GW1--00482_Well Construction - GW1_20240116

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WELL CONSTRUCTION RECORD F911*[dental;Ise GNLY: .
This forth eat!bd used fat sine;Sr.nutItiple wells•
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I.WelItiintraettir hi(Ormatitim
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-:.1ATEICZONE.S"
John Eisenman PROM 10 DESCRIPTION •• . • -We R.- ft. I
ll entAtaCipt Nottie,
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ft:4439A . - • .1[..
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NC Well Cakoactar Certifidition Nuirber :IS'::OUTER CASING(Dienititil-WSCilicilKORIGINER(if.lin"fienhicl 1 _ I
Intosi RI DtAmETER.1 .: rtrintrass'• ' MATERIAL
.SAEDACCO . . : R.: ". .. it: l• !t.i'
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Co*p;oty Name: • JIJIINS.A. tiSCil-his 1`.”-•_,_ -. . . ,- --TV ,
:FROM TO- DIAMETER. THICKNESS MATERIAL
•Weil COnStruCtion Pertnitt . - 0 It.. 35 ft; 2 ' In. SCH4 0 . "PVC
List oft -iwe ts,c11 pq0kts(Ee.'eaynty;...qtri:e,170.1 awe.InjOarkcirA) rt. ft. hi. . .
;.Well.tise.(Oteric.Well Use)t , II:SCREEN- . •
, • W'IrierSitprify:Well: • " ., PROM- -TO DIAMETER I storm?", TIIICKNS. MATRRIAT
35 re,'. 45• 11.,- 2 . iii '.010 SCH4 0 PVC
0 AgliCilliitini • OMEtildipaliPIAIRS,
C ;• . , •,lGeothermai(IleatingiCooiMg Simply): EIRcsidential'Watcr Simply(single) 14' ft in, .
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_ Ellndustrial/Conuitercial. pResidettrial WaterSupPly(skired) ,-Ivt9tioGRNI rr.4,-3. ._.. -'TA,i,ERin—,`, E•ii-n;-LALim52.•• ,i,,,ii,Tiuip..6.310u,i-
OirtiOatian •. • , ft. , .. it. .. i . . .: .
NottTarattr$uppl*Well • . .
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dilvionnoiifig - • • . _ .bitect-wery . . • , . .
. - -Injection Welt: . . •ft, 04 . . .
ICI Attniferjtechdrge.. . . DGioutid4ater Reincdiatitin ,2.ts:f SAN OIGRAVELPACK Cif:avOlirilde).-
. .. . --FROM . 110 t-marontat, • 12S111.16-MENT A-111110ti .
pit*9.-SiOragOikl.Ft*Pi3iiY. PSRlittili,13arrirci • 33 ft: 45 ft. sand i, #2
I3Aquifci Test 1:1Slorritwatet Prnitiagc:
. . •--- I. ft. . '. ' •
13Experimeniol Teeitsoia& OSobsitienee C.anirol. • - - - -
-.. - .. -. . 11/RIL LING'LOGIatI4kii,add itinnitt stiiiiiif heck's-Wu-ST " . '
ligeotitennaWlosed Loop) - . , IcITrac -riww'- - TO nrsourrtux(tohr.barditc..m.iellItneklyre,,trAin tirti,dc-.)
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,1........kt.....,.'L.'f: 1.1 4...: J:-.
EIGeothennal(Fleatine)Cooting Return) 1:10ther(explain under#21 Retualksl 0 ft. 45' . -It -sand stone
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-1.:•Date willgs)ConiPleted:- 1-3-24 ."well nht TMW-2 . .
07 : - p .,,r'''',r— .!..
Sa.Well Location:- •
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• ft.: It: JA N 1 6 2024
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'FactliiglwrerisIalue .Facflit)"ON(ilalTlicabl9) •. '
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Infrqrr,nzir-1 F)--— ,
710 Piedmont Triad West Drive „Mount Airy, NC, 27030 . . QPI 1....
••-v•X.i.•.: d
Physical Attils:is.Cit..aiiti.tii3' •f!. ft.. . ' . OW
OG .
,.21..;REMARK.' . . .
Surry temporary well '
Cooly . . . rarcal teciattIcAtion No..(PIN). •
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' 5b.li.4111R16 and.Louglide iRtictrecsiinliontr,sisienndS lir dceitankteMicM. -,27„.6viiiiitutim: ' . . .
*Nan field,one latilool:IS•SofriCkitili .
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- N W --i' - . ------ ----- 1/8/2624
. . . - . Sign3hoct4..:;•••,;4174-::indIOCS: - -Date •
6.Is:(ari)the well(s): CIPerntanent •or laTeinpotary.
ily•aignihg:this log.JA,''.:..:4,gift,tig-Lf:i.1.?.14 WJS f 1:e.:r..)allai riffled ift,oprorihtnce
with 154 aycr1C Oki-1,41..',•4.--t...,.. ;;.2,1;;;14:7 020.10 Wilt Camitergiiim Smiviaids and ilia:a
7.Is•nds.A repair to an iiistinic well DYeS or BIM) voilkolthifrect;n1 hoi benliroritir4.rq Okellrli moier.
!pis repair,fili oar bujiv4 iwIlayLvrircitorrinfigmar.'ast awl pplabt r1.1.e?Ware of flie
repair tinder#21 remarks:.iiaiiira'di cm the hark of this Pm. 421 Site&want or additional well details: . .
You mak.Use the Welt-of-WS page.to provide additional well she details or Well
S.Numb er of Welts,eonst meted: I-- V consiniction deiairs..' ou R14 also attach additional pages if oecessa*.i. -
For ma0-Ve injecrOn 9,- ialAY npplyivOls ONLY with 11e.Sirfilf'cOstrirelleiT, ctlii.ara
' — -- :1 ' - • • S(IBM'IlitAL INSTUCITONS' .', •solmirow'fonw.. ..
9,,Total Wen depth beton-la:id strukm _ 45 ._ _ • • ift.) 21a..Fur.Alt Welk: Submit this font-Within 30 days:of comploitin Of iy.el[
For mill*irdls-!kr all dop.rks if deiroit(ateroptc-30,266'mut 2@ MI „construction to iltettolioning; - .I ': .
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i.O.State water level below tap of easing; (ft.) iiiiision of water Roiourt0,IntitrmatiOn Pruiessing Unit,
VIAller kvel is abbre c;asNgc•iiie"+" 1617 Mail SCitiiC Center,Raleigh,NC 271699-16 i7
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11,notsehote diameter:6 • (in.) 1411.For.Iti1rctiOn Weill ONLY: In Odartion to sending-the form to the address in
24a ab0e,•also submit a copy-of titii.:fottit within 30 dayS-of completion of well .
t2.Well constructioulnethedi Air . coostructiontri the follOWing:-6.e.akmr.rotary,C.ible„:direa pash.cte.1 .
. Division of Wateriteseuries,Uudergrotmd Injection Control Program,
FOR WATER SUPPLY WELLS'ONlLY: 1636 Atoll Serelee'Ceitter,Raleigh,NC 21699-1636
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.24e.For Water Si'nuIV..tie Injection Wells:
1-4a,:yio it(Om) . 'Method"of teSt: •
Also'submit one-copy orthis form Within 30 dUyS.ofecitnPletion of
l3Ii.Disinfection Inter . ,A. .mount: Well.construction Ri the-county hcalth!dcportm6a of the county.where•
• conStnicted.
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tom GW-t North.Carolina DepaA mcio,o f EFIV I ro lune I t.t.a nci Na n 1 ral Resources-Dion ok Water Rosotirces Revised August 19i3
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