GW1--07669_Well Construction - GW1_20231122

-WELL CONSTRUtTION.RECORD• Far literal 14c.ONLY:
P ThiO•fonticattbe-used Itir kiiigkar maltipk veil*.
. - I.Weit..Contrattoi Inforthatioti:- . . . .
.-.14e..WATERZONES . • '• I ., . .
John Eisenman EtICIIII. ' .10 DESCRIPTION
Wc.11Coalraciar IOW, - 1.3.401f. 18.0011.
ft, ff.
4439 • .
',i15.-GUTER-CASINC(PirlittltkitiiedllieltsVORIANIER:tiraii-litabkl, ,.
NC•Well CautractiarCenificatlenNutrlier .
PROM' ' TO DIAMETER' - THICKNESS MATERIM. '
SAEDACCO - • • • ft. it. 1 ..•la.• . . •
•
Commuty Nemo, • . ' . . ',it6INNER CASING 0 RTUEIING:tieatheriUal claed•laititt,,,.-2 _-.,- .-..
•Frtom TO . DIAMETER THICKNESS ',.._MATERIAL
2.. 1414/0(CORkIMCitRII OPXOlit 4.: N/A .
, 0 R. 8 ft.• 2 1, -..ial-. SCH-40 PVC ..
Lin''oil opp7kable wel pripiirr.a.:o.Cpuiey$frop,..Variairce,freectki;ese...). .
- 'ft.• . -• • ft, - , '•
3.WeiItlise(ehotli.well use): • .37:SCREEN
. .
. . .
Wiltpt,-.8R.lipili IN Ult• ' . • - • FROST, TO • DIAMETER' SLOT SIZE THICKIHNS MATERIAL ._ .
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8 ' 14' 18 'it • 2 . !". -.010. scw-4 0 Pvc
ElAgticulintal . 1:114iinicipal/Mhe-
. .
CIGeothemtat(Heating/tooling Simpl)) • 1:1Residentiat Wiitet-SupPlY(singie) * ' ':ft";. - . '-1.1!' : " • . . .
18'GROUT: - _.„._.•, .... ... ... •- •. •_ .. , , .'n
ElinduStri.117Contourcial , CIRcsidential Water Supply shared) -'
PROS!. -TO. . '--MATERIAL. ENIPLACESIZIT METHOD&AMIRINT
OfTriptian-. . . . . „ • • . • - O. ft. 3 ft4 Portland Pour - •
• . Mtn-Water Supply Welt: ' .-• • . .... . . , .. ., . . .. . . .. . ..
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.... ... • . -Ohliaailgring . '1:1RWoVety ' • ' - - .
•
IttjeclIOtt WO:, . ft. ft.- • ' • . •
• . .
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ClAitifet lleClidigi - DOMundwatcr Rcinediatiou 19.'SANDIGILAVELPACK•iiiirpOlielbter
. - . • -PROM 'TH M ATRIUM. -RNIPIACEmENT!a ET lion -•
• LI"Attnifct:SIOMge a tkl iceoliticy -EiSalinity Eiirricis - 6 R.: 18 ft. Sand' : #2 . - • . - •
El ArtnifeiTcit• EISIOrnkitee,lititiongc- •
' . It. . . ft.
bErosieintental Teeenoto ' 3ubSitcocc conrol38l l . ' -:.-„,MiDRILLNGLOGlataetaddlioliO1h.cai if itecisso.ri
tienrt Oisd Loop) . :Treer
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TO - •- DESCRIPTION toter.hard110(1,4i1VnICI:OPGILralitt File.tita .
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0 .It. 18 ft, Silt/sand/clay
CJOMitettnal(lBeatingidoolitia Retum)- ClOther(explain under Retuatks)
. .
ft.. ft. " .... ..
4.Date Weiks).cOMplefedi 9-12-23 '' •Weil Int/mq-6R _ .
. . 'ft.
54,Well I:Ovation:"
• .R.- •ft. - .. •. ‘. ,
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• `,•--• , tt..... `r,
. :
Arlington Branco.Oil Company , . . • • .- ft.- . ft,- - ,
FaollitylOrnerNumc • - FaFilk.tifl# appiimble).,. NOLV— -2...2.023 • '
R. - ft. •
. . ,
270 N. Main St. , Jonesville, NC, 28642 . , . . ' ft. ft.,• . ' '• . In;•:::: ..'il ,.-'•—:-%-:.-..;: s1 Cri
• . •. 0105td'A-i!‘*5.titY-•‘11114 4'. REMARKS. - 17.:-'',c;C.,.1..''......' ,.,
• . . . .
Yadkin' - . 123134 - . • •bentonite seal from 3'176'
dmmw • . . - Parcel Iclutitifiwtou
. .
.41i.:f-ittilittle.alitit lingtEticlii degrcesimintlidhiCtin4 riP 4=14041-deem* .21 c.e'reiftealion:. • !,
dr-nen'hettli Otia hiti101ig liSviriikatly - ' . '" '." .
36.22958 • N- 80.83859 'W . -,......ie...--;K. ...- ....----' i2.- :-- 9/17/2023 •
-
Sigioatore(p1e,TAAt.'.:Fidimi:;,i,. : •,,...: . • Doe
. • •. • . •
6.Is(.are):the:weli(s): RIPermaitent or. 6Tempopley i .i. -.L.,_.-—-'---1:,y(z,,,t,"4,•Ap.•.,:crl.:....r..-...es ...,...1 , .,
4.sIn.iii io,-.‘iv,..,a-,, ....,!,•:...;,..roi:h.....z.,..1.,.......hid,i44.er ii:e;.FITunFInglexi inAleopArticie
iiiqr 15A ArcitC 02C ....It_ O'OO Well Constrorrion Souokrds and stud o
7.Is-thisa repair-to ad Ciiitinjwrilf- b'W.e - .or No Toit!pfrilifir,r4jr4 kik been piorirferl ro.,*welidir,
If rks:11 a 4,...tk./d1r,rirkrioitri loii1cvmspuciimliVorrnailon iiiif t..Ayil011 rho norare of rile'
lipids'rade(112 i'remier.VA.O.i.thira Or on lie bark of diii.krur.. -.,13;She diagram.or attittlia ual.‘I'ell ljeInits:
You Ma}..use the.back of this page to PrOVide'additintial Well site details or Well
13.15untherof WellS enitstructed: 1 • „ '•COnstniction delai(s: You inay also itlaciiadditional pages if necesSMy.
For litillilple klecrion
Nalratir ri*forin. or ao*•rer supplyivs ONLY Ihagcostrlit•,Y02rkiM . SUBMITTAL INSTETCTIONS.''
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9.TOtiii.iTtili depth helots:land stiff:Min: 18 . . (ft.) .24a..Far AU Welliti Sithittit Ilti s lot*vrilltiti 30 days of,cOmptetiOu of well
For itrillilp.fi ii,ells list oil(Irprki liciaiwiir(ex(roiptc.-.3.E5200*etrul.2.9 1(k)) constiticticurto the following:
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10.Static*Ater lei:el hitter top of easing: 13•40 (ft.) Divisitin of WateritestairreS,Infornintion Pineessing Unit,
If mite,10e1 iv dove Oristo,v,ke"+ • ." 1617 Mait.Serviee'Center,Italeigh,NC-27699-I617
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11.Borehole diameter:9. 9" . . (in.) Mb.For Infection Wells ONLY: ilin•addition to senditig the form to the address in
24a alioi*also submit a.copy of this forth within-30'd4s•-of completion of Well.
12,1yel1 construction method:asA construction Cotise cohoMite.... I
(Le atiker,rotar).chl?le,"..dimet pish.ctcf.,l - • t I
• • • • DiviSlo it of Water Risen Fees,tUntiergtouttil ittleition Control PrOgrant,
. FORWATER SUPPLY WELLS ONLY!' .1636 Milt Service'Center,Raleigh,NC 27699,1636
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24e.For Water Supply Zit figeetion Wens:.
Il41,1rield-Wm) Method of teit: •Also subtiit one toy of tins fOni %thin.30,t,ay. of cOutlldtkit of
13li,Disinfection,typer. Amount: well-contimetion.to the county health departnint of the,cointly.wheie-
constrocted.
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Run GW-1. North Cal-0am vulmeatef EeriMMIlela aud Natural Resources,1:4ii/00 ok Wale R'qatrozs RevlsedA.ugust1013.