GW1--06692_Well Construction - GW1_20241108

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• • WELL CONSTRUCTION RECORD • .
For Internal Use ONLY: " • '
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-)his form can be used for single or multiple wells . I
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. . ' IL Well Contractor Information: • ,
,• AUSTIN RANDALL SCOTTPRESSLEY • . '::::14MATtItIONES:f•:::':IA::::;]:::;:;?•::Miii;:I:i:: :;:,.;:%,',..'i:;,: :•.i:g:ii4::,: .:I-:,.:..r-.. I
,_ FROM To . .DESCRIPTION • . , - • --.
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ft* • . I.1 .
• Well Contractor Naine'', ,' ft. -, , ' . ,
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4701-A • . . . ft. ft. * '
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:',35.?0D1rElt1CASING11.0tiaillifti4aiediiiillS).01111ANER1fifitiiitieiible.):.--
NC Well Conn:actor C:intification Number •' ---,
FROM TO ' • DIAMETER TRICKNESS - 11f ATE221A!. _
CLYDE SAWYERS & SON WELL & PUMP INC- • +1 ft. 42 -rt' 6.1/4,q '' in' '#21 " PVC
' ::',16"..:JNINERCASING:DECT111111NO:tkiiidithii:ittftie,ethfticii0,1..-.1 _I
Company Name : .
, FROM TO DIA M ENEH THICKNESS j NI.;IT KL M _2.'Well'Construction Permit#: WEL2024-00487 - • , ft. ft.
List all applicable civil permits(i.e.County,Slate,Variance,Injection,etc.,
•. ft. ft. in. . I
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• - •. -3.Well Use(check well use): iii:I7i.SCREEN:.:•:1,:•,.::,:.:.f,.:••:-,::,.:•:::•!•5:::I:c:ri,...,:.::;,:,',:,:•,•.::.•.-..:-.i..,-.:,.,.::•••',....•:,-,•,X•i••••.•:.-.•, '' ". 1
; FROM . TO DIAMETER SLOT SIZE .THICKNESS 1 NI
Water Supply Well: • , ' , , .• . • • .
' . ,. . ,. ft. • ' ft. in. • • I _li
. ' DA.grieultural ' ' . -, 0Municipal/Publie -•• : •
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t in.
.I ' r f. I
: •OGeothermal(Beating/Cooling Supply) •-;:BResidential Water Supply(single) ft.
• .18;••GROUT•i,-.,1•:.1.,•:,::•.•:,:,:f.;.::::::0?':fi::?i':::'::: ::.:i:,?:'..:-i:i':':-:.::'::.I.-:::::'?;':::::.:::,:::rf,':....'.•,-..'..'... i
Olndustrial/Commercial • OResidential Water Supply(shared) -.F116 •• •...
... . ' .. ..II4.kif:it,1L F.MPLACFMENT METHOD&
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0Inigation . . , , 0 ft' 20 ft., Bentonite. • Pumped• , i
Non-Water Supply Well:: .
. It. - • ft. tap Top With Bentonite el-:•--s1
- 1.:3N4onitoring CIRecovery 1-- 1
Injection Well: . II. , ft. . ,
HAquifer Recharge OCiroundwater ReMediation -.:19,1SAND/GRAV..EL,PACK(if ilioliCable)..-1-- . --:.'..:..-1.......-,.....-•.t '
FROM TO - MATERIAL EMPLACEMENT i',i IniIC,..1
DAquifer Storage und Recovery - El Salinity Barrier • • ft. . ft.
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DAquifer Test- • '. ,.' ..:"OSuirmwater Drainage '' _ .•„ . ,
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.. . bExperirnental,TechnPlogy ' . . OSObsidence Control ------,
1.:2"1b.DIIILLINOittiG..."(affailihiddiiiiiiiiiilieetS.ftineceiiaiq•::;-:-1:s..f::;..1:-.,:-•
• •CIG9ollienrint(C.194:4--1;oop) ' - ' '- OTracer". • •,• , • : moat . To ,. DESCRIPTION(color hardness soil/rock tVt),2.
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•LiCiedtherin af(Heatidg/Coolinf!Return) . ' pOther(explain under#21 Remarks) 0 ' ft' 42 .';ft• - , _ • OVER BURDEN-
. .10-21-2024 . - • 42 - -fr. 455 ft. . .. . . GRANITE. .
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4.•Date Well(S)COMpletpd: • Well ID# , • . . , -- -1
' .ft. ' ft. : ' [7 - -:-- - --, -•-•••,•-. 1
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5a.Well Location: c.::..-:.(.„,,a,-..--1
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• James Harvey . -, - • ft. ft.
' NOV .o .8 2024
Facility/Owner Name Facility IDil(if applicable)
ft. ft
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32 JR Estates Dr., Candler :• • , ft.
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ft. . , .1 ,
. 11110:771:-.',In-:: ...),.-:.•-;.z.r-,,---7-;1.•IJI-A 1
. . • .1'.: . ... .., 1":3-.'.' 2'.2; - . -1
Physical Addiess..Citi,,and Zip ' '•" ' . .. :
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1.f.:211.R.EMARKS•:,', „:.:i.1i-1:-:-..-.•-•',1...-1..1::::.. i:::::.::ii:::.:-..,:----...:-1.:.•::::1;i:::,.,1).?...
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• •BLIDCDMDe • ..' .- .. ' . 960705122600000 ., . r Self Certify - • 1
toasty .. ,''• . ., .r ; : '' ' . • - .Pdrceildentificiaion No.(PIN) .. - --: " •. ,.: :..- - ,:, -,:,.1,,, •• .. '..', ,..e,':-1:.•'. . "• ' '____]
513.Latitude-andlangitude in degrees/minutes/seconds or.decimal degrees;. --....
h2..Ce. licatidn: A . . .: . •
(if.well field;cue Int/long is.sufficient) '- •: - : . , ,
f„.,. - k. ;476-_,c...-.6_,.',-/
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" - • . -. ' • 109-4-1094
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. . • ,. . Signluir7 of CertiTIM Well Contracto r ' Date .
6..1!;(are)the well(s): IPermanent or .0Temporary. .• . . •, ,. Be Signing this fin-rn,I hereby centry that the wellts1 was twe'el eon.orzule‘l in on,
...with:15.4 1,1C4C 02C.0100 or 15.4 1/( 1C OW.0200 Well Construction Standards and iiitrI If
7.Is this a repair to,an existing well: Dies or IDNo . copy at this recarrl has heck proric1c4a the well owner.
1/this is a ri pair.fill out loot it well construclion inthrmation and es:ilain the stature.,!(the , ,"!„.:;.;'•• •
repair under 1121 remarks section or on the hack ol this limn:. 23.Site'diagram or additional i411.details: . '" •
• -, , - ..• • ' •..: , .,. ,'., , • .1 ..• ... . •_.. ...:..•, :,- .. ....•• •• . .• •. ,.:You may.use,the hack of this page to provide additional welt site detail:,,ir:••••:11
8.Number of Wells constructed: : . • , . . consiniction details..You may alsOaftacti additional pages if nceessar,,.
' Or inaltiple(giallo);or 11017-water supply yvIls ONLY with the samcgonstruction.you can.-• ,.
sslant one form. 1 • . - ' . . • • . - ,. :•-- . • , ' SUBMITTAL INSTUCTIONS,''•..,- • • " .,....., ..; ,.,.: . _ ,
- • ' 455 " - ,-.. ' - • , - „ .„: •
9.Total well depth below land surface: _. (ft.) •24a. For All Wells: -Submit.this:form within '30-days Of complcion or.•..v.:..
• For onthip/e'wells lit ill depths if ilfthownt(example-1frt.200 and-24,10V) • -, ':, construction to the folltiwing: ,,•,.• ..,. - . r',-,•, y-' ,
1 O.Static water level below top of-casing: 60 • ' , ' (ft.). , , •Division of Water Resources Information Processing
//nyder level is above easing.use"!- .
.. „ 1617 Mail Service C.enter,Raleigh,NC 27699 1617
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II.Borehole diameter: 6.25 - (in.) . . ' " 24b.For Inlection Wells ONM-In addition to the limn to the adc.i....ss I::sendiri"t,
ROTARY • • 24a above, also submit a copy!of this.form within.30'days of coati-lei:on .,:"v-e.
, 12.Well construction method: • constniction to the following:, 1: 1
. (Lc.,a tiger.rotary.cable,direct push,etc.) ' , . ,. •. . • ; • •
. -• ... .. . - '' • . . • " . ' ''' "' . -.Division of Water Resources,Underground Injection Control Progrm a .
. . ,• , 'FOR WATER SUPPLY WELLS ONLY! : ' - , :.: ..-„ „, :. ' - - -- 1636 Mail Serviete Cente'r.Raleigh,NC 276994 63.6
' ' •.. - - ",-•,'''• --. :- '. -. ' • '- ' •' , :- -RIG • •-'-••" .." ,24c: W -•: .: ., ,1 ' Ilion Wells
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ter.Supply&Inje :' -' :'•,. -
13a 100Fora:•Yield(gpM) •• ..' • ' Method of test:, _ .. - ,• • :
.. , . Also submit One copy.of this!fonn within 30,days.of-dornpletion o
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- '• - '- : . -'' -'.''';'PILLS ' -'' - - ' 30 - ,well construction.to.the county health.department ot'the counts',-1-k.,i•c •
..- -1 .Disinfection,type; . • - - Amount: :
constructed. "•' - . ,-.1- •'. . .,, . ,, , ..,•, . . .
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FOrel OW-1 . . .-- North CaroliuuDepaMnent of Environment and Natural Resources-Division of Water!Resources ' ' '- . -. Res..a.:,:d.-,,u;::ist-':,i•',
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