b.Ysi iiiicellott Well9 ONLY:l'In-addition to.senditiglireform to the address in
2.1a"abo*also submit a,cOpy"Of;this form within.30 da)s of.completion of Well
12,Well construction method: HSA • constnictiou tntfte folloiiino:•
(Le.attici-,i:otoy.ont;le,,iihrct iosh,cto.} ,
. . ftivision of Water liethurees;IJildemro •und Injection Centro.IFrOgram,
FOR WATER SUFFIX WELLS ONLY: . 1636 Mall Sersice Center,Raleigh,NC 216994636
. . •
. • • 24c.For Water Supph &Ittiecttoit Wells:
13o,.Y(F141(g0) Method of test: • • ' , '.. aS of conet- . Also submit one copy of of this jiith Within-30 dymion.of
13h.Disinfection 1)0e Amount: .
well:ceittrueiton.to the-county ItCalth department of the colinty'whCte
: •
, • constructed.
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Fenn GW-1 Nash Cato linalkpanausta.0f Eaviromuctut alKINatural ReICRIICCS-DSica oi WM'r FIeqUe04 itcvlsed AttgUst 2013