GW1--06641_Well Construction - GW1_20231006

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WELL CONSTRUCTION•RECORD Far lenla!Usc.ONiY::
' 'ilk's form can based fir single or multiple wells,
L.Wal.Cantractor Infoi•nlation:
:I I.WATER2,ONFS
Rich Lemire FROM 170 DESCRIPTION
WellConrlacturN4mm4: • ft. ft. l j
2593A if. fl I l
NC Well Contractor Ccrtiftealion Nwrher 'IS:OUTER CASING(Ifirri uttl.sued mill.)OR LiNERtii'eti ticablel" .. _ _
FROM ' TO ' DIAMETER THICKNESS MATERIAL
SAEDACCO •
f4. fL in.
Company itanw. Hi.INNERCASING'OR-TU91NG:1ii'utbeiroieleCu cd•looef;:: _ .
FROM • TO DIAMETER TIDCKKNESS' MATERIAL
.2.We l Construction Permit li: 0 . R. 14 rt. 2 SCH-40 PVC
l ir'i ua npplirubfe well penrritc(i-r,.County:Steen,Y.riaper,100'6 i err,.) R, fie
3:*l l lise(chacl:‘t ell use): • :17:SCREEN .
WdtcrSupptt Will•
mom TO nbtMET£R St.OrSltk T!IIERNISS 1 MATERIAL _
®elglicultitral [l!4liaicipaliPoblic. 14 ft: 24 •Yi. 2 in 010 SCH-40 PVC
• ®Gebtllermat(Heating/Cooli Supply) ®Residential Water Supply(single) fie ft. in,
lttdustrial/Conmlercial ©Residential Water,Supply(stetted) aBi:GRO
Cl _" ;' .. .. . _ _ .
FROST - TO. MATERIAL I EMPLACENIENT.MEi OD do AMOUNT
Dlrrtmtion . . 0 ft. 12 Ft. BENTONITE C.AEGBRED
dfon-Water Supply Well:. °_
6bMnrl taring C]Itc metg
Injection-Well: ft, . rt.
DAijllifcrRccfiarge Cl9rontidwticrReiucdial;au. .,19iSANDIt:ItAVEL PACK'{ifnuplitantkl' _ -- - -
:-BROM TO M%TRRIAI. +I l PL.sfl. E4TNLTNOn •
. []Aituifcr.Stordgc and Rceo%:ery IDSalinity l3airicr 12 .• ft..' 24 ft. SAND; #2
0AgnifcrTcst• . ❑Starnil5atergmion e • -
fL ft.
❑E erin cntal TeelmotoSi•. J ISubsidcncc,Cooinnl
•.211:DRILLING LOG(attach,adilltionnl iliecti if neccsuu 1
d. C otllennal(Closed Loop) diTutecr most • 70 DFSCRIPnO1q(mbr.4 uthe.o.sritrometi htx;stdn we.stal
13Geothemtal(Heatine/Cooliue Return) Mother(explain under.#21 Remarks) 0 " :ft. 11 • ft, RED SILT
11 ft.- 24 IL GREEN PWR
4:DateWt.11(s).Conipleled: 9-7-2023 Wen EDhGTA-9. - ft: ft.
5a.Well Ia)catElin: I, 1'. .`
• .rt. ft. e L r '6N ATM,;m^
WIX FILTRATION fL- ft. _ ��}�n
facility,!DirocrNulue Facility 11)k EappliaOLL `r2-3
ble). •
ft. ft.
• 1301 E. Airline Ave., •GASTONIA,,NC, 28054 , ' • rt, rt. tnIcTiP.24izm Y-'r ^�.vp, g 1:131
Plgsiral-Address.Cit}•_aimd Zip =:21:REMARKS .a(11.'
GASTON -
Coimly' Parcel ldeutificailon No,(PIN) ,
•Sli.,iattitade;in iL• thig1 ylein degrees/minutes/scerinds nr decimal degrees: 22.Certification
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Ore di meld,one teuloiiissutnckrd)
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11• W `� "t'�� I,e•.‘ ",_e.4....,- wG� 9/16/2023
' SiemtuecofCcmt _Well Ce Wader: - Date
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• 6.i9(are)W"e-irell(s}t DPenn Brent or �Tempor°ar3 i signing tkir far e..l!tricky ern ofv,rllat the,r•ei1(s)i-ua(r4-1 ctn,reri tu;mrerrrlmner
Ida 154 NOR 02C d1100 or 154 tVC4C 02C MOO Well Ow/roc/km Sraodards trod rlrm a
7.Is this drelmairtoadezistingVent. /]Yea or ?iNo eap-rofrhkrrrenlh:a.1t*enlinwid.rdraio+.!rtvlirnriier.
ifth(s:is a rpalr.fill eo;krtrnrar hell ear i ret(ori hrfcrmarlon 4m4raptaln rho moire of the.
relmir raider0J21 ternurks'scrriem arm the brisk of thin form. -23.Site diagrani or.addltiouat•well details:
Yon may use the back of this page to.prov ide additional well site derails:or*ell
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S.I innberaf Wells constructed: 1 consrniction details. You May:siso attach additional pages if urcesSary.
For tnuhlpkirde.tiro'.»-ormr-nwrer supply n'rfl:ONLY frith the same!cortsrrurti ut,you ran '
srthmiroaie form. SUBMITTAL iNSTUCTIONS 1'
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9.Total Well depth bete*land surface 24 (('r.) :ZAu.-Far An Wells: Submit this farm within 30 days of COniptetiori of well
For mrultipleii•elfslest all dryrltsr/dli n'tufcrumpfc-3@209 errul.2@N7.7'1 • conttnictionto the folonirig
10.State water level below top of easing:"19.5 MODivision of Water Resources,Information Processing Unit,
limner 151W is above cask:.Use'•+" • I617 hlail.Seiz'ice Oilier,Raleigh,NC 27699-1617-
IL Borehole diameter.8. r25"- . _ (in,) tab.Fin.Tutcctilmfl With ONLY: ,In addition to-sending file fomt to the address in
24aaboie,also submit a copy of this form within 30'days'of cotnpletion of well
12.Well construction method:AUGER - • constriction to tite follos{i»g:•
(Lc.auger.fetary,cable,direct push.etc.) • I,•'
Divisoit of Water Resaurces,,Undergroand injection ControUPrbgran,
. FOR WATER SUPPLY WELLS ONLY: - 1636 Mail Scn'iceI.Centcr.Raleigh,NC 27699-163G
13; YFc1d' i<tethod of test: .2'te..For Water Supply&Injection Wet's:.
b fsl►nt) Also.submit one copy of this YUrm Within 30 days of completton.of
13b.-Disinfection npc:. Amount: well,con51nrctioo to the'county health department of the.county where
• cottsiniatcd,
Fanu GW-1 Noah Carotins anmenl.af£nvitotui ni and Natural Resources-Division of Water R,eatran Revised August 2013
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