GW1--01510_Well Construction - GW1_20240312

1
WELL CONSTRUCTION RECORD Furrntatiutlt4eONLY:
This Cormcn beused for"single sir multiple wills'
I Well.Contractar information: ,
t•ri wATLR'LON ES -
Robert Miller MIMI TO DFSCRIPr1UN
Welt Coilmeter Nine R. ft.
2675-A ft. ft. !
NCWellConlraclorCcrtifcalitinNtitittcr LSOtiTERCASiNG-Ls. )GR.LINER ft fUl!fable'.
FROM m DrAMIETER•, THICKNESS. - MATERIAL..
SAEDACCO n fL 1tL .
Coug,my bans: • t6.INNER_CASING OR TUBING(reotheniral clnscdaonll ' •
•FROM • TO DLSMETEK THICKNESS MATERIAL - '
. 2,Weil ConstructianPcrarit#:m0100707 'R. . ft. 'ht
list all applica6lr mill penults(e.Counts;Stapp:,Yariaaer.fryectie/t etc.)'. •R; ft. in
•
3.Wcll.Usc(i harkwell use):• L7.SCREEN '
water supply Well:_ -
'- _-- `- . -- - mast. TO .- •DUMF.TEK •St..OTSIZE THIICKNESS. t MATERIAL
❑ttgriculnttal ClMturicipalwPublic ft •
. •ft
©Geothermal(Heating/Cooling Supply), ®Residential Water Supply.(single) • . R° fa_ in.
l3lndustrial/Colltniei iat CiResidential Water Supply(shared) :'4oGRH OuT•-To MIATERLAL'' • Iur ACEM1{niTMMELf10D.OANOUNT I
Oftigalion . ft. •fL
• Nou-Water Supply Well: • - •
f]Monitoring • C]Rccovcry : . R,, ft ,
injection Well: h.` • f1
El Aquifer Recharge . Etlti ioulidaatcr Rentediation Iv SANDIGRAVEL PACK of appileablel` - '
'FROM' ' •TO' •--MATERIAL . • EMPLACEMENT METHOD '
DAguiferStorige and Rcco►•ety' clSalinity Barrie' R.. . ft. -
lAgnifcrTcst - C]Stomm'atcrI3riinagc• •
ft. ft.
[]Rrgirtirttrntal TocHnatogy C]Subsidcnec COM- .10.DIM LING'LOG(attach additional shedstf ncccssanl '
CGeothetinal(Closed Loop) ItITracer FROM TO - DESCRIPTION Ic+nbr,hm]gcd.mUniekll�r.' n w:.Nt t'
ElGeodtennat(Fleatiog'Caoline Retuni) : ClOther(explautunder#21 Retoaths) it. ti, ! -.� ...L ;.w . .r• .
-ft.• (G t...i.. 11 �. L.
• i.Pare Weil(s)Completed: 2/19/24 ,weu m#C-1 .-'•C-5ft: R. . •- M�1n -
Sa:Well Locatrnn: .ft. IL:•
-
In`:r:r%4 a :.v.�,.$N .
Former Foothills Service Center - ft, ft, RR .V ,, a �rti!
Facility- icncrName. facility lDp&awliable)
R.' ft. • i
312 E. Union St.; Morganton; NC, .28655 • . . . . :ft. ft.:-s •
• . Piry'areal Address.City. .2l.REMARKS
and Zip•
Burke • .Injected 120 gallons of Cool-Ox per point; •
-
Cannh' I!areel tdeulitteatiouNo,(PIN) 15-30'
' Sh.i a.titude ariil I.ongitnde in ilegrecs/minutc&Jsecoads or decimal degniest 22.[edification:.
(if nen Staid,one litrlotia is iuffltlkid) -
N W � 2/27/2024
Signature ofi.:ir:.r.4A.=,�rx! > ! --- ' Date
. . 6.Es(are)the tcell(zi):.I7Pertnanent..or $ITemporat}' • •Ry signing this form..Irereb)'rennfp that thr,nrll(sy win 6 Ire$cvri rntcted Lit wtanlance
frith MtiVCAC 02C.Odt7l7 or 114 NCrtC 02 C.0200 Aril Constr ter(on Sraiulards o:nd Am a
7.Is this a repair toan existing'welli l:]Yes or RIND • 'cop-aofdir record,8asSeanproritli'd.m phi!iTilminer.
if ihis'Ia a rrpalr.fill pat ATa sit well cvrutnrcrioa htformatiwt and ciplahi the'ware of the
rep-airrirderfi21 remark :ircfion stay the bail•of diir form. - 23.Site diagram or additional well details: '
• You may use the back of this page ta,pro►'ideadditional well site detailsor.tell
8.Nutnherof wells constructed: 5 consttuction details. You may also attai:lt additional pages if necessary. • •
For milrlple Iri jeetlon or non-norer snppli wells ONLY with die wine cousirurrlou,_'coil can •
4f)1)iNITTAL INSTUCTiONS •
saymif'onr forri. � - �. _ _ -
9.Total Well depth hetow land surfacer 30 (ft,) '2da.For All Wells 'Submit this font within 30 days of comptdiort of well
For mahrple,cllrl(st ail depotsifdiferent(eroopte-3@200°and2@100) construction to the following; -
10.Static water level below top of casing: {(t,) - Diviriun of Water Resources,Information Paacessing Unit,
Ifni level is above casfetn:we"+" 1617 Mail Service Center,R•leig,NC 27699-1617
11.ligrchote diameter,?•5" - (in.) 24h.Par injection Wells ONLY: Iniaddition-to sending the form to the address in
.2iaabose.also,submit a copy of this funs within 30 daYs'of completion of well
12.Well eiinsinuction methods DPP - consiiuctitni Lathe following: I :-
tte.auger.misty,cable,direct push etc:}
'Division of Water Resources;Underground Injection Control Program:
FOR WATER SUPPLY WELLS ONLY: -1636 Mall Service Center.Raleigh,NC27699-1636
.13w,Redd(gpm) Method of test:_ - 24c.For-Water Supply&injection Wells:
Also submit one copy-of this form within 30„days ofcompletionof
' 13h.Disinfection type: Amount: well constriction to the county health department of the.connh•.whcre
constntctcd.
FontGN-t North Carolina tkpmtmrmofEmicama-mand Natural Reso owes-Dtvatonof Water Re u'cw -ResvisedAwed:RNA