GW1--02150_Well Construction - GW1_20240409

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. ..WELLS0 NSTRIiCTION RECORD(GW-1.1 For Internal Use Only:
1.Well COldrider htfern'tarmi=, •
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Ricky Ccrriher '
10
Weil Commas Name
a • -P YE 2_ --.- 1: !' a d
2464-A
ft. . ft. 1, i'
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• NC Well Cootroceor Cortiftratina Number •
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Frank A.Colder&Sons Well Drilling,Inc. ffi . ..ft.tom 1 ___0 turaffinst ThiCICIUSS NIATERML .-----:-
ft. ' ..-----------------------,
Omputy Nam •e .
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, . 2.Well Coadradies P 4n eridtd: 4-•'' 9to..6- 7 •
Lisitallappliaible mei I costrosetionperrnits if.e WC Como.State,Variance,etc) -rt Q. , it. .6 is I hi* SCR-21
3.We Use Week wen me* 6 ft.. AllenVwS-k . W ' 0
Water Supply Weil: :
Nem - 7-0 --- -iiitiariatit- iiire
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ft. . ft. •ie.
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U c"•".- (Heinin/VCeigilig Supply) _ . ' ' Water Supply(single) ft. ft.
LIReddogial Water Supply(shated) _:: -
- -• -- '- '
I ithgat6
nom to Mareicies. EMPLAOMIENTBOSISODJk Amciatia.
. ft. -
Non-Water Supply Welk: ft.
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' . DReeevelY ft. ft.
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.... weft
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•- Recharge ; 13Grounduuter Remediation -
II --,A:- Stange aud Resin-try OS /Bonier FROM 10— MATESTAL zetsiumakerstrrnoa-.--
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• II .......- Tat • EIStommeater Dminage ft. ft. I
• . III I- .- - To:Imolai* OSubsidence Commit ft. ft. I -•• '---,,,-•(Closed LooP) I:1Thu= . ._. . .. __. __ .
most TO .•.,.• , . - r.aIlespektne.millim alle,Ite.)
• -...•-,.. ,NleafingICofaig Retton) Daher(=Wahl meter#2I Remarks) 0 ft. 4.ye a.
4-Date D.retted Complete& if Weft NW 1-1,0 IL _4 3 it !'5 z ---A--Ka CK---
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ft.
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. 63 /4S---e* . .1,' &le 6 h.lef_wt4,
s.2:168 N-e. 60ble •
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c-----..7— ---.;---,: 1,7,•-•::ie.-. — -
• None eN Fnedity ID#Ceseplisablei , fie? ' ft. .k." i'..... ....^1...:. k. Ks:
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Physical Address,My,sad ra,
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1-„..,-,--.:„,,-)c-.,..:
-ccmity .
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S .Leila&sad leagitede in degmeemdmites/seeoads or deems' al degree.= , •
(Rung add,one Istilam is sufficient)
35,EL- •
1s:0190N 80-7a88g5 w .....,
se o..--‘. ,_.......well Coeseme
• 6.bOire)thewell(maKmment or DTesaperary
Bi 4*W this Ana.a hereby ce10_,Ihat the lail6)MET(IsCre)conconaed hi accordance
7.1s eb a repdr to an mitstiag weik Clifes or CINo • xi&ISA?CAC 02C.0100 or ISA Nr...4C 02C.0290 Weil Construction Standards and theta
rdtis is a rapair.ffliena ban*will coastruettort information and explain the nature of the PM'of this•e co 1%i ka5 beerPeWerttt thr well owner-
repair sadert121 Immix sectia;re woo the bock°Otis form
23._Site diagram or additieng well*daft:
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8.per Geopiebempir or oesed.biap Geotienrod wells imam the sit= You mayese the be&of this page to provide eclair:1nd well site details or wdl
connuedon,only 1 GW-1 is needed. Iodinate TOTAL NUMBER ofwells construettOis deans. Yoe nay also attach additional pages if necessary.
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suabinTAL_ThisrRucrioiis
• 9.Total well depth belowilasid surface: I 65 - - 1
(D4 24a.For All Wells: Submit this fonn within 30 days of completion of well
For oadtipk was Nand aptly fertiferent(eramolo-3@200'and 20100)
coastruction to the following j
10.Static water levet bdOw Imp of casing: 3o:
(ft.) Divisieu of Water%lemmas,Information processing Unit,
yusiser kluier above mess ate 7+-C
1617 ma Service C.enter,Rakigh,NC 276994617
IL Borehole diameter: II0 (i .)
24b.,ft11• _ve__Losi In lisidition to seeding the form to the address ilt-24a"
___„, Air Drill * above also submit one copy of this fonn within 30 days of compietion of well ,
12.Well asastruedasi -.nomal: .
ecesmacdon to the following I;
. (Le atittat.retny,cable.drec4posti.ctn.)
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Diven of Water...., ..:,tintiergressed Injection Control Program,
FOE WATER SUPPLY WELLS ONLY:
. , 1636 Man Servirie tenter,Raleigh,NC 27691-1tB6
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13a.Yield(iiiao 6 Method of test Air 24c.Yor Water_Sunedv&Inlectiou Wean in additive to scoding tiae Run to
the address(es)abcrve,also sub*one copy of this faun within 30 days of
130.Dialaftedee type 1,erle .Amoust ta Ca/5 completion of well comma:tine'to the county health departmeet of the county
-where constricted.
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Foca 0941 . i North C.erarasi emon=of Envtrannetiod Quality.Mid=°mates.Resources
Revised 2-22-2016
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