GW1--00043_Well Construction - GW1_20231218

WELL. RECORD
Far Irrarnal tlsc l3NLY:CONSTRUCTION CO I '
This farm can bcused far:sin&temr mulliplc well
1.Wcll.Coutraetoe Infatuation:
7.:I1I.%►`ATIIR2ONFS .• -
John Eisenman FROM. TO DF_SCRcPi1ON
),VW1l Coritrenrir.Ns RK: ft: ft, I '
4439 ft, fit I i
NC�VellCmutractorCenit titiooNu>r6er ',SS:t]tiTER-CrtSiNGlfareiutti=rivallitlls'ORLiNERiILSn'lka6tel •. .
FROM TO DIAMETER•. • TROCKNESS -� MATERIAL
SAEDACCO . f4 H.'9 I Ia'
callowllaplc. 16 fiNNER.CASINGORTUIIING.{i iiarkimal-duscd-lain!, ''- _
FROM TO DIAMETER THICKNESS'. . MATERIAL
• 2.Wcfi tonstrµctinit Penpit 1: • 0 R. 7 6 ft. 2 °71114
.. SCE-40 PVC
Cut aAnngicable i ell peiTu s.(Le.Couney.:Stp r.,-Variance,friethefi or J
3:Well.Ifse-(cltixl:shell use): • :17:SCREEN' '
Watt r Supply Well: _ FROM- TO - vrrsrE.TDR SLOTS?". TiJICNNi;yS MATERIAL
. -
DJAaticultuta! fJMUuidpallPublic.• • 76 ft. 86 ft: 2 irr O10 • SCH-90 PVC
IUGeoihetnal lieatin ICoolin '5u l'}' ,DResidential•Wrater Su I°(single)
• ft.' ft...' sir
l �' $ t?P-y PP} 8�
Ditidustrial/Contntcrcial. DResidential Watet:Snppls•(suited)' :%ta GROOT ..: -
FII03I' TO. r MATERIAL. I'EMPLACEIENT METHOD SAA100NT
I7lrrigation . .. . . . • 0 ft' 69 .ft,- Portland Tremie
-Nan-Water Supply Wel: - - ft; - . . fa i.. .
EdMonitgring DRAND,VCry _ __ ' '
• Injection WO: - ft. ft; •
• ClAgttifcrRclliarge I]GioundlrticvRcmediattiou ,I99S,wilt;RAV1L1'ACKtlfaiillticintcf -= _ -= -= - •
-
:•.FROaf - TO MATERIAL ttMPIACt:IFNt'MRr'IIOn •
. l7AgtiifcrStoragc and Rectiic�t' 19Saliliity Hairier 73 R. 86 II. Sand' #2
C Aquifer.Tat ❑Stonrinatcrfiriinov fG• ft. ! .
DF perintcntal Te4hrro ou 17SubOricwc C otdtpl 3:0:'DR1 LLt G 1 OG'lallach additibnaf sUcrts If:acccssn l
t7Geo(hennil(ClosedLoop) l7Tratcer - . FROM'• To - DESCRIPitON{t+o}ar.hnramti,sonlntstYhpr. o!S„e,dc.
DGoDtheatval(I1ca1itulCeoUltg RetunlT • O17dier{expluiv mtder.#?i Remarks) 0 ..ft. 60 - (4 .Silt%sand/clay
60 fit. .73 IL PWR . -- •
4:Date WCEl(s)conlpletedc 11-10-23 %VitI IDgMW-4OA 73 •fi, •86 It. Rocki _
5a.Wd1 Lncatinu: . .ft.- ft. I %"^ '
.General Electric.Company ft.- IL aiI
•Fac[]ity,!13ir•ticrNart+c Faci]i1p IDk - .,(ifapplicable). R. ft. '• •�:•.;:..,i;-��-.,,
3010 Spartanburg.Hwy,, East,Flat Rock, NC,, 28726 , ft, - ft,. E:�a`Ly Dial ' l:„•
Pi(y5iral Addrss City_add Zip 2 t:RentAHxS'..
Henderson Bentonite seal from 69-73e
Cooly Parcel IcIentifiCation No,(OM I;
•
$It tannic alyd'liin_ fttldic in ifegtee.slmiittttes/seetinds or dceitimi dcgrcCS: 27;Certification:. (et,o!frets,one1.1iiloeig1x-sulfitiont) •
. •"
N NV • _. '— 11/22/2023
.Sigtnt icmf�". `l tif,u's.,- Date
6.Is(are)(he:well(s)t XlPenriaitent or n7'ernporar% �" xsyt4fv: ! �s ,, ., ra
itp N;Smibig:hit foiA. ,r.,ef0!in�:r,:•,..'N ri..r,y,:e:.:,elm!fueled iiktkYbrrleair
- with 154•NCtC 02e. b:��i�.�n n:;ail:....Vag Weil Caresimcrion Srarxlaais and;bar a
7.Isithis a seliale_[u an a ustingwells Dyes ;tir Elko. 'rery ._'of hlr'ieeorrl hiisbeen i,muifed r�iha ur/miner,
if rhls.Ii a 1746417,fall lot,hoout7i lee t50usncetloa liVi.grouttOi end(*OMdu!Wrote oldie
rei"urir wale!821-'remarF..s sertwn or at the bail of day formic. 23.SIte.d1it rjni or additional t►�en)4etuibi;
You tiny use the back of this page to.provide•additionat well she details:or Welt
8:Numbered Wells cotlstrneteil: 1. consuuctiondetils. You may âlth-auacli additional pages ifuecess:sty. •
For ritatrlplelrtfecrirn'rirnonrtlutersupArriregsONLI.OfW thesmrreeorrategetiorr,yorteoo
sthud(ei,ie form. SUBMITTAL INSTtJCTION3
9.Total Well depth lieloil'land still'ace: 86 - (to. VI.Far Alt Walk: Windt 110s:fona within 30 ditys of completion of well
Foe iirnhiple wieifaIist all dcprhs ffdif�'errorulexmrple-•3@2110°anil.2 u@ l0Ii) constnietion to Me following: i,
1(1.Static Wittee lei'el below top of caving; 10. (Ib,)' Dh'esimi of Water ReSpiwcc t,Intormatian Processing(Tint,
N •27699-1617
1Jumrer lei�el Is Ohm tnafr�,sus,.+" 1017 hL•tU.Sirti'fcc Ccattr,Raleigh,. �""
IL Bumhtite diamctcr:10.25"/6" _ 00 2Mb.roctpicerirut Weill ONLY: in addition to•sending the fomrto the address in'
24aabios'e.also submit a copy•of this fortis within 30'days•of completion of Will
11.Wcllconsiruction method:HSA/AIR CotnsinUCtioti m the following:: i '
(lc.auger,rotary.cable duce(Fasts etc.} 1 ' .
Diviision of Water.Resources,Underground Injection.Control.Program,
. FOR WATER SUPPLY WELLS ONLY:' 1616 Mali Service tenter,Raleigh,NC27699-1636
I
• 24G;For Water Stiltnfe_&Injection Wells:
13;t,Vivid(figiln) `foci!od of tat: Also submit one copy of this fonu Within-;10 daysofcompletionof
13h.Disinfection Qypet Amount: .wcll-coastnrction to the county health department of the county where
constructed.
• Form GW-1 Noah Carolina Deparuaent.of Environment cud Natural hem woes-Dfti loo or Water ReSottte5 Rcviscd Augtat 1013