GW1--02638_Well Construction - GW1_20240501

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WELL CONSTRUCTION RECORD 9)C( L.
p Foa lracriral LJsc ONLY: l'
This Curiilcan bc used lot single oa ttultipk wells
1.WellContractorinfornlation: - . . • .\ � •
:_t.1:WATP.RZONIS' I _
John Eisenman . . . . . FROM ' TO • DFSCRtPr1ON
Wait CnrlrtaorNanw R.•• rt• . ' J • . - • •
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4439 •It. ft.. • •-
• NCWeil CoNrucaarCcniftcatiotiNitrite( .15.OUTER'CASING(forleutli-¢aserinetlslORLINERRfdp flcattle
FROM TO '- - DIAMETER, TRIMNESS. MAATERIAL.
SAEDACCO (L tL In.
@:1agimiy Mauro 16.INNER"CASING OR TUBING(geeebermaI efoced-lonpl
-FROM TO DIAMIETER. TIQCKNESS MATERIAL. - '
2.Wd1.Construction Pcrrntt#: 0 It: 10 . ft< 2^ - :`,:tit- SC11-40 PVC ' '
1r;t all apptlitnbletcrNpcnnisfir.Cuann:5tutc,dturianer.IryerOrnrtr,;l'. R. ft in' .
3.Well-Use(chcdCw'etl use): • t7:SCR);EN
Water.Supply Well FROM.- . TO • .•DIAMETER summit - TIICNNISS_ t MATERGt6 .i •
I:Agricultutal• UMuufcipaliPllblic. , • 10..• ft. 20 'ft. 2" in; .010 SC11740 PVC
DGeotlietmal(HeatinglCooling Supply) • DResideutial Water Supply(single) fL ft,. r� .
" Dhidustrial(Conuttercial , DRcsidcutial Water Supply(shared) -18c GROUT .. , _ -
• • FROM•.' . TO . .MATERIAL ' EM PLACEM1MT METHOD SI AMOENT• I.
' ❑lrigation • . . . . 0 ' .ft. 6 ft. Portland Pour
• Non-Water Supply Welt:: -- - . .
fT. ft.
®Monitoring . : _ • DRccov'cty :. . : . •
Injectton:WdU: 44 ft. - • .- .
• DAgniferRecharge DGmundRalef Renicdialion 19'SANDIGRAVEL,PACK(if uiiplirabtel
'FROM TO' • 'MArium!: PMPI„5(EMENT H Liana '
. 1:3Agtiifcr Storage and Recovery • I:Salinity Barrier 8 ft: 20 It. Sand #2
. ❑AgtiiferTest 17StoimratcrDrUiriagc ft. fi.. i'
. . ❑Experimental Tcclinotogy 17SDbsidenncc Co»dial - - - .
• '20:ORILLiMG'LOG'(attach nddllioualstieets if necessary) '
ElGeodiennat(Closed Loop) ❑Ticker- . FROM- TO DESCRIPTION(color.hatdger'.,n4'ntek11 Vt.Mitt eire.Atl
❑Geotheitnal(HeatinelCooliue Realm)" ❑Other(i tpiain under#21 Renimks) `iL ft, .
ft. ft. . ,, •
4.Date Welt(s)Completed:•3-21-24 ,WelllDtrMW-1. it: ft.
Si.Well Location: fL ft .•-. .... 7.-.
Former Black Rock Trading Company - ft.' ft ` , `"'' .lr" ��� `mar
Faclit)•,'€)ii�ncrTTmna • . . • Focht).IDR(ifappiiubla) -- . __ . . _- n_�_��r;�4
ft. ft.- M-fi i V d LU
• 13 Woodfin Rd.,.Sylva, NC, .28779. R. ft. •
P1tv31cal Address City.and Zip• .. t---L 3 ',5,.g.
�.21.RE:iNARK.S•• tr,.:::""_ F
Jackson bentonite seal from 6-Bft Lr,v ^% %u�
Comb l ateet ldsitlificntiou No.(PEN) • j
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Sli:l ittititde and"Longfade in degreesirninutcstseceinds or decimal stcgti a. 22.Certification: '
(ittiril Bid,Dire Ia0Iouu Is'turrtieleul) " " - " '
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. N . ' W ",-- I 4/10/2024
- & uitureof" ,its:vlir..,,,`e: • --' • : •
Dad •
' - 6.Is.(are)theuell(s):.10Pennanent .or ❑Temporary �'xa6�'f v, t,f3?�. � t cnrr,><cr�rJty wtonhmtC ay sign44 this.fe.ih6 !:4•,1 .1 t r,: t
irith 15A NC.AC OW. « 7..'fz a:it.:..it;.1C.0200 We Cnirstrti'rtorr Smodords and Char a '
7.Ls this a repair to an custin bell: LDYes or IgINo t•.yivofrltu wool. •becn'proiitkd"rathr in-Nmoter, .
iftlhls'is a rq,o r:fill oa.1410 i Weil carumictloahrforenstlon and explain-the rarrure of the
repair tinder v.,rctnurks iretiun or an the bail of this form. • - 23.Site diagrant•or additional well derails; •
You may use the hack of this page M.provide additional well site details or well
• S.Nunther of webs constructed: 1 - constluctiou details. You May also atlaclt addilioual pages if necessary.
For madrtple ir,Jccrlon or aea-werer sapplri,�efls ONLY irlrh Mt'same cmrsiruiteotr,yea con
submit irneform.- - SUItMITTALiNSTUCTiONS. •
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9.Total well depth below land surface: 20 ((k.) 24a. For All Wells: Submit this tams.w•ithiu 30 Clays of.completion of well • '
For mahlptew•cNsIrsr all drpthslld(f,'lore,u(cxampk-3€20tV dad'dia•100) construction to thefaltosing: - -
10.Static water keel below top of casingi -•((It,) • .• Dir islun of Winter Resources,Information Processing Unit,
if nvi t',level Is above casfag use-"+" - - . 1617 Mail.Service Center,Ralc gh,NC 27699;16 L7
•11.Burchotediac(er:l0.25" • .(in.) - - - 24b.For Ieifectioji {W 1is ONLY:nr In addition to sending the form to the address-in
• .246 abore.also,submit a copy of this;faun within 30 days•of cowpletiou of well
12.Well construction method:IiSA • . _ constmctionto the following:' -
(i.e..auger:;Nan',oabl�ducci pi,-- etc.} Divisiou of Water Resources,E ndet•pound Injectlon•Cantrol Program;
FOR WATER SUPPLY WELLS ONLY: I636 Mail Service Center,Raleigh,NC 27699-1636
13a Yield ?de.For Water Supply&Injection iWclts: . •
(dim) Method-of • Also submit one copy OF this foam within 30 daysoi'completionof
- 13b.Disinfection type: Amount: well tonsirnction Co the county health;department of die.coiuily.wIere -
consinieted.
Fenn GW-1 ,-Nnfih Catalina rl.:p:Innrrnr of Em iietuucnl and Natural Resources—Dhsiiloon of Water R -ntrrns .Revised Atgust'ZUl3 - . •
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