HomeMy WebLinkAboutGW1--06598_Well Construction - GW1_20231006 i
YELL CONSTRUCTION RECORD For{ttinualUs DNLY:. '
, This faun con L'used for single or tnnliipk wclis-
1.W`elL.CoutrnctorInforntatiou:
-tJ:WATEIS2ONES _
Brian Ewing FiROM. TO DESCRIPTION
- -
WcII Curtrtctor N7mc R. ft,
9240-B il. ft; f
NC Well ContmciorCcnifi�ilionNntnbcr '`IS..OUTER CASING'(for`multhei ietinellsl'OR LINER'Rf aft Rabic) -..
FRONT 'i To DIAMETER TinCfiNESS MATERIAL
SAEDACCO ft, ft. I in
Comp:m)-Naurc 14c INNER CASING OR:TUUINGtevtiiermal doled-loapf,: -
FROM TO DIAMETER_ TUICKNESS MATERIAL
2:}}+c11 Construction P nuit1I . 0 R. 20 ft. 1 'hL SCH-40 PVC
Uri traamicaThug-tlprnti.s the.Cotnty.:Vote,l'nrienrce,Ilectk,4 main ft, in
3,WcU Ilse(check wdi rise), :17.SCREEN - - - -
-WaterSuppl Welk most a 10 I:aw TIR. s LOT SIM Tn Nli tC) .S I MATERIAL
C)Agricultutal C1141tltticipal,Tublic•
20 ff, 30 II. 1 in 010 SCH-90 PVC
DGelitlicnnal(Heating/Cooling Supply) DResidentiat Water Supply(single) ft. ft:. in, I
DiudustriallConuttercial ORcsideatial WaterSupply(shared) t9 GROUT: -: _
FRONT TO. I MATERIAL I EMPLACEMENT.ME1110DS`&,MOUNT
DIrrigation . 'ft. ft. _
Non-Water Supply Welt: • _.
ft,, ft.
IdMonitoring GIRtti(it•cty - -
Injection Well: rt. ft.
C1Atluifcr Recharge 1.1Cfroulldv t!er Retticdiation 19:SANDIf:ItAV>:L I'ACI{'(if:utgrncabtel''' .
'FROM 10 1 MATF.RtAt. ENiPLNCI:IENT METHOD
ID'kindles Sttjtugc aid Recovcty i7Salinity Harrier 18 ft, 30 ft. FILTER SAND # 2
❑Aquifer Test EISIoraiwaterDrainage
•ft. ft.
ElEiperintental Tcilmolo '• fa5ttbsidcpcc C'gtdnl -20;URILLING LOG Initach additional duels if itccrscan l
DGeotIu anal(Closed Loup) DTracer I FROM TO OFSCRIVTION(wbn harvnc.r,at44uc►i trim:grain wra dr,I
17G•:othhenml(Hearne Cooliva Retu n) Obther(explain tirtder#2 i Remarks) 0 .It. 5 ft, FILL SILT AND SAND
5 ft. 10 ft. SILTY SAND
4.Date Welts)Completed: 9-14-23 WOO.iI/#TMW-3 -10 It. 15 ft. WET SILTY SAND
54,Well Location': 15 .14 20 ft, SILTY SAND MOIST TO WET CLAY
Kimball Auto Glass 20 ft,. 30 R. CLAY PWR
Facility,OtettcrNart_rc Facility ll)k'RI-applicable). I - ,—R }... r:"�"-'
R, ft, ; ' _f ',-1 I 748 N. Main St., High Point, NC, 27262 ft. rt.
FitySical Andress.City.and Zip -.21.RENT ARKS O C T 0 6 2023
Guilford BENTONITE SEAL 16 TO 18'
Canal's l'arcdldenti£tcaIiouNu,.(PIN) I`.....,......� '•: •N �� 7,7'�' IL''l'
Sri,Latitude and•lingitnlic in dcgrocs/minutes/seconds ar decimal d gr'ics: 22.certification: '
(ita en fold,wig lnl1 any(s-srtiticioitn ��r�1r
N NV Brian„ Ewing.
i i g. 9/26/2023
Signntur afCcnilicdWellCoonnactar • Date •
6.is(ape)the n•ell(s): DPennanent or xiTentporaty its signing this faun,.'lrerrly eerrll,I'Blaa she,tr'eifrI Nix IN 09 n rifLied Lr;at!ronirtner
tiith 15A.NC4C 02C.011k0 or 154 NOW(12C,O200 Writ Coils/nor/km Sf.iodards and:Mr a
7.Is this a rejtair to an cirstin(;ssclli OVcr Or KM) 'capf af this rrcmrf l S been provided tq the or/iowner,
if th(S.fr'47 Tip*.fill that knmtvt iedf constnivion lr(gratario,r emit 6pl.ahi thl,urrnre of rho
iipairtcrr,Pcr.21 rw»ur,Crsrcuun or on the bark of this form. —23.Sltediagralnor additional well details:
You may use tfie back of this page 1o'ptoc'ide additional well site details::or*ell
8.Ntintberof Wells constructed: 1 coustructiun derails. You may also attach additional pages if necessary.
For multiple 4rfeerlon tH-ofan-never supply ii rfls ONLY Mei Ostontre cotrsrrrrr(iwr,yourart
bm m -
sa if one form. S IiDNIITTAL iNS7'UCTIONS
9.Total Well depth below land uirfacei 30 ((1,) 24a. Fur All Well,i Submit this form withiti 30 days of completion of well
For mid*wellslfst(A depths ifdlfJerrnu(cxaorp(s-.+i200*and.:0MO) consfnictiontotltcfoltoniug: ,
RI:Static water level below top of casing: 01.) Division of Water Resource's,Information Processing Unit,
If nine,Ind Is iztore eas(ar,6se•• ." IG17 Mait.5rn•ice Center,Rai-CIO,NC 27699-I0 L7
El,gorcho@c diamcict:2.25" (in.) 24b.Fir Tnfectinil}4'cU1 ONLY: In addition to sending.ltte form to the address in
24a above,also submit a-copy of this font within 30 days'of completion of tt�ll
12.Well construction ntetbod:DRIVEN construction 10 tke fo lloit'ine2
(Le.auger,rotary,cable.direct push etc.) .. •
Division of Water Resources,Underground Injection Control Pi'ograut,
FOR WATER SUPPLY WELLS ONLY: 1636 Malt Setr'ice Center,Raleigh,NC 27699-1636
13a4 Yield(Om) !ETctboil of test 24e For Water Supply&in_lectitin.Welts:
Also submit one copy of this form Within..(I.days ofcompletiott.of
Il3h.Disinfection ape _ Amount well canstmction to the'county health dcpanment of the calmly where
construeted.
Form GW-1 North Carolina Dcpantecta.of Eiwitutunera and Natural Resources-Division of Water Rmotrcte Revised,ttEttst:0I3