GW1--06577_Well Construction - GW1_20231006

f '
WELL.CONSTRUCTION RECORD" Frit[dental tlscONLY:.
31iis form canttcuscdfar:singleor multiple twits. '
1.Wcll.Contracter Information: • - , .
%f4i.IVA:'rRRZONES 1. .
Brian Ewing tROM. - 'tti DF'SCRIPTION
Well£oittrrctorName- ft. ft. I I .-
• 4240-B ft. ft I
NC Well Canttacror l�nificdtion Nunitcr r'15;'Ot1TER_CASfNG tfoi�muill-rry'd-riellsl`OR LIPIEft'litan Oeybtel=,
most II To _DIAMETER' . THICIKNESS MATERIAL
SAEDACCO ft. ft
. • I I'In.
{:ontp;my'Nerne . • • '46 INNER CASiNGORTURING:f e.iikratalelosiddratl .p)' ' .
• FROM TO . DIAMETER THiCKNESS. MATERIAL.
2.W.4'ConstructiriilPcr*uit#: 0 • •ft,. 5 . ft. 1- I .�11L SCH-40 PVC
Litt aaiyrlf,ial ie.xrllpeimfts(Le.County,'Sas i',.lrarimece,lreerbi t'i J'
(t,. • ft, in. •
-
• 3:Wc11_ifsc(cheek Well use); 17:SCREEN .
Water Supply•WeIL•' - FROM TO n1AMETF.R SLOTSi72; T111CHN1.S I MATERIAL
COAat(cultural: ElMtutiicipab ublic 5 R, 10 Tr. T In 010 SCH-40 PVC
©Geothermal(IleatingJCoolingStipply) UResidentiat\VaterSup ply(single) it, . 'it' lr''
Dlnda*ialiComutcrcial DRcsidential Water-Supply(shared) FRom. ,TO.'
MATERIAL -EMiLACEM> 7T!METHOD S AMOUNT -
DIrrigation -. :rt, D, '
Nou 1Vater Supply Well: • • - .
�Monitorini • DRecoyctg ft:. ft
In)ecltou Wellt " rt.„ fa • , .
ClAituiferRecharge C'GiouiklwaterRciucdiaiiou '49:SANDGktVELPACK'(ifiutM116iutiV-- -_- -
• ' -FROM • TO slA'rRRrAL - . •.MN_AltAiENrstL'1'uou. -
DA4 ifcr:Storagt:and ltccoycty DS,'tlin ty 13airicr. 3 : :it.: to ft FILTER..SAND # 2
❑ArloifeiTest. 1:1Slaiintr tcrDriinagc it.. (t. . '
. EIEVer mentel Tn huology 1:35tibsldcncc.Corldrot.
r.211'DRfLLiNGI:OG(aiticli•iddltionni itieets iinceessnrv)`
DGtodhenual(closed Loop) :DTracet .Elton- , TO ' D1i5CRIPnIONteobr.berinetkvirrnetttypr'arin.ite.Ncm
DGeodiennat(Heatiiig!'Cool(ug Return) ClOther(ecplain under#2 t-Retuarks) 0 .ft. 5 ft, FILL,SILT AND SAND ,
5 - ft. 10 ft. MOIST TO WET SILT/ CLAY
-1.Date We1L(siCarnplelcd: 9-12-23 WII ID#TMW-7- . _ .
rt.. rt. r
S .Well Location: L
•(IL fl rt rN: `° ' r`
:�' ��r is ? ,-.
•Matthew Market • . ft,- ft, r ' „ ��7n'�
Facility,!OwrcrNanre Facpity1D#(ifappliablc)., R, ft.. �" O=6 J--
3196 Vass-Carthage Rd., Whispering, Pines, NC, 28327 1b rL, if`JIFF e4 1 7r r , i 1 1
P1y*ieul Addiarss City:upd Zip '. e2 L.REMAR S- " . w c-n o o
Moore bentonite seal 2 to 3 •' - ' •
• ' County Parcel ldeutirrcailoo No:.(PINY
5b:I.ittitudcaail:Liing1taile'ia dcgt'ccxlminut /eceondst r decimal dcgiii : 22:eertitrcatiort:
(tf ur•n Iteirl.ona ratnorir;is•tuffk csd)
N W Brian Ewing- 9/21/2023
.SigmtnrufCertiiedPiellcourmtgr - Date
6.Is(are)the:well(s)t ft&niiatrent oi' 2DTeniporary 'ttr se nzn met tm;.I here cerrr r 4ref the well s1 earls Item)iv strrrcxed htacx.'onlrrncr
• i irh'Ill NCAC Q2C.01A0 or 1501 Nt rtC'02G;tJ200 Neil Cnlrstrrt'km Sthrxiards end flxua
7.Is thls a rrepaie to ate eristiaj with." Dye.; Or No rrrlmo;Mil=irroni brie ken provided ra ilea urn turner,
If ibIs:(r:•o rstxrl fill roe krouvi Well e+atuyrerctfati lrtforoiarlar.md(iapiahr the igmvr of the
renter reader N2l-icrnrer..i'.seal=or an the brsz:t.of fhb.form.. :23.SLte.duigrtim or additional welt details: " •
You may'.use the.back of this page to'provde"additional well site details.or Welt
S.Nuinberofwelts cotuttuetedi 1 construction details, You May iilso attach additional pages if tiecessaiy-
For mid*!rt(eorlon or nine-ntir..r aaplrlj wells ONLY filth f rue same rarestrtictiwt,pan creel I
srbnrft one form. SUBRiiTTAI:iNSTIJeTIONS
0.-Total well depth hetow land stirlik • '10 • (ft.) •24a. For All Wells: Sabrnit this.form within 30.days of ceinptetion'of Well
• For imallpfciirllr list oil depths(Wows(raemrple-3@2Q,0'arul.2 loll) constnictionto the following: •
10.Static water level below top of easing ((}) Division of Water Roan eeaurces,Infurvuntian I?rdcessirig Unit,'
If miler level is above dasfn,;,Ilse"+" 1617 AlrailSkrvicciCiiter,Raleigh,NC 27699-IGt7
p ; •
11,Borehole diameter 2.25" . (in.) 2411:For Iiefcction Welh ONLY: ;In addition to sending the form to the address in
24aaboVe.,also submit a-copy'of this feriii within 30 days'of.completion of hell.
•12.Wclfcanstractiou method:DRIVEN- cotistinctimutotlre tolloMiig!•
tic.auger,rotary.cable,direct push etc:}
Division of Water Resources,Underground injection Coutrol Program,
. FOR WATER SUPPLY WELLS ONLY: - 1636 Mal[SercicejCenter,Raleigh,NC 27699,1636
i3a,Yield(gbfg) Method of test; 24c..For tauter'SupNv tic Injection.Wells:
• Also submit one copy of this`futiu within 30 dayrsofconipletioitof
13h.Disinfection type Amount: wctf construction to the county health dcpanment of the county where-
' constructed. 1
Form G W-1 Noah Carolina Deepartment.of Enviroturrns and Natural Resources-Dtvi;too of Wardr Restores Revised August 2013
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