GW1--01383_Well Construction - GW1_20240304

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'WELL CONSTRUCTION RECORD
Fin[ateraalUsaONLV; '
This Fannon leased fit:single at maltiple walls' ()\
. d:Wdl.Cu• ntractorinrnrmation l )i
.• . .tt WATER ZONIS . ,. r .• . .
Stefan Smith -. . . FRUS1 r TO ' •DESCRIPt1ON' . .
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WallCntntaclor•.Namc ft: ft. I I • .
3576A In- ft {
NC Well CanraclorCenihcation Nuthhcr =t.S.OUTER CASING(for iihi-caseifiretis}OR LINER Rtap llcabkl• • •
... FRFRONT .TO - . . DIAMETER,' THICh-NFSS." MATERIAL• d •
• SAEDACCO .0 ;ft.. 5' f[.. 4 In. • SCH-40 • . PVC
C+rntp,uiy Nance - I6:lNNERi,:ASING'ORTUBING(Sevibcrmateeascd-Ionp),,'
FRO,II - - TO DTAMSTRR - THICKNESS MATERIAL .
2:�YdnlCo ti'uctionPciTnit tft tdR0500150 • 'ft: •• ft; : ,hi.
f.+tJ nlltaprilicnble w tprnnits•(i;e.County;Sttric•.Yaiia ce.fa etr...J',
_it; ft. ' m.
3,Welt Use fehecic well uKe).:' _ 17:SCREEN
WaterSuppl%Well: - mRorr. -TO .- .•DIAMETER St4TS17$ TniCK'*3 S. 1•.MATERIAL •
•• DAgtieultutal . . • DMunicipaliPublic 5 ft. 20 ft,• 4 • la.1020 $CH 40 PVC '
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DGcothennat lieatirf Coolio&SirlP>3) DResidentiatWater Supply(single) ..rt. rt.'
BhldustrialfConudcrcnal ®Residential Water Supply'(sinned) 21ac.GRotfr'
.FROM. - TO. .MATERIAL. 7 RIOPtACEMEiT METHOD,&AMOQVT:i .
❑Irrigation • 0 '• f• t. '2 '0 rt. Portland Pour
•Nou-WatOSupiplp.41rc11: . . . . . ' . • • . . .
- I:Monitoring. . _ . . .0:tcct:ery . tt., fa ;• . • t
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. Injection:Welt:, •fb
el A.giiiferRcc[iargc • . lGtoundwaicrReincdiation t9'SANINGRAVEL•PACt{(ifappl hrid' . -. t '
• .. . . . . •FROM' . TO. •' 'SIAYP,RIAI, . • t?MpLaCtaro rstr_'rrion '
JJAgniter Storage and Recovery DSalinity 13:itacr. , ' 4 • • ft.. 25 ft. Sand ; 3 '
DAgn fer Tcst. ; ❑Slorr water Drtinagc• . - '
• gEcperinrental Tecliuotog)•. ElSribsicdet+ce Cordwl _ .. . . . :. ..
;ft.. ft
' 20,DRILL➢NGLOG(attach additional rhesus if ntzt.,arvl
DGeotllerival(CloseclLoon) l]Tlacer. ' . .FROM• .TU • DESCRIPTIONkobr.hardocti.soIlAitekinitcvpriinNW.Ma .
• DGootlu:uual(Beating/CablingReturn)• : ElOt11er(militant uliderli21Rettiail¢s) o ift...28 . ft. silt trace sand
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•ft. •. • ft. .
• • - 4:DatVe Well(s)Cdntpleled 2/2/2024• ..Well iDWRN-1, . • •
It. IL .
• So.WellLicatuin • ,fL' ft,. - A. \:v
Wicker Mart No. 10 IL. ft,fL
p `F .
FacililyiflivacrNance '.-. Factlit}•IDR(ifappii:able). -, MQs 0 4 20 q.
200 S. Horner Blvd., Saitford,-.NC, 27330' . . . . .- . 'R. •ft. iniCrpCie^sit£71 Pr Ong VAf . • '
. . Plrys,cal:Addicss.City.and Zip' '21.RI:aLtRKS . . Cil.`t tp"3Lg.r • -
' ,Lee - • • 2 foot bentonite .seal from 2-4'
a?iaty patco i courir,111On NU,(PIN)
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S6.L,Itif idea11i1 Longitude•iti dcgiteshdinuteslsccontdsordccin.d(I4gidrat .2Y.0 a on•-,
. (Ifsiell Setif etro Iti4Met�t5•suillcicii)' •• - ' ' .. . .
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35.478458 N 79.179648 . - . ' W ,A 12/21/2024 ' .
• • Sigtnt afce lli d{Well Contractor i ! .Dale
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6.Is.(.ire)the.weli(s):.7DPcrmaitent. .or 'DTemporar' . . '
Ity signlgg tf is.form:'!hereby certify 00;4.nenis)trvs jiarfr)cxmrrnrererf litAnonlamce
hid(15A NCrtC 0$G,nit7b.oe 15it NC,1C<02e,42W7 Will Cortalaeecriar Start lards and Mai
7.Is this a repair to an c.isting hell• ElYer- Or :IDNo reir of Mir ri coal tnt lr. proi'irkd to tl,i�,irtl nnvtcr,
If tets'it a repulr,fill air kroaw.well Mani aka lufgnmadon and erplaht the sabre Odic - .
repair tinder ei rernarb•.s+rrtiun or on the balk of ilnx forma .23 Site diaitrain or additional well details:
- You May use the back of this page:to.pros�ide.addiuonal n'ell`site details'or.ii'ell
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- S:Numbeiof wells constructed: 1• • • . • • coustnietiali deltiils, You May also atlaclt adthbottal page's if lrxessaiy •
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Farieulrtplela/ccilom-ornnat-ir'alersuppfrwellsO,YLYrulrhthe snore construction,vaticon - i
=Omit one form: SUBMITTAL iNSTUCT!ONS. j • .
9.Total well depth below land surface: 25 at) 24 i.•1.4ir All Wells;• Submit this form within 30 days of'completion of.lti'elt
Far watrlplc'ncelrlrsralideprhsifd i'irm1(ctanrpifr-3020p'anri2@llOO) Constnictiontotitcfoltotting: -
' 10.Static Water level below to iof casing .•(ft.) • UiriSlun of Water Resources,Information i'rneessing Unit,
if-ruay kde(psabove.cpslr use."+" 1617 Mail Scn'ice C i tct',Raleigh,NC 2 7699-16 17' -
• I t,Borehole dianieter,1°-625" :(ice) 21h.'rim-Infection Welly ONLY: In addition-to sending(he fomi to the address in . -
- 24aaboNe.also:submit a copy of tllisjfonn within 30 days-of.completion.of well
12.Well constrtrctloi iuethod:HSA tonstrnctloutalk fouoning:• `
(ic.auk r.-rotary,cable,third pilafs etc.) .
'Di1''isiou of Water Resources;Undergmuud Injection Control Program,
rFOR WATER SUPPLY WELLS ONLY - 1636 Mall Scrtice Ceitler.Raleigh,NC 27699-1636
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13 i Vidal WO Metho •d test: '24e,For Water Supply&Injection Wells:
• Also subunit one copy of this form nithitt 30-daysofcouipletionof
131r.Ui3infeetiun.ti(rar amount: w•ell Construction to the cdtmn•hc11t6{dcpanment of tdre county.
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constructed. 1 .
Farm G W-1 Notih Carelltm U.panuirrnt of Erninatuiral and Mantra],Renames—Divisional'Water Rmttrtes ilivised Aiguit An Ii
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