GW1--06580_Well Construction - GW1_20231006

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WELL.CONSTRUCTION RECORD ForlrtentaluscONLY:
This farm can be used for glutton:mull iplc twits- '
I.Well.Contractor lnfortnat)on:
`.ILiVArER'LONE5'. i
Brian Ewing I FROM. TO , DESCRIPTION
4l'c11 Cot entclnr 1s tnI j ft. ft, 1
4240-B i ft. ft'.
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NC Well Contractor Col ift 1ioaNunitct 15:'OIITERCASING:(fririrrut1l:caseirnei1slORLiNER111ap-ticabk)%
' FROM 'I TO DIAMETER TIRCKNESi MATERIAL
SAEDACCO f4 ft. , • in.
Company-Name. ,7I6:INNER CASING OR,TUBING(*lil:tr al etuscd-laic :
-FROM TO . ILAMETER THICKNESS MATERIAL
2.W It Constr'uctitin Perrilit#: 0 ft. 7 ft. 1 111. SCR-40 PVC •
!Rion applicable rrelpenults(Lc.Cntoity:State,tlariarxe,bled*etc.)
• ft.- ft, ' • to.
INFO!MO(Oat:I:yen use . -.17:SCREEN -
-Water Supply Well: FROM TO OIASIETER 5 rot Stn; T1hCI<Nrss 1 MATRRrs4
UIrlgficulnital OMutnicipalLltb)rc 7 ft, 17 R: 1 Ili o10 SCH-4o PVC
DGeothemtal(Heating/Cooling Supply) DResidential\Vater Suppl}•(single) . fi. I tG ( in.
0industriaallComrtercial Oi csideutial Water Supply(sictred) • -•1
9 CR0[JT
PROM •70. MATERIAL I EMPLACEMENT METHOD St A`IOuNI
Olrripation 'ft.. . 1t.- • 1
Non-Water SupplyWe,II: - • ' fa , ft; • .
RIMoniioring IJRccovely • -
IttJeclIon Well: ft.' ft.
❑Aquifer Recharge ' DG►oundwatcrRemcdiatian 1925AN01(:RAVEL'PACK(ifatgdiiabky •
,FR •rp • 1 MATP,RRrA4 RMPI.ACEMENTNInTn0u .. •
17Agotfer.Storagp atld Recovery' °Salinity'Barrier' OM 5 R. 17 ft. FILTER SAND # 2
❑Aquifer Test- DStnrnnti rtcr I mina p (L t6 •
17Rxperinicntal Technologgy OStlbsidcnce,Corttrul
1-111.DRILLiNG�LOGiatlaefi'add11i0oat ibeeti ifrtece snn•I'
. "DGeotlnnuat(Closet[Loop) t1Traper. FROM• - TO nrscutrut itwu.6;trooeli,yitJ,h+r!4t7pt.^J+prtWie,de)
DCfaatlter:nal(ileaiinefCoolind Return) DOiher(etplain under/)2I Retuadks) 0 .14 5 f4 FILL SILT AND SAND
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. 5 ft; 10 fL MOIST SILTY SAND '
-l.Date Welt(s).Cantpleted:. 9-6-23 • 'WelliD#INN-1. • 10 •ft. 17 ft., WET SILTY SAND
5a.Well Llleatton: • .f4 f4 :1....,.,�:-1 b `r w1 ,1�
Uwharrie Lumber Company ft, ft,
Fact7itykOicncrNarue Facility IDk(f appticablc), T. - ft. • - aeFI�V�{D3
355 Page St., Troy, NC, 27371 . it. ft. - Iinfa ,:.;,.':.•it r. s rr
PIty�siealelddrss:City:aitd Zip 2I:REMARKS r:,s.•^:::J r ...11 z,•, .
Montgomery •BENTONITE SEAL 3 TO 5',
(runty Parcel ltkrdiftc;tlioallo.(PIN)
Sb:.l ittitude anit Longitude in degrees/Minutes/seconds or decimal degrees; .22;Certification:
(ituell acid,of*1nli1 uyisVstrfiekrd)N W Br"i a.n,,EWi ng. 9/19/2023
.Sigaltur:bfcenined Well Canrtactds - • Date
6.Is(arc)the welt(s):,I]Pertttattettt or %ITetnporary _ l0y ylgning this'faim:.i lrrrdby certify Oaf the welds)kris 641err)corlytmeted JR eecorttente
. • - nisi 154 NCAC OTC•01(t or lsrl.NCAC OTC.'nco Well Ctntstrirrltu;Standards and that a
7.1s this a repair to an c.iistfng,weUi Elites or ENO eakeofdr(s rerOrt1&Owen provided tithe:till tanner.
Ifrhls.lsa?pfrle.flltatinouitliellcons!1Udtlatidnformatron and explain rho nitrate ofthe
cilieir mulctd+?l reo us'tls sdrtian area a the buck of this fornc- 23.Site diagram or addition:t wen.details:
You,may use the back of this page to-provide itdditioual well site details,or Well
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S.Number of wells constructed: 1 . construction-details. You inay aLo attach additional lieges if necessary.
For tirahlplc Iri(ac'tkm or ntrrt-wafer supply wells MIN with the same eotrstrrietioa,you ptrn
submit one fame SIIBIfITTAL iNSTUCTIONS
9 Total Well depth below land surface: 17 (ft.)- 24n. Far Ail WeM: Submit
this. form within 3U days of eomptefiou of iA•eIt
For multiple ityUs list all depths lfdiffiTenrfexmrple-3e2200'and.2(1.9WO) construction to the foltoniug: I -
lU:Static water level below top of i:as1ng: . (ft.) Divisfnn of Water Resources,Information Processing Unit,
If water level Is&tine easfrr„'. tte••t" 1617.IHail.Scrvice Center,Ralcigr,NC'27699-1017
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11,'Borehole diameter.2,25" (in.) 24h;Frt 1 Jj. 1nVr_,,Ilq ONLY:,in addition to-senditig the fomi to the address in
2.1aabave. also submit a copy 'or this foes within 30 days of completion of Well
12.Wellconstttictiou method:DRIVEN constmetlou to-the following!
(i.e.auger,rotary,cable,ditto push.ctc.)
. Division of Water Resources;Underground Injection Control,Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Malt Service Center,Raleigh.NC276991636
f3a,V ctd'(glim) Method❑f test: ' 24e.For Water Supply.&Injection Wells:.
Also submit one.copy of this hint within 30 daysofcorupletion.af•
13b.Uislnf'cetiutt-i,pe:- Amount: well constriction to the county health department of the county n•itete
constntcted.
Fenu G1V-L A:onh Carolina Department of Envinuuucm attd Natural Resources-Division of 1Yaii r rttxotev= Rcv'tsed.,4tgttsA 1013