GW1--05816_Well Construction - GW1_20240926

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i-WELL CONS`PRUG-TION'RECORD. FortturimlLissONLY: 1 .
• 71tis Roan can be(sad for single or tmtltlpk welts
1.Well Cantrnctdr Information:
'IL WATER ZONES t .
Rich Lemire FROM TO "DESCRIPTION! -
Well Conn-mot Nam ft. pi
2593A - .rt. ft. I 1 . '
NCWcfConnaclorecrtlfientionRaabe'r • CIS.!OUTER'CASING Rormutli ikdru'itIOOK-LINFIt aria tticabk):
- FROM TO '• . DIAMETRE I TITICKNESS \TATEMAI. •
SAEDACCO . IL ' IL Ida • • - -
. (tngtuny Nance. .16.INNER CASING OR TI/BING(geothermat'dosed4oen)',.:
•FROM . TO DIAMETER Tr1ICKNESS _MATERIAL '
2.Well Construction Permit#: '0 ft._ ' 15 '. . ft. 2 ;ill. •sea-40 •Pic V
Lust ail amilealik tseitivimits(Le.County.State..Variance.lljeco'CIt err.:)
•ft;. ft, t Ina
. 3,Wcll,Use'(cbeelcwcffuse) • 17:SCREEN
Water Supply Well - - - FROM. TO AMMETER METER ,SU1TSTEE TIIICKNI;yS. I MATERIAL
_ DAgrieulttttal .CthluntelpaliPtib.lic. 15 R. 25 ft. 2 in oio SCR-40 PVC
DGeotlieimal(Heatin&'Cooling Supply'). l9Resideutial"Water Supply(single) fi rt. in " -
.C1InduslriallCoomntereiai ©Residential Water Supply(slated) IS'GROUT
FROM- TO MATERIAL''. ' EMPLACEMENT MEfTIODRAMOUNT
. ' IDirtipation •. ' .ft. ft. '
Non-Water Supplf Well: . • .
letionitoring' 1]Rccatety • fL "
InJection.Well:- • . • - •
..R, . .ft . •.. -
DAquiterl2cehargC ElGfoundlw.tlerRoncdiation' :19:SANDIGILWEL PACK ofnppllcabtc):
FROM TO' MATERIAL, - et\IPI.ACEMENTmr-ttton
rliAquitr.Sto[agc;lnd Rccovety f7Salinity Haiti. , . - 13 R.. 25 ft., SAND t 2
' ❑Agir.iitoTest own aterDrtitia ' r
• ft. ft..
❑ XpCRIRCtt(i!I T�IittDtOgp. OJrlabSidCrKC Cott/ .:20;DRILLING LOG.(attach adttitionai sheds if eccessan•L• - ' •
OGeodtetinal(Clasen Loop) . - ' t7Tracer .. .FROM ' TO DESCRIPTION(c»br,lerMiea:itateeknne`CFaig site,&t t
DGeotheiittal(Hcatiug(Cooling Return) ,•❑Other(esploiit under#21 Reuiales) .0 • :ft. 25. . fL BROWN PWR 7 .
4.Date Well(s)Con(pletcd: 9-11-2024 Well ID#58-4. / .'°''
50 WritLocation: ..ft. ft,. S E P 2.ai 2024
SONY-7047 ft,' ff,
Facait}•,t0uocrNamtc : • • " Facility ID I(ifapplicable) R ft lr ?'.c L£a. t rt.r, 1.
fs ` ' sc.'rg Jul
306 N. Main St., SPARTA, NC, 28675 . ' . It, , ft.: D'r'i'Ce,`n
•
. . - • Plnsidal-Aadixss,City.hind Zip• -2L HF:AIARti5. .
ALLEGHANY - .. : • .BENTONITE 'FROM 11' TO.13! •
ly !?atcel lderiiifi.;itionNo,(PIN) -Cxom
Sb.I,ittitiidcacid Longitude in degrees/m nutc&fsccondsnrdecimui ctcgma. 32.Ccrl3ficadi►n: t
(if Well tg41,ow 13.0oaig is 3tdRcknt}
.
r r •
N W. ....F/)'n;t!:c. 9/14/2024
Signature . WcllContmctar : Dale -
6.Is(are)the tvell(s):,T3Pertna neat. .tie Z1Temporary .14,3igning than.onu;'1 hcrrb Geri t rhar;he nrll, was run!vorx rinaa mrcted htaeForce.
. - ,4r{i h 1 NCAC(1W,0100 or!SA NCr{C•O2C;0200J14t (µ
1l Coarstnictin t Srnix(ords and that a
7.Ls this a repair toan existing well; OYes or '11No • lea ofdhisreyonihastremomr4kdi?thaerilmtnrr
if nWs'ir a lelaitr.•fall oatalri tvi well taasuucdon information acid riplain the nature of the V
repair under 6'21 terea..r dwn or ivt the bawl of this forme, ' • 23.Site diagram or additional well detaits:
• You inay.use the bach'of this page'to provide additional well site details or well
•
S.Number of wells cottslructed: 1 • .• • . . col:situatioii details. You may also attach atddlitioual pages if(necessary.
Foy aeaaltlplr lakeilon or non-ivarer supply melds ONLY midi the&erecanrstrue:io n,you eXaa
=Nett one twin. ' . . , , . SUURTITTAt.INSTUCTIONS '
• •9.Total well depth below land surface: 25 - (ft.) -2Ia. For All Wells: Submit this Dim within-30 days of completion of well •
For maahlple wells-list ail depths ifdtj Brent(example-3@200'and.2@ WO) constmction to the following: -
10.Static water level below top of casing( 19 •(ft.) Division of Water Resourrti ,Information Processing Unit,
/peeler!sill is above caging;use"+" V 1617 Mail Service Cmtcr,Raleigh,NC 27699-I617 •
li
11:Borehole diamctera 825"- - (in,) tab.j:nr Infection WOIIONLY: rn addition to sending the tom to tbe:addtess in
24aabove..also.submit a copy of tliislfottn within 30.days•of completion of well
12.Well construction method:NSA cousttuctiou to the following:' I' ,
(Lc:auger.rainy,cable duvet rush vie-}
'Division of Water Resources,Underground fttJeetion Control Prograui,
FOR WATER SUPPLY WELLS ONLY:' 1636 Mall Service Center.Raleigh.NC 27699-1636 •
13a 'Yield(goat) Method of test: 24e.For Water Supply&lnjcc_tton Wells:
- Also subunit One copy-of"this fonu waithm 30,daysofcotuplehtonof
131i.Disinfeetinn type: 'Amount:. wcil construction to the county hcaith'depanmrnt of the.county.wltcre
constnicted. lI
Fonu GW-I Noah Carolina Deponntrau of Etnir011111:Matad:pima Resources-Division of Water Rmourcm Revised atagust"D 13'
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