HomeMy WebLinkAboutGW1--06124_Well Construction - GW1_20241014 • - i ' - t • • i 0.30.S ....Q
. WELL CONSTRUCTION:RECORD ) O '
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Thisfarinaanbc land Cuis[ngloarttutltipkueils \ •
1'. Yell.Cantrati tar Information:
. 'ti:.WATER ZON rl.S
Chris.Ruffer. . 1 FROM- ' 10 • .• " DESCRIPTION- ' l
Welt Gatatranor,tcantc R. ft. 1 1 .
4223A • ft. ft. j
• NC Well CanuaciorCcrtifrcationNalier ' '-11 OUTER CASCNGtforetnni ve!liid;1ORLINERlltrip'ticobkh •
-
FROM TO DIAMETER. 'Tttictcross• • MATERIAL.
SAEDACCO -fL (L. 1'IS. -
• Ccmpanj•l in . •
. "YLc1NNER'CASINGOR.TUBING(tco tin rmalcfosed-boar;:,.'
SFROM 1O- DIAMETER;-.. 11 ICRi4ESS MATERIAL -
2.Well Constrtictlon p¢t'tnit#: WM0100582 _ . . • • • 0 ft. 40 fti 2 . • ."ua sal 40 " PVC
. fist o �.•prr ilirpble, penults ti'Comity:sse6.-..wie arxe:I? ?Bert rlr..1' _ �. .. - -:--——
. 3.Welt::Iise(Chcck:wClltlsoir. I7:SCREEN • 1 -
• •WaterSuppty WithT .- . , FROM TO .• •DtA1tETSR 1 star sic 11nc-Ksris I•M:ATRRt41. .I
40. R. 55- ft.• 2. ilt, .,:010 ' 'SCH 40 • - Pvc
• Ci�lgncultutal• . . El Mulncipal/Public 1` .
CIGeothnne al(He atingltooling.5upgty), ®Residential Water Supply(5inple) fi ft.• " . in 'a
• ®hlduetiial1Conmtcrcial •- - . OResidentialWaterSuppl)'(shated) •18LGROUT• - • ti =•'- :. .' _-... . , - . .I
FROM'. . -TO '.'MATERLti ' !EMPLtCEMMTMEInOD.VASIOLIRT•
17itrieatian r. ' ' ' • . . 0 'ft.,. -35 ` •ft. Portland Injection •
Non-Wald ipiy Wd I . .• • I
IW)L4onitoring . Oitcco►r0' • �' h
fb .
. Injection.Wctt: •
. OAgtllferRcctviri,,'C' OGmmunlit1"iter Rentcdiatiori• • l9:'SANDIGRAVELPACK(if amolk.iWtl -. .. - .
- 'FROM TO' - .1"-MATIIRWt. •FAIPI.AC:E:HENTMETHOD ' ' ..
17Anitifer.Storagc and Reeo'et)" • ElSalinit)Barrier' 38 R,. 55 ft. Sand : . #2
•
• • E]Aqu •
ifcrTcst. • ❑Storin atcr Dminagc • •ft. it •
CIES2pr,ritnentalTechnology- 17SttbsidemcControl --
20 DRiLLi\G'LOG7aUieh additionatstieds ifncccsean) •
' l7Geotltettna1(Close4 Lnap) , : [7Tracer. . . FROM-.. .TO'. -, -• DESCRIPTION Oulor.luminc+, 1 Mtk eftx:Rctin eiie.ttr.1
OGeotlietmai(IIeatingiCaolioe Return} ••CJOther(explain under.fill Retuall sl . • :ft. • It
ft. ft.
•
.1.;Dote Weil(s)Completed:, 7/17/24 . •WeII IDi#MW-4. ''
5a,Weil Lnea tttn: •, •J ',•
Service Cleaners • . . ft.' . ft - '•k . a• .
. Facdity.!OwnerNtamc ' ' . : .Feeiit)ID#(ifapplieablc) R. ft. If
• . 115 W. 1st Street , Ruther£ordton, NC, 28139 t. .tL•.
PLysical Addtvss.City.and Zip', ., } `;.,,
'21.R1 hiARfi$'• �,,c i`;
Rutherford 1610812975 .Sentonite seal from 35-38'
Calmly parscl w oitirlCnnnon Nee(PIN) j' .
Sb I...,ntiide and 1:ongitude in dcgeces&minutcslseconds or'decimal'ilcgrccs' .22.Ccrtiotation:•• '
(1fs ell met m e tal/lo e h uuffekid) -
N W. • Ghris :Buffer • 8/7/2024
SidmturgofCerttliedV,cllCantladar-- , pale
6.Is(sec)tbetisell(s):.ZlPertnanent .'or tTetntuniety 1i
N}signiag.A•s farms I frerrby reality that,dig.trellis)tsar rimer cawnicird in;acrordaace
'l ti�154 NCAC OW.0100 or ISd NOW02C..0200 l)'ell Constrnrtiaa Sratldards and that
• . 7-Is this.a i-Lpuirto an existiitit well; 7Y,tt,e,_n- or Q9No t piyof Mkt record ht{s1u..rn proride4i to)0 sWil F1 drrr.
If:hls.ii a netvi.fill aurr k'onva lydl comltrir loa br`orro rlon and rrplaln the encore of Mc
':Oar-toter irnuirfiiaresiika or on the&Ai*of diur fora. - 23.Site diagritn or additional u'elidetails:
' You tua use the back-of lhis page to pros ide addiitional well site:details or.welt
S.Nuntberof Wells constructed: 1 ' • - - -- ' • cottstiuetiou details...You may also attaelraddilional pages if neeessat}•_ .
For mitlrtp/e t.decilan or non-saucer surpp(ilullt ONLY ukrlr dm issue construetlau,you eon
suhmironefon i. SUBMITTAL iNSTLTCTIONS- , .
9.Totat Well.depth he/ow i ind surface: 55 • ' - a) 2ta.,Per All Wells:-Suhnnit this form within,3u•days of completion of iyell-
For muhlplc'utlli lisrofdepths if d1,jjivc a (exompho-3@2O11•ana!2@ 100) • eonttioetiori to thin foitosfin3: • 1' ` . • .
10.Static water le el below top of easing; (fti) Division of Water Run of iwt.lnfrirmatipn Processing Unit,
• if si clew!Is Aare:cusftia;'Pim"+•. 1617 R1aiI.Seivice Center IRaleigh;} eigh;NC 27699=2617
6.25" I - -
11 lloreholediainetcr: (ire) 2db,For iniect(metro Well'ONLY: In addition to sending,the form to the.address in
• .24aabove.also submit a copy of thisrfonu within 30 days':of.completion.of well
. 12 Well eoust inetian nacthod:NSA . • . rcanstnic►Ion to the follolu inng: -
(ic auger taiary,cable ditectpossh.etc.)- ' -
Disisinu of Water Resources,Underground Injection Control P ogriun;
FOR WATER SUPPLY WELLS ONLY:` - . • • • -1636 Mill Ski Tice Center.Raleigh;NC 27699-1636
13a.Yield(gptn) - Metltotl•nf test;
1r Wells:f oi'watcrSupple*AIinjectionWe 2
• Also submit one copy of this'foam within 30,day'sofcoinpletionof'
•
131:.Dis(nfi tinn,tyltc Amount: well'construction to the eoutm'health department of the couint nhcni
constructed.
1
-Fenn,GN-L woilh Catalina Dx7an?uxnt.of Etn'irennrtlland Vanual Rewarces-Divkion of Water Ro ottoes Rci'iscdAtgust2013