GW1--02647_Well Construction - GW1_20240501

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WELL CONgntuctioN.REeCIRI) .
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- FcrtippulluscoN.Lx: .
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hits fano can bc used I-Or:single Or multipte ViCHS':
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,' • . 1,Well'COntntctor Information:
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. . . ,:,11..WATERZOISES-. .
'Brian,Ewing . ,. . . •' ' FROM. - TO '• "DFSCRIPTIONI ' • " • • :.
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Welt contractotbrant!:. • .. :
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ff.• ft,
. . .ff. • ft - - •I' I:. • . '4240-B. . , • . - . •
NC Welt ConuadorfcrtifientioliNutiiie-i..- • • • _ • ::15.•OUTER:CASING rfoilantti-Ctisedisetls,YOR•LINER(Wait'fletible1, •' - ,
• - FROM' ,70 " " DIA3SEIRR, VOCKNESS: MATERIAL- . .
• SAEDACCO . , . . .1L.• im;• • '
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Corupuri Nolte. • . • • ' ' ,I6.1NNER CASING:OR TURING(efflaibermarefored4onp).•••••=.' .
, • . . . , . --irorti "TO- DLLIIETER. . THICKNESS - MATERIAL '. . , .. .. . _
2.Wcil.ConStruttifitiParinit#: . .' . . . . ' . -.. . • O. It 15 . ft, 1" . ' .i ilk. 'SCH-40 ' 'PVC • ' ' , '
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list all aillticakk..1,-41 penit44.fEe.County;Shilit..Varlartcr..Nadal.etc.).,
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. , 3,Wc:11:1Liscyhecicssell Use): • ' - "
- • - IT:SCREEN . ' •„ ' .
: : Water SUpply.Well; • - • • • ."-. • FROM. , -TO . -OtAMETER' ,.stormar. TIIICKNRSS. 1 IATNtiTAT,' . .
- • • " 15.. ft. 25 -II.- 1'! : •iti.• :410' SCH-40 PVC I. • •
.1:1AgliCultutal .. • ' .1:1MuniipatiPublie . I
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. EIGeothemtal(HeatingtOoling Supply). CIResidentialWatcr Supply(single) ' . rt' .
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. .- Cibiltistilalicon.inteicial • - .• ElResidential Water Supply(shared) '''1,,LGR„.OUT.it,--. .
.111auRrALI ' ENIPIACEMILN T ME1110D&AMOUNT
. , 0 irtiOtian • • , , . ' - !!..- ' ' •A. - •
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, .. Non-Water Suitt);Well:: ' -- "- • . . .
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- ID islonilotiog"
• Injection: Yett:,- , - - :IL- . - ti. . ' . . , •. . . . - • .
• AMptifer Recharge .• . CI6itomidivater ReMedfation * • • :-‘19,'SAND/GRAVELVACIC(if applicabterg- -••- _ .-. , .,-,.- . _.- ' ,-- = . •
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. .., . ., . . ".114070•- ' •/0" " ." •!it-A/Ratak ' • RNIPI.ACICIAK..N/ME/110R --..rlArMifer-Storoit and Rccovci) . ' ' 1:1$11inity flamer , 13 • At... 25 fl. FILTER SAND # 2 - • - .- . •
ClArtirifer Test. . . . . t3Stpunwatcr Drainage- • .,- • ... if'ii. - .
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1:1E*perittiental Tcchnoloa. Osidaxe"COntrol .• • - •. -•- - - • " " - • . _ ...., . . . - - - - " • - •
" • -•'NI DRILLIING'LOG(attach additioial shectiiroccessani ' • .
. EICteotliennil•(Closett•Loop) . . . Ot01Cei. :FROM•- TO DESCRiPTION'otbr.hardnevt:suRfrock Ofrt...-min rite.003
LIGeediethial(FleadligfbiOlillg Rt:AURS) .'1:01Iter(explain under Reniatlis) ' 'n• -5 . ft. i FILL SILT AND SAND _ , ' , •
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• • • , . . 5 ft 15• ' ff. SILT CLAY MOIST . . .- ••
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• -..• ,4,Date Well(s)font-Wiled: 42-24 - - Well IDR tmw".7 • " .• . ' •
15 ft, 20 ,ft •SILT CLAY'MOIST TO WET
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• 5o.Well10.1cadioni .
' - • , • 20. it,• .25 . ft,- SANDY SILT/SAPROLITE/PWR
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Four.Points 76 ' - . . • •• -.
. . .Facility;OWnerNmue. ' - '. . • - .•:' Facility IDA(itappiicablO '
ilrii.,.- -ft.'.'. . ', ., . . -7,;7-• .."•-',...,--,-.- --•-• : .'• . .
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1702.Hickiary Groire.Rd., Gastcinia, NC ,,' 28056' . . . . :ft. . . ft.
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, . . . . . •. -• PIOCal Ark:Reis,.Op'.nitZiti• ;It,liEN.IARKs. , .. . . . . .., ., .
Mil y. 1.-^n^. •• • ,Gaston ' . - - - • . BENTONITE SEAL 11 TO 13' 4 . 11 7 4Ut4.. .• ' . -
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- _ • COlini)' - : • 1!argel Ititudificallon No,(PIN} • . • 1, ' Inft...7Frg..•, r.r:;')•:•••,-.--: -
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4....i.1;Q;•,;;;•.-h-.3 -- .
. - . • 51).,11441610c inil-Lcingftitlelii degreciitninuititscainds or decinitl.;tetra's:. - 21 e kit- • • •• - .: . -: ••
..•- e motion:
Of WOII Hold,01WIatiloit innftlei,tiO)' • •. : ' .' .' . -'• -
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. N* . ' NY' • Brian Ewing____ _ ' . 4/5/2024'
" • ' • ' " •- • -. Sisnatrue of CatifiedWell Cantracla;- '' •' -. ; ' Pam -• - ' - '- • - • '
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. : . . 6.1s(.ire)tin.well(s)r.pPerinanent .or XITenittorary
- liy signing aqs fettur,'I irefTby rerttry&will?inillis I was(w..nq cwoanreted is ttccorthrtare
• . - 'wily 15.4 NOW 02C,0100 a0,15ii.NCitCO2C.0200 Will Canstaiet fon&alder-ids and iliai a . . •
7,Is this a repair titan esisting well; ' ElYes or -111No ' 'cor•qof Mir riyoal?la's 6.icaprovirlf41 trigii\iyihrrit:ner, '
_ 11 tOls'Is a irpairdill air knowa milloaastarciloa•brfarasacian awl rxplok-the.narare of rho _
try4r tinder#21 irtntarlaZirciidia.cir LU1 the bailie.thLi form. • 23.Site diagram or additional will deit•itits:- .• .. .
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• . - - . • •YOu may".ale the back of this page".tOpositle additional well site.details Welt
• S.Numberof welts constricted: 1 • • • • . - • cot sist:chi:ladetitifs. You May also attacirlidditionaipags if necessity. . ' • •
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For Altilitiptf la/thin!i fir taia-iyarir apply ives ONLY itirh itie SIT Ifid canitritilloa.yaa coo IN
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(JBNIITTAII, STUCTIONS
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• - . . - 9.Total well depth belaw.lantl.suffice:- 25 : . . • • .• " (ft) 140.-Fur ALL Welk: Submit this loon. Wilhin•10-tlay of cotoptetiOn of well
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Far ntiltiple'rsills list all alyabs if GiViaiw(Csaraple,3€100'and.20 100) . • cOnStnictian to the fiattquing; • 1 ''- ' •
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•. ', 10.Static water level below top of casing:- • '(ft.) . • Division of Water Resource's;htformation Processing Unit,
/Jim ter level Is above casfag.:ase"+" •.- • -. ' . . - 1617 ISIAH Service CertMr;Italetglt NC 2769910 17
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. . ' 11.Bot•chote oliainctcr:2•257 • • •"*•am) ' • 24h.For'fii*Itio rt ,Veils ONLY: In laddition to sending,the form to the address in
' 24a aboye,also subunit a copy of'this fbmi within 30 days of.completion.of well .
. • 12.Well cianstruction'method:DRIVEN - ' . . - construction to the.folloWing:• . 1 I . ' . . .
"- (ix:nuger:rpiasy,Cable,di rcit rdsh,ec.1 • . . • • •
'Division of Water Resources,Underground Infection•C" ,ontrOl Program;
FOR WATER SUPPLY WELLS ONLY: ' ' ' ' • .1636 Igall Sersice"Centter.I Raleigh,NC 274599-1636
. 24c.For Water Sootily..'i:It.Jjectioli Wells
13 .Yield"(mint) - • - Method of test: .
- - Also'subritit One cony.of'tliii faun*Rhin 30,days Of tionipletionsof - •
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13b.Disinfection type: •- .. .. .Amount: . . . . .. .1%.•ell'construction to the erintuy healtE department ot-the.cout#.where
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.ForniatiV-1 • . iqtwihCaralMa Deprirtment of Pouironnryt and Natural Resources-Division of Water RrNof'em, • - . . • Re'rised Augmtlill3 .
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