GW1--05774_Well Construction - GW1_20240926

• I''
WELL CONSTRUCTION RECORD POr faternalldsoONLY; - l
This form combo usal for singly of muttiptc rids•
1.Witt Contractor tufornlation:
e 1i::WAtER ZONis- .
Rich_Lemire - . FROM " TO DFSCRtpt1ON i '
. • ft. ft, f
Well CnalnulorNalm
2593A = ft. ft.. J L
NCWcI1CanimcibrCcnific�lioIiNiunbcr 1S:OUTER CASING lforeiutII�caitdricth}Ott LINER Oral) liable).
PROM to DO.SItETRRC 1 TOITICNESS• \IATEntAI. . •
SAEDACCO IL (t. ito.
16 INNER CASING OR TUBINGa tbennatclasedaoerp)
Company Wank. �
-FROM 70- DtAMETERi! _TUICKNESS MATERIAL •
.. 2.Well Construction Penult#: . . - 0 ft: .15' ft. 2 '..•{ta. SCS-40 • PVC
•
' list all vourafalc 1srllponmi4(Le.bonny:S:AtiX.Yoriarrcr.Ilea'4 etc.) - . . -
. .rt;' ft, �in ' .
3,Wct'Use(crux!:Well use): • - - . . - t7:SCR1EN -
. WitterSuppivWeilt_- . , - . — - ` FROM.• . 70 • .•DIAMETER ;StOtmix tntCKNi $ 1 MATRRiAi.• ,
Dtlgricultu at . - • ElMuriicipaliPublic. , •
15 ft. 25 rt. 2 in ''.010 sCB-40 PVC
- . DGeotliertal(I1eatingiCoolingSupply} ' DResideutial Water Supply(single) ' • ' Ft' ' ft. in, .
, DindustriaUConmlcicial • DResidcntial Water Supply(shared) -:is:GRvur
FnOM- 70 . .JIATERFM:• . . EMMA. CEJIEN EIn AMOUNT'
TMOD&AMOU
❑ftripation•- . . . . it, It. ,,
- Nan Water Supptf Welly .
RIMonitoring- l7Rccovety. . '
Injection Well: . - . .. n. tt ,
❑AgniferRcsbarge _ 0dioundisaterRentediation - =t9.SANDlGRAVEL-PACKiifupplicabte1-.. -
- ' 'FROM . . . TO' •' MATRREAI. 'ENIPIACtwENT METOOn
DM-mitt Scourge and Rccov t) , 17Salinisy Uamcr . • • 13 R.- 25 ft, SAND #2 -
IDAquifcrTest . 'AStommatcrf}rdnagc ;, -
. . ft.: • ft.. .
•
l71 glciimcrlt)I T Iinology ❑5ttbs)daiCC Control- 2(1 181tiI.LitNG'LOG7attach ndditiorial abed s if neccstun-} '
DGeotltenual(Closed Loop) . . ❑Tracer. . ' • FROM _ O DESCRIPTION(tubs.harvnece.wiEnwkn re.t;rstn pin.ct.}"
DGeodtenwil(FIeatingt'Caoliva Return) •Meer(e q laiitunder:e1 RettiatTsl 0 f4 25 ft.. BROWN PWR, . .
•
(L. ft:
• 4.Date Well(s)Completed:"9-10-2024 Well m#sB-1, •.
•
t4 • fG
Sa.Well Location: • ft. tt. •i 1�2
L' °3r 6'�f'�
• sDWY 7047 re.. .
�pq
''
Fact)itylOtvacrNamc. .. . .Factlliiy IDN..OrappGcable) R: ft.. "
306 N. Main St., SPARTA; NC; 28675 . ' - , • R. fl., 1114*: FO
S�F'a LPl}sienlAddicts Cit}.andZip ;2t:REMARKS'-' fQ:ainA; .
• , ALLEGHANY • - , - .BENTONITE FROM 11'-_TO 13'' •
•County Parcel lthriiitlepionNo,(PIN)
Sb.l:atitudc acid 1.6,ngitude hi ttegrcos<minutestseconds or decimal degrees: ! ' • •
(Irma field,om taii'luug is sunlcleni) 2-- etTlftChW►n: yy,,,,rr, P .7'.'. ..
N ��' �!-- V11 •
9/14/2024'
Signature of 61t.IN WellCanitxtor-' I' .Dnic
• 6.Is(ire)the.weli(9):.❑Permanent: .or SlTemporar
4'signitrb then'fantk i lrrreby eerti,(y dirtt rhr'trills)twos?wen!)cnrkrnyc-tetl braceorthai - .
with 1M NCAC 02C A1100 or ISA NCAC 02C.0200 Weil Cone'ens lion Snir(ards and Om a
7.Is this a repair,ttl an existing Well: YY e. or l No ,copy al Mir rrecruit'ltos them pmvidrd to:lim;i rll[wrier. -
• If trl1s'it o irpertr:fill D oar kuouvi ws'JI com'nrcdoa:(rrforamslon anti CA f1obr the tiarore of the
• repairrirer&tl2l irntrxkssretiun or lei the bad ofthds form. - 23.Site dingr'atu"or additional n elf details: - • • .
'ton map use the butof this page to pros ide additionalisell site details or Well
8.NumtherofWeellseanstmeted: 1 - - - ' - constmctioiiideiaiN. You-may alsAIrou.inay Au aflaclt additional p s if necessaty.
For multlplo lr(leeitnn or nnrr-darer sirpplx wet OA'LY'iriJi idle same coirstruc8on,yot;coo
subtnirnne form- SUBMITTAL iNSTUCTiONS - ,
i,
?.Total well depth hclo t land suttace 25 ((1.) 24a. toir AU Welly;..Submit this•tans within 30 days of completion of welt • .
For rnalJplc wells-list ofdcprhr(fd(ffiyein(ex m ilk-3@2VO citul.2kv AV) • ' constnlction to the foil:o ing;• '
• 10.Static waterier:el balm top of casing: 19' • illy) Division of Water Resources,information Processing Unit,
!Alike level is close cvstag:use"+" 1617 Mail Service Ccti(er,Raleigh;NC 2769')1617
• ' IL•
-It.Bor'eholedianictcr;8'.257 - . .(la) • 24h.Far tie(colon,Welly ONLY: lit addition to sending the fart to the addicts in
' 24aaboce. also.submit a copy•of this Tenn within 30 days of completion of well
12.Well construction method:USA • - coustmction to the following:'
(I.e.auger.'ratan}',cable.direct push.etc.) +'
• Division of Water Resources;Underground Injection ControlProgram; '
FOR WATER SUPPLY WELLS ONLY: 1636 Mull Sen'ice Center,Raleigh,NC 27699-1636 •
,, ,
13a Yield(gpm) Method of test: 24c.-For-Water Supply&I icctiou Welts:
Also submit one copy'of this'fi nu;within 30,days ofcompletion of
13h.Disinfection type: Amount: • well construction to tllc county literdthfdcpanment of the.county.wlicre
constructed. '
Fanu GW-LNoiihCaraltna Dparinteta of Etwitarusntn and Natural Resources-Dirfslot►of Water Eieatortm. •Revised Atguut2DI3
. I
1