GW1--04882_Well Construction - GW1_20240828

)
P)......
WELL CONSTRUCTION RECORD Fo,ll,knmlUseONLY:
Thu form can be uyd for single or multiple ncis 00
1.Well Contractor Information:
I J.%AT1tn ZONIS
John Eisenman ►ROM t0 - Dt3('aiPT10Y
Well(•nnrranr Nank ft. ft,
4439 _
NC We(Cnntruelor Ccnifaat,on Nuniu r iS.OUTER CASING(for null-cased wellsLOR LINER(if no Nesbit)
1'NOM Ti) PIAMFTFR TNICKNYSS MATFNNI
•
SAEDACCO n. ft. u.
(,,u1,am N.,,n i&INNER CASING_OR TUBING trot Rental closed-Woe_�
PROM TO -- DIAMETER _ rtin(_A]FSS MATTRIAI.
2.Well Construction Permit I: 0 ft. 21 fi. 2 m• SCH-40 PVC
!Jrr all applicable urn pen"h i i.e.County State Variance.IniaKba2 elr.) - R, fl. in.
3.Well i ae(chock well use): 17.S('RI HN -
Water Supply.Well: 11110M TO Dt4MtTnit SI.OTM71 TNI(1iNt0S marginal.
21 R. 31 ft. 2 in, 010 SCH-40 PVC
U Agricultural DMunicipaL''Pubhc
OGeothennal(Heating/Cooling Supply) DResident►al Water Supply(single) ft' rt - ra.
DlndustriatComniercial DResidennal Water Supply(shored) it --,
moor TO MATERu1 , rMrIACEMENT M£71100 A AMOUNT
❑Irrigation 0 It. 16 ft. Portland Pour
Non-Water Supply Well: R It.
E Morutonng ❑Recosen
Injection Well: n. IL
❑Aquifer Recharge ❑Groundwater Reniedi;Lion If.SANDVIAVIL PACK ill apMMeaNy
IDIOM TO MATRRtaI.__ CMM.A('MWNT%melon
❑Aquifer Storage and Recosrty ❑Salinity Barrier 19 ft. 31 ft. Sand 82
❑Aquifer Too ❑Storlmsatcr Drainage n. n,
❑Egocnmcntal Technology ❑Subsidence Control
2o.DRILLING LAG(attach additional ihcr,if,srcessvy)
OGeothenual(Closed Loop) ❑Tracer FROM Ti) biMMRrrnos I,nt.r,kardae.,R.4'nnk opt.gram aaa,eat.)
OGeothennal(Heating/Cooling Return) DOther(explain wider 0021 Reloads) ft
rt. ft. '• - . . -
•
4.Date WADI Completed: 8-7-24 Well 1D,MW-67 6 , ._ a I i
5a.Well Location: rt. ft. AUG 6 G 2 ?024
General Electric Company n. n.
FadllirylOn•Rt:rNone Facility iN(ifaeplicablc, ft h. I.it,...Twdi.:a: ;v.,-,.may:." ,
kk
3010 Spartanburg Hwy., East Flat Rock, NC, 28726 n. - ft.
� �
PM will 4ddress.Or".and Zip '
r 21.RCM.IRKS
Henderson I bentonite seal from 16-19ft
(noon.. 1'areel hkntdxaIion No iPtNs
Sb.Latitude and Longitude in dcgnceslminatestseconds or decimal degrees: 22.(.crdfIcadnu:
Sid ocll held.one I:al1ooa rs suflseseid1
N W --- ---_. - 8/19/2024
Sitnatarc o�%1'a..*t ..aact;,-- -" Date
6.Is fare)the until %!Permanent or Tcmlydrran in si8 •8 brd 2 !!a ifi,y. y,''t w ii IF milli feted 1R antaniancr
wit*/54 NCAC 02C.'< 1, :il'A.4:1C.0200 Well Cos irie-liar Susd,u,s and ratan a
7.Ls this a repair to an existing well: Lill es or EL NII rope nick,record ha.,hem pro,'irkd re, te tell witer.
!I tbi6 11 a rejkrir.rill,.u(knuwsc 4e11,(man,IKON mforurou,u,owl r.,plunr the oorare,1 the
repair urnler 021 remark,,return or m the boa of thin foray. 23.Site diagram or additional well details:
YOU nta, use'the back of this page to provide additional well site details or well
8.Number of wells comitnucted: 1 construction details. You!nay also attach additional pages if necessan.
For main*rnjerrion re nMr-wear supple wells ONLY with rbe atticeoni4itcN,ts.turn Om
,ah,nrr..n,.r:nn SUBMITTAL INSTUCTIONS
9.Total hell depth below land surface: 31 (fy,l 24a. For All Well{,: Submit ibis form within 30 days of completion of well
For maltiplr..iris list aN depvhs ifdi,8rrrnt(crumple-?g200'and:FP 1001 con.Slnrction to the following-
10.Static water level below top of caali (h,) Division of Water Resources,Information Processing l nit.
it".UN h.,r'i.al.,mr•anat.ate"4." 1617 Mail Sexier('cater,Raleigh,N('27699-1617
11.Borchok diameter:8.25" (DO 21b.for',Octillion Wells ONLY: In addition to sending die form to the address in
24aabose. also submit a cops of this form within 30 days of completion of well
12.Well cuastnietion method:HSA construction to the following.
i c auger.roan.cable.direct push etc.l
Division of Water Resources,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh.NC 2769l.1636
2le.For NAter Sunnis t injection Waist
t3a.Yield timni1 Method Otero:
Also submit one cops of this form within 30 days of completion of
tab.Disinfection t)pe: Amount: well consmiction to the county heahh department of the county where
constructed
Fonn GW-1 Nonh Cardillo Dsnurnwnu of Ens Hourly and Natural Resources-Diswioo of Water Resorrons Res wed Argtat 20 l l