GW1--02787_Well Construction - GW1_20240507

, , •
. . . • • - L .' .
, • • , • •
. , . . .-: _. .1 i • ,
, , • • • ' .
• . . • . . ,
, -. . • • ' 1.: .
,., • . . . • . , . . . .
WELL CONSTRUCTION RECORD • Per Nepal OsoON,L11:,.•' I.'!' ,
This form can bc%Sal for gled(nsultipk wells••. , ' 1 .it• - - ' - - •
.. „
. .. ., . .
1V 1. ell:Contraetor litfonnat inn:- • •
. . .. ... ..
•
. , . -;14.WATER ZONES- • .
. , .
FROM. . .Stefan Smith70 •, 'OESE.30PIION,
-. . •
„ . ..
•Well Contactor:Nagle ' .r.j, :77: .''''''F7',1'',:•, ,- $'C'..•T--.,. ..fri-.: . R.
• t, . •
, • .
' • •it 'k,......,it....'Ii..., . -V .- ,..... • :ft.. . • it. '' • .
. . . 3576A ' - - . 1
. • . '. ,
"- - NCAVeil ContracharCcaiticalioii Nuttier.: ' ' - MAY•Cu 7 t024 - . .t'S.OUTER CASING(1orinatti-elsedwitIs1OR•LINER Of itti Ilcable)-• •
FROM TO ., . DIANIETER, 1RTICRNESS ,,ARTERIAL • -••
. , , 0 _ .11. 14 11, 2 ;In.- SCH-40 . • PVC
•
. . . .
SAEDACCO • • . .
INNER CASING OR TUBING(geothermal elosed400pl:
D',NC.15:03 -
•- FRO,I , TO- DULMIETER, .. THICKNESS ARTERIAL .2.Wei!ConStrpethin Perinitii . . . -. • : . ft,' ' . It.; . . -• in; ' . . . .
. . . .
list as-vitt/m(7/e 14-41:permiti,(Le.67unty:StaliT,Vai•fairce.filectioft esc.,)! . . . .
-ft"," . 0.•' !Jot.; '
• 3,'Wel4.Use(Optic WO use): • • _:. 17 SCREEN • '
Water Supply Well: : .• . - • ' tatost. . TO •DIAMT.TER STOTS174; 111ICRNM„ I MATERIAL •. . , • .
. . , • ' 14- ft. 24 s ft; 2 -* ifl.- ''.010 SCII4 6 PVC •
. : ClAgtitul' tura! , . , . ' Elhlunidip:thPublic' . • . ,
•. .• •
- ' ' :" . . _
"f3GeoibeimaiBleatinglePoling Supply), EIResidential Water Supply ft. . It int
.(single) ._ ' , . • . . . . _
... . . . . . • . .
. ., • ._
I G'ROUT . ' •
'. .,, ... .• Oludustrialf.Comniercial • -- - - :. ORcsidential Water Supply(shared) -
FROM' TO . -SIAIRIMAU ' ENIPTACE:MOT 31EIROD&AMOUNT - . -.'. . .•
. OirriPtation ;. , , - "ct,•' "•ft. -•• " '. . - . .
. . ., . .
Non-Water Stipp Well: . .. • •
' -
. • " •ft., • ft.: • . .. .
• _
DilMonitoringl ; - . Oliceoyery - " • ,,..
• R. tt,
. • - IrtjecIlon:Well;- . ,- . . . . . i
' . . . • . . ..
• • : • . . .
• ElArptifer Becharge' • ClOtoundiater Rcniediation - . . kl9.SAND/GRAVELPACK(if applk.tblki
• ..
' - ENIPI EETETHO ACMN MD .
El AlptifeiSiora.g e and ltecovetz,• • ElSalinitY Banict • - 'Fi'").11 'it... ." ' . NIAnlellAl. ' • - '. . • ft, ' : •
1:1,4nolfei Test. ; . 1:1Slomurater"Drainage- . . . .
. .
' - - - • •. - . ft. ' ft..
bEVcrittignolTcchtiotog IZISubsidencs• ontroi • • . --
• .-20::DRILLING LOGIallach aditilimfal lbeels4 accessari)
DOeothennal(Closed Loon) : - OTracer . " " ," " • • , Amcor- :to • • DESCRIPTION pmbr.hAninevoi silltoitek ont.imin lati..!.'etr.1 ' . •
bCuhstItenual(11CatineCoolitie Return} :-['Other temittiit utuierklReutatlisl .0 ,.rt. 24. , ft. silty ,". • .
..
• • •. - - ft.-. ft.; • • i, • • •. ... .
_ . • •-. 4,Date W.ell(s)Completed: 4/9/24 ' Well IDSI Tw1-3• . . • •
..ft.
. ... . .
. . • .
• -
.
Sa.1Val,Location: . . . . -• .
' ft. ftt'• . ;• •. , . -
•
• • . . .
, . . •
. ,
•
' ' ; It.' ': ft.• • "
Citge ' '• . . •
. , .
- - . - • -
..., . . , . .
Facility(OienorTtante. ' : . .- Facility!DM(irappliortb.10 '
II
. .
1204.River. St.,.Wilkesboro, NC, 28697 . . . • - - - 0 . - • ft.:. " " . •
. .. ,.
• - - . . ' : ' Platiaal A4diess.ark.aid ZIP. . • ' ,' :s . • •
. •. . . : •, ..- . -21_111111ARK.
•
Wilkes ' . . .temp well . -. , . .. . . . • •. , • •
. . . . .,
. • Cogte .., : • • : - Nigel Ideplitteation No,(PIN} • ' • •
. ' . • . . '•
• ., . : . :" .
51i.ILittitildt'and LOngitude in degree,
OnitweeitseeriodS or decimal 5111i6gs:- .22.Certifleation: . .
• • •
. ,.
druen field,oue tetnotig isSitt6eict4) ' , ' ' ' ' • . . . . . ,
' .
' • • • .
. • '
' 36'.141850 ",N 81 176753 w 4/16/2024
•. • . • • . .
gigtur of Cc.li-rd Well Contractor . .Dato •' • . "
.. .• . . , . . ... . .
, " • 6-is(are)the-went*-OPertnalicla.• •or XffeloPor4r3' " • • ' • , . •itisignbig WI'.funtr...1!tacky rergry that!die wellt0%vs ii;rry.)corimisted Lit anordance• ' •.- .
. with154 NCAC 02C.0100 or 15A NCAC 02e.0204)Well Con;tnierion Standortis and dm::d 7,Is this a repair to an..elisting went- Vito or 4N1) • • - , .c.tvis of MK record loos N.11131-41videitro•;1,! ijrli owner.
if*VII 0 work fill oeit Ano4ii leen coovatalotrbrfomurrioy awl expla01 the aware ofrum- •
„ . repair tardir#21.icenarks,Sicliera or on the bad of this-form. .- . '. 23.Slip'dingram•or additional well dehdis: - . .. '.- ; - . .• .
. . You tiuty_use the back of this page M.prONide additional will site details or:welt •
- - 8.Number of wells constructed:1 . .- -• • • ; tonstmctiotidelails. You may also attack aidthlional pages if necessary. . ' •
. .For Ittalripi.e if yecrin ar non-ivvirer suppl i!cells ONLY with ifle same consiruttion,}wit Coo . . ... •- . .. !
sanniconc jolt:. : .. • - •. • . SUBMITTAL.INSTUCTIONS. ; . • ' - -
• •
. . .
9.Total Well depth below laud surface: 24 , • (01.) 24a..Mir All Wells:•Submit ibis faint within-30•days of'completion of Well •• .
For PT dilliPiC liT111 list all dirks if Mivem(exert:ph.-3Q200ari120 AV) constructiots to the folloni t -. - . -• ' . •,"• •
•
'• 10.Static water litVel below top of easing:•17 . • • , -(9) .• DisiSiun of Water IfetourceS,Information PrattessIng Unit,
. • Ilwillet level Is above casing;awe"+" • • . ! 161.7MaiI Service Center;Raleiet,NC 27699-1017
it,Borcho/e tliatneter:8.25" . - (in.) , . . , . .
' 2-lb.For•Torection Weill ONLY: Itt addition to sending tho faun to the address-in
.' .
24a above. also submit a copy of this;faun within 30 days of.comPletien of well . •
12.-Well obusDuction'method:HSA • • - constmition to the folloWittg: " .
lie..aug..^r:(Nary.table,direct gash.etc.) " - . - I- , . • -
-
• . . • ' 'Division of Water Resources;Underground htjectiott Control Prog,ram; •
FOR WASTER SUPPLY WELLS ONLY:- " • - - 1636 hfall Service Ceintet-.Raleigh,NC 27699.1636
• 1 ,
• . , • .
. • ' -t •
.2•Ie.for Water S,oppyS Injection Welts: . '
llacd(gpvt) ' ' • 4hoIOftet ' - ' - ubthtno i, _ • Also si o py of tins firutwIht 0daysiiCotufletonof •
well eonstruction to the county health department ot the..counly.where ;
13h.Disinfection type:- • . . . ..-Amounu - . •
Constructed.
1 . .
. •
•
. Fortn.GW-I. , Nodlt Canillnal"...spaseitent of pm:humeral and Sandal Resources-•Oivelan of Water 8(Ntutrn . Re lead_kugustleli
. . .
. , •
. . . .
• ' . .
• '