GW1--02786_Well Construction - GW1_20240507

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WELL CONSTRUCTCON'RECORD . ' - ' FarI 1na o lVsONLY: !
This form can b.uscdfoiSingkormultiple ells• ,
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1.WddI.COntnictar Information: - i
• : 'Lt.WATER ZONES.. .. ' ,
• Stefan'Smith . . . . FROM' • 'W ' DESCRIPTION]
14c)ICaCAC1d0rNalillC• R.-^f_a Q%r C ' -" • R.' tt.. 1 1.
• .,�,-.(.-''".► 11 • ) • ft, ff. t 1
1.
3576A :- • . _ .-
P. LS.OUTERCASING(fotmulti-easnfnclis)OR•LiNERRfap'fteoble)i: • • '
NGNc17CaNracar c If1C.R1i001'fRlltl"er v MAY. V t UL1 •
. "FROM TO • . DiAMErint TifitKNi:SS MATERIAL- _
SAEDACCO 0 ft.- 14 ft.. 2 • !'in. SCH-40 • •PVC
n to Naive-. . . 1I1:v:r•. •-'• — •'" ''".;.;�v''-- t6.• -INNER'CASINGORTURING(gmnilt.rmaletoscd-loop) :.
! - - LrJ6Qy ` ,3 . .' .:FROM TO DIAMETER THICKNESS MATERIAL .
2.Well"Consttucthin Fern*n: . - R, ft: - J'41:
1.isr'all eppittoeh a well pi:mitslid.County;Sh e.-Variamre,14e 8'. rrr,:p
3.Well:U kw'cll se(chcc use) " , t7:St:REEN
SVaterSupply We11:,-- - FROM.- . TO DIAMETER SIOTSID: TniCKM S l MATERIAL•
ClAglicultptal ClMhrucipaUPttblic" 14 ft. -24 It. 2 in 010 SCH-40 PVC
. ❑Geothermal(HeatingiCoating Supply}._ OResidentiat WaterSupply(single). ft. 1 " is _
. - - .©hidustrialfConunerci l •- - ©Residentiiat Water S.upply(sbatcd) T oGROUT'TO MATERIAL . cnmf..cerlENrueTROD&AMOUN1'
- Cllnipation .
-Nan-Water Stgtpty Welt:' •.
Monitoring 17iReeo cty . .
. injection Well:. . ' �_
El Aquifer Recharge ' •• OGioundnatcrRe mediation• 19:SANblGRAVELPACt lifapptkabl )
.. FROM" ' " TO' NIKrtiRIAI• ""• ' " ENIPLA CEMENT mu:TttOn' • . . '
• DAgnifcr.Storage awl Rccovcty° - f7Salinity Hari-ice .:. ft.
IDAgtiifcrTest • . • OStomtieucrUntonge. •--ft. ft..
. ORxperintcntal Tcclinologs - ❑Subsidence Control - - - ,
• •"2O D1t1LLONG'LOG(attach additional sticdl if ncccwan•)
17Geotitennal(Closed Loop) • ' l]Trdcer: • FRROM' TO DESCRIPTION(cobs.hard't+,.w nick O ix.pulp wa do t' , ,: .
OGthithennal(HeatingtCooling Return) °Other(e plainwtder'.#21 Rethinks) 0 R. 24 ft.. silty ; . ,
LDati Welt(e)Com pletetl:, 4/9/24 ' tiVeltiD/iTMW-2
. ft.' ft.
5a.Well f.(rcatnin .ft. f4. •
Citgo' - ' •ft. . ft, • . .
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.Facility/OivrerNantc. Facility IDk(ifappli:ablc), • .
1204.River. St., Wilkesboro, NC, 28697 . ;R. " it.- I .
• Pllisical Address.City.and Zip" "2 t:REhLlftti.0 " -
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Wilkes • • temp well . • • .
Comity - Parcel iiI uliftC:liiun NO(PIN)
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. - 5ti.I-itcitilde.andLongitudeindIcarceslminutcslsecondsordcciritil:degrees: 22:CectifccatLrn: • " .
' (lf uoll field,ohihal1 tt it4i fI1 id) . - . . •• . '
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36'.141850 Is,- 81.176753 - . - ' - W . ; .' 4/16/2024 .. '
- -' • . Sintfeed Well Contractor I. ' Date . - .
6.Is Ore)the nell(s):.L7PCtm tnent. .or 10Temporars si viirr iIir.arm,'! 'lrerebr era thew;thr'waist avr tome an rmreted hr canrrlancc
. . • lath/SetNCAC.OW.0100or1sANCACO2C.0200{Yell Cc-manic-durSraidaids and rInaa
7.Lv this a repairta an:Misting will flYcc or MINI • _ 'rlyirofrhil rcconl lira Nar'prol'ide..1 tart'wet/mown.
- lfrhfs"fs a repair:fill mg A-wirai mer!corastruc,ioa.brfanrwrion and ciplahr Me rurnue of the •
repair tinder A2l liana(kV:ircrionar kin the bail:of this firm. ' •, 23.Site dialtramor additional well details; •
You May use the hack of this page to.provide"additonal:cell site details or.Dwelt •
' • 8.Nitntber of wells Constructed:1 - - •- " - - Construction details. You may also attach additional pages if necessary. .
For in akur.ulrlpl.r Inj cr non-:rarer supply ice!!.O?.LY with Me surrte corisp urr/on,;oG can . '
' s Nato:le/rrm. - SIJBMITTALiNST(JCTiONS` I' .
9.Total welt depth below land surface;• 24 •- (ft.) 2-IrL Our All Wells Submit this-•Inn within 30 daps of completion of well
• • . Fer Ianhlpfe u•an-lisi a/rdcprhs lfdt9i'rent(crrrrnpfe-3@.00'atull@ W0) construction Co the rationing:
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. 10.Static water level below tap of casing:'17 "(D.) Division of Water Resources,Information Processing Unit,
/f rcmer level If;Move casfitx roc"+'• - - 1617 Mait'Scrs ice Center;Italei0,VC 27699=1617
• - • 11.Borehole diameter:a-25" - . (in.) - 24b.For Infection Wells ONLY: iii addition to sending.the form to the address-in
. -24a above,also.submit a copy of this;form within 30 da)s-of completion of well
- 12.Well oauStruetion'method:/ISA • - cottstniction to the following:' , I, , - -
(i.c:auger rotary.cable,direct push.etc.) ' i I• .
'Division of Water Resources;Undet•gound Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: - ' ' ' • • •• 1636 Mail Service Ce:ter,Raleigh,NC 27699-1636 •
f3a Yield(gp-• • tilcttrad'of"test: •
'�"2-Ic.Far Wafer Supply&inieetton Wells:' • - -
- Also,submit one copy-of"this•fonnj,withiu m 30 days ofcoplelionof - .
13h.Disinfection type: • Amount: - : . . wail consUuctian to the county health;department of the.cottnh'.vhcre
consinreted. I -
. Foirn GW-1 " • - NorthCariliaa Dep¢Amcra of Enettat4t01 and Valid,Rcaourees-Dtvuioa of WalcrRi " RtWscd_ltggrat2,013 •
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