GW1--06546_Well Construction - GW1_20231006

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WELL CONSTRUCTION RECORD
",(' FettmernaittFpNLY:-. 1 :
Ills form can benseil for Singtent multiple wells • •
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1.Welt-Coutiattot Itiformation:
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11AVAIERZONES . ,. . .,
John Eisenman - > FRO!,I tro DEleRIPTION
Woll Co timimor Nelme, ft i it. • 1 ,
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4439 • ,
IS.OUTER-CASING'itrWittilii-eiSitrit c1151'011 LINERtilifn•ritatikl•t. .-.-.-
NC Well Cowart&fertifbeetieti Nowlicr
FROM - TO ' DIAMETER 1 THICKNESS ' MATERIAL,
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. . (4 fi. fl/'SAEDACCO :
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C .ompanytiamc. • - `16.-INNEE .• .CASING ORTVO1NG:(gpoikiiintareinkil4niiisp-,' -.--.. .
FROM 'TO . DIAMETER' THICKNESS ,MATERIAL
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2..Welitonitnittitiii fie***ii; • -0 ft, 8 .It 2 . .-"IL SCH-40 PVC
44 i oil aictible will pitorits.(te.Coonty:Mare„Vbriarree.Ireortkr4,ert4 ------ •—7-7 . •
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3,;',4yetilUse(elteckitcli use); .! -,17:SCIIKEN , , •
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Water•Sopply-VVelh• - • • FRt)W I TO - DIAMETER: SLOTSITY. TinCieNrss MATERIAL
iicipalf.Publie
8 It.. 18 - ft . 2 lit .010 SCH-40 PVC
ElAgrieultutai Oldin - .' .
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• Creiitennal alcatineCcoilut supply): inesidentialWater Supply(single) IL .in
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OlodusItialitonnuencial OResideutial Water-Supply(shared) '
FROM, • -TO. . MATERLILL EMPLACEMEST METHOD,&AMOUNT
Cl Irrigation" . . . 0 'ft. 3 ft. Portland - Pour ,
Non-Water Su pplir Well: - . . , .. . . .
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itMantioring
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Injection Well; • • 11. .u. ' .
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11,Aquifer•Rceita .rge-. . ' 17.1(3totoidtialcr ReittediAlon Tr9.:SAND/GRAVEL-PACK'OrAmIkabr.te --.- ,- --.-:•-•- •-: 7,:7.' . :'..:. •
. ... _. • :&ROM TO NLATERIAL • - ENIPL MACEENT.METHOD •
• PA.01116-1: 1;111BPROICCOFtIi', OSalittit'Hartier 6 ft. . . 18 -ft. Sand ' - #2
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El Artulfci'reif CISIOinitutet'trailing
IL. . - ft; , .-, . . • .
i43srperiniental
. . Tehrrilo 13Sthsiticoce:eantole 4t1.DIM LING,LOGIitart•additiOnelsheetslirice6•sar•il'
LCeo'kenel(Closed LOgp) CTrcer
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. . -FROM,' TO ' DESCRIPTION Icolit‘Intrditert,6011:rotk ly K.p.e0i.d.k.de.1
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EIGeothetmal(Heating/Cooling:Retool) ClOther,(explain underini Retuatksl 0 .It. 18 -tt,- Silt/sand/clay
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ft.
4."Date'Well(s):COMpletedt 9-12-23 '.viim m tolvi-6 .
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. 54:Well LAteatitad .IL, , ft.
Arlington Branco Oil Company . • .rt.- tt.;-- • I .'..:..,,,,
f:k 11 itY,S9)YNY'AIM • . Fielli*lim 0eappii'Fable) ,'
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f.I.- - ft, ', -::. c ..
270 N. Main St. , Jonesville, NC; 28642 - , . . . • ft.„ ft. . ' • - - OCT o_e_ • „..... •
iiitAieol.-A4diess,.:City,:and;zip• '.2LREINI,‘R.K.S: . - -• - - . . - • .
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bentonite seal from 3'L6",-4,1=':,',,, .7., .
Yadkin ....,,, ,---,.
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County-. • tiareetid ntifteall on NE(P114)'' :
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56Liktifude:Williingtioikia ogrcatailaatc0cOia0Or-,dtichaai,qctiecir. ,22,ccriiiHotion:.
tit well rictd,Dila liinlon -inftleiesd) ' t
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N •W ' - ;4_,;„"•°;9_.,..---_-,----ir- ------7----- 9/17/2023
. sidtatute'ti..7,-.. T.V..r11;4.7..iil.co.,.et------ Bak
G.Is(are).therwell(s): 10Perulanent or 13Temporary ,
ity si.gribigAirfahr0."!ift(:.4rr"ilto!ice.f.t.,...?A'M''.7 6-o.f-ZZY arra'biter.et!br4m.Nr‘i rrharce
OA'T 5,,t lircitC OW..i44-:' -.1,..-7.1::CliC.alt7.0206 11'.ell coirriirretio.-n kantraar Ond firm a
7.Is this a repair Itt au aiisttag walk 1:IYes. or IIIINo -iyiiiiof Mk iecotrl biii:been to-inured iib;se well owner.
f'Lthr.slt 0 Omit.fill nay knotee yeti Com-m(0W Won-nor/6n*obi(4...probr rbenorate virile
eepoir wider 0.1..reaulibsrseatarr or an rbe bad.of this form. 23i Site diagram or_additional well details: .
You may use die:bacii of this page Its..pro%iide'adifitional well Site,details or Will
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8.Nutober of Wejls.Cottstrueted: 1 • • • Coustniction details,-You inay atiOMiach additional.Page,s if tiecesSiity.
For ntmliiir!re Injection-or owl-I:rarer ift-p•ply'we(4:19NLY iiirff riiii.sione,cansterterforr,pm orn -- . • I '
.0niir rifp!Pm. . ' , - SUBMITTAL INSTEICTiON§1,
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0.TOME Well depth-below-land stirfacei . 19 . • - 014. .-.2.14,Far Alt %Venni Signitit this form within 30 days.of:c0inpleilOtt•of livit -
For matrip re Wells Ho all&TWá if tiffferent l'exaorr)le-3@200'and 2G,100) constmetion to the following-. ! , .
10.StatieWater level helot.top.ofeamingt . • ift..) itivisitin of Winer ReSourteS,InfitronititinIirtieessitig Unit,'
If Weller kleyi is Advil easrop,km"-+" • f017,hlrail.S.triee'C*t6',Raleigh,fi.C.27699-1617 .
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il.Borehole diameter:8. 8" (in.) 211b:For Trifeethatt Well ONLY:,lib addition toleading.the form to the address in
24a abeke,also submit a copy Of this fount within 30 days of completion of well
11.Well construction method: HSA consiniction ta--tlio followingr
(i:c.oil*,Mtaty.cahlc,:.ditcct pusketo • .
Rivhioit of Water RCsourees Utuieraround Injeiithan Contro.I PrOgrant.
FOR WATER SUPPLY WELLS.ONLY1 - -1636 Mail.Service center,Raleigh,NC 216994636
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14e..•For WatekSU1101 &illitcitotir*cps:,
13a,)4040 Method of test: , _ . . . . ....... .
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• Also submit one:ciat3y of thiS Irani%titian'30'ilOyS of completion of
1jb.-Disinftwtitin.typet, Amount:: .well:cot:Stomata-to the county heal1h department-of the.county where
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FOrm GW-..1 Ninth CarolLna DeparneentorEinitonwent and Natural Rewurees,-Dlyiston of Water Et -qutop Revised August 2013
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