GW1--01506_Well Construction - GW1_20240312

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WELL CONSTRUCTION RECORD Far Internal Use ONLY: .
lids Conn can bc used for,singleornndlipk wells' . ' '
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1.Well Contractor In(orniation: ;
U.WATERZONES
Robert Miller ROM FM F .- TO • 'DCRIt'r1ON
WeJICma[adorNaRw - ft, • ft, !!I
2675-A IL ft: • t
NCWc1lCordmtlorCccnificalionNmilier IS.OUTER CASiNG.(firuultt-cased"nefs)OR LINER Bran.fksbIc)
FROM TO •• • - DIAMETER.' TRICKNESS• • MATERIAL
SAEDACCO it., • in.
Co true.N:mro• td.INNER:CASiNGORTUBING zsrotletinAclued-loop
FROM To DLtiMETER , THICKNESS MATERIAL .
. 2,Wdl Construction Pcfmit it:w10100707 • - ft; ft, 'in. '
Liu all�lirallk well pehaits(La.County.Stote.,Varia,wa.fty-e ran etc,.)
R; ft. in,
3.Wetl;Gse(Chock well t(se): t7:SCREEN -
tTROM. . TO .DIAMETER -5r�rSIiz, T1110ENESS i'MATERIAL
Water Supply Well: .
°Agricultural CiMuliicipat/PublIc R. R; in
IGrothemrat(Heating(Cooling Supply) ' ®Residential Water Supply(single) R. ft. in
IIndustria)/Contniercial - ®Residential Water Supply(shati:d) . 18:GROUT
FROM . -TO MATERIAL , EMPLACEMENT METHOD&AMOUNT
Oktination . 'ru- ft.
Non-Water Supply Well:.. '
:ft., - 1 rt
IJMonitoring •°Recover•. - .
dnjectlon'Welt: -ft, rr. •
®Aquifer Rccttarge itlGiotindivater Rcnicdiation - L9.SAND/GRAVEL PACKiif optrttcabtel .. .,. •
- T;Itr)'I ' TO' • MATERIAL ' EMPLACEMENT mutton
['Aquifer-Storage-and Recovery InSalinity 13amcr R.- ft.
El Aquifer,Test : IJSloirn tcti E4*' - '
ft. ft. •
' Dexperimcnlal Technology. l7Subsidence Coi rot
20.DRILLING,COG(attach additional mbaNi if necessarvt •
DGeotbemral(Closed Loop) OTrieer• - FROM TO • DESCRIPTION rwbnhanisc i mi1'hmcktttrr.`m n eirn tit 1
DGeotlienual(Heating/Cooling Return) DOther(explain udder ik21 Remarks) ' `fr.. • rt. ; .r^ ,-> ., ,
ft. • rt. i1 I. kl,,.n L=i V a`n) .
4.Date Well(s)Conlpleled: 2/19/24 ..Welt miiD-1 --D-5,
ft. ft. M.AF 1 2 2024 5a,Wd1 Gicaliune • ft. rt
•• - Former Foothills Service Center - ft..- ft. 'rotor rinat.icn rn:—..r?,r,,;•;ti.l ',,)t . .
. •
Facfity,+OirlxrNuine, FacilitylDO.(iC liablcj G'Crr' ;� r,
ft, ft,
. 312 N. Union St., Morganton, NC,_28655 . ' ft, ft,
Plt ical Addisss City.aid Zip• •,..21.REMARKS. • -
Burke Injected 120 gallons of Cool-Ox per point;
C.ouuly •Nice]ttkntif'C,lliun No.(PIN) 15-30' - -
Sly.Latitude slid I wigitude in dcgrce/minutes/seconds ordeeinud degrees: 7�Ccrtificatlrrn: 1
¢Cnrll field one 1 hl0ouy ts'srdtiekia) a
• 'N' W ---.....,....:67 2/27/2024
. Stgmtuteofr::rs:ar.1r'_ s — Date •
6.is.(ire),the lscll(s) DPermairent .or 10Temporary .
K3'rigidng thin jorm:(lrrreL}•certify that she,rd!{4 nvr(ister)cariyrruelyd ire;mcrorthare
. *id)15A NCAC 0ZC.0100 or 15rt NCACO2C:0200 Well Constrkr(on Standards and 11187a
7.Is this a repair to an existing well Eves or ➢QNo rvlisofdilr record'liasG en pror;dm1 rode in ll tamer.,
If Will a repair;fill rmrlaroirit*tell coristnrcrlaa lrrfomurrlon and riplahi the lutrare of the -
-repair order B2P.remarksireliaa or On the bail of rhisform. 23.Site diagram ur additional well details: • .
. You may use the back of this page to provide additional well site details or well
8.Nnmberof wells constructed: 5 Construction de tugs. You may also attach additional'pages if necessary.
Farrnnldple intecrion or non-fearer supply wells ONLY with the saute coustruetiau,,coir eon .
submit-one fomL , • ' SUBMITTA L iNSTUCT IONS -
9.Total well depth below land surface 30 • • - (ff.) •24a. For AtI Wells: Submit this form within 3b dais ofcompletion of Fell
Formaltlplei ellrlisraldepthsIfdiperent(example-3@200'and.20100') . construction to the.following:
I
ICI.Static water level below lop of casing:' (IL) Diyikiun of Water Resources,Information Processing Unit,
if water level is above casth are"+" . 1617 Mall Service Cotner,tfalci y NC 27699-1617
1•5"
ILBorchotrdiaoicter, (n) 21b.Tiir Injection Welly ONLY: In addition to sent)iDg411e famt to the address.in
.24aabove.also submit a copy'of this form within 30 days'of,cotnpletion of well
12,Well cOnstiuuction Method!.DPT coltstntetion to the following: -
tie. nrtary,cable direct pasts etc.) 'Division of Water Resources;Underground InjectionControl Program,
FOR WATER SUPPLY WELLS ONLY: - .1636 MaI Service Ce •
-I tcr,Raleigh,NC 2 7699-1636
13n Yield(pm) \ih tlrad of test: - ' F For Water Suftply de Injection Wells:
Also submit one copy of this fanniwithin 30,days ofcotupletion.of
13b.Ditfnfsition type:
es" . • . -Amount: . - • - well cousin:cairn to the county hcalih department of'the.cotntty.where
constructed.
FennGW-t - Nonb Carolina tkprtn etaofE,wmuumruandNatualResources-Divi;ionofWaterRootrrm •RevisedAugust2Ul3