GW1--06812_Well Construction - GW1_20241114

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VVELLeONSTIZUCTION.RECORD Fpi.Tricynall I.*00:
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This fcrrticatitiehsal foi.."OngR or nuthipk:tvglIS-..
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1.Well Oititiatok fiiforniatinti:
f.I4iliVATER•ZONES'. • • • '
Stefan Smith " :mom.- TO. . .. "0.E.St!'Din" itE.i" . . _ . '•
• " ' . '
. "%l'iil CDMMOX t.f"Mile ft, ' " ft; " 1 • - • .
3576A . rt.;
--,.15011TERZASINGlIoeiiiiiitigaliDyills)VKLINER"filiftlitittre -__.• -
' . NCArell•CcinthdOrCetfiftelitioitNindief • '
•FROM • , TO ' " 'DIAMETER' ' ItficKtotss.- MATERIAL •. ,
SAEDACCO - . . . ..".it. (t." . • 1 'In.
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f,blititasyllain0 - -4:19":"-INNERPASITMOIV,.. WW--i,itite"rtiti1itopell4odit) , • . ' ,
• . .PROM• . TO DIAMETER . TIIICKNESS• MATERIAL ! . ..
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4;. s.:4.%,..ullStrtit.tiiii Pefinis#:W10400630 .• ft. - - D. i -".iii, - - - - - - •
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piaIlOkiiimiii.r 1,001 poiiirli liio,..Coulty;Sfrge..:.Vorionrg,„Weaker;cfc.-) .
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'..'•i*e1/ie i lt... , Oteelt*eilsatiej.:: • , . ,17:,..SCRKENT: t.
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• • • Foot,. • •...TO . • tstA3tholst s LOT St7,E. TIIIERNMI ;MATERIAL . . •
' .Water Sip*Well::: •
• . iiAgfenittinit CigiPiclrialiPtthlie.. • . it. •.II
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ClGeotheunal(11eatingtocang•Stipply)• 13Residential Watet Supply(single) .' . ft.. AFC- -
Onidusttialfgoauitercial . • .
Witei (sliateil) '.12ROM'.- .TO. • • - - MATERIAL• EMPLACE'MN—Tr METHOD&..10101INT .
ClIrtiSation. . .. 14! ft.• '
l'i:tip.Water*triply Well:.
-;.- ' 0,... • -• .f.t, - . - .
diwenitnring- .. - ,•1:10c.cPWY • • - . .
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• IttleetionWeitr - ' - ' • • -11,. . - 11: •, • i . • . .. • . . •
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'. • El AntliferTe00yg 01Cirtituidatct•riOnidiiilliOtt It9VSAND/GICAVELI,P.ACkfilajtailiMitiiV— -
=:7,-1.....:,"..- "--•'-' '
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, PRONI• . .TO•• ." • .MA'rittuAt;. " .iPLA-mosNr mullion.
ElAijitifstSiOnge 4itiltY • ' ItiSidhilty ItaWiCr 11.-, . • ft:' I. • . - - - - • • .
. • Cl.aigititer Test. 1:11iimrivatct Ontittipgc.•• • .
'ft. . - ' it". . • -•- •
P4P-LiMcrt01 Ilich!Fit9ZY psosictcncop-.4Foi. . .. . _
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. „ flOAYR/ELINGIOGliiii2C1i3141iiiiiltiliiiiltilia' 1E1URCCS9/7;21•: -.7---- -...' •' -- -.-- ,
Itid.enthennal,Klosect Leap) Onager.. . %most• •70. DESCRIPTION Ioilor,hinSncti,valftilCts 171.1e.-Onin iate.ite.)
ClOtoiltentia1(tleathig/Cooline Return) : 131Oilier(explain under 421 Remains)• j . ft; 1.6., . .
it. . • it... .,
4.Date*!4*(g)co•DijOe-di,;•10-16-.24 .Well ling Pr 1 - IP-128
- 1ft, - i.t. • • I 5:1:.Well . ‘- 2
Lneittinti:. . - ft. . . ff.•. ,...,`it...“. . 4...,—,
Auddies #4" " 's • - •"" .11i• ' "" ft. ; •
Ficpity 11)4(ifapptiable) NOV1 - -112 • .• •.-
ft; • ; ' . . .
• 9105 Old Lexington Rd.:, Asheboro, NC, .27205 -' , " • .. 1.ft,..... • ... fi. U71
. ' ril-3*.TrA.'•.If::•,-71 I'--1,--5'..,;:".; :1 .•
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1104,71IA:.-00.is..cAlt-•104 0:. 7-i2IREMAIIKS!•!,
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Randolph " • , DPT. injection's
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Pateet lmattfiquoi No.(PIN) . . . .
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5 .1;.'iiiiiitte ati' ll-1.iiiiiltuile in tlegreeSiminittek/Setiiiilsiir.IteeintattliiiteSi• * • • • • :
.'22,Certifleationt - - • . '
(ttiell field OO liailei*.issaftlion) . 1*.- • •-*' ' ',' ' " " ' *- • • . . .
• . •-,N• . 10/23/2024
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Sistili *of C .chid Well Cohtiatiof. - - • 1:1*.
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6.Blake).the stell(s):;rtrentatten1 or grfetitttoraiy.: : • . " )
' .sfRibie ihislignN.1-liereby ecilift:Omit the iyelit)isi.e.r..(rkna!cTlytnreted in cilmixtazFe
with:1 f.et.NOC 02e..0101)on I U Mc d4C:q2C.426 il'ell Ciinstnicitoir Stahitartii and!isaTi
7 Is ifiiS iiI•kelf;iit:to ti..e:iiiitittit•Wellt PA* or W00., .colj.fr of this:recarri hax'Oili pOI-#1ded iiidie-'ilyllinOrer.
ill:his:4'o rilnifr.Ifill net ktnitotimil'ici-Olaiircdon.ifiloi-oiatioqeiy4'dyildly1:Or noryre.of rise . "•
repo;•knife'r#21..irinarkskkikniiii-on iho'bock..irthis foi•nr. .-23:Sittliagraiii Of additional 5iVell tletaits:
•Yon itiaY use the back of ibis page in:provide itdditipital Well site details or Well
8.Ninithekolwelli entiStriteted: 128 - . coitstmettaii•detgits irou.itialSOIlittaelutatiitiotil pages if necessaty.
For
iaknniiatornOd AiirprAa:a. lonof anti
-yther supply vflpRALY lath le Foconiructlog,yoglco-
' . . ' , . •SIRMITTA S.INSTJCTIO,N,.4 1,
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• 9.tidal IVelideliitehnviatiti.MITine9i 23 • ' 64 24a.-Par-All Wean'.'Stibiith IliS;fent A.,,iiiiii 30 days.0f:ctimplcihiti-cf-Well
.For 4.ivolkok weliflisroll itiVh.s.Oiffeielir-kAttn:Pfe,3€100,eta V'Pietrli '011struction to ilk':fttltovihg;-. I'
- •.• . Ip.$tAtic water level beluiv top of tasiiig: • • (PO tiiiihin of Water Rivkin rees,Inforniatina Pairesaing Unit,
, frimme loei.th,illtou.e cas(4:d.r-i.!i.-1-'.' I617:111ail•SiaI
rviee'Ciiiier,Ralcighi NC 276194617
11..Borehnle diameter:2.23" ..lin.) i413.-EDLidtx,dpp2010.4NLY: 'in addition to sanding ti, fomtite,,the.adcir III
24aI4hi'e, also salthil a copy of this.'faith! Withiti.10 dai*oleifittipletiein of well
- 112i-Well ctiostivction InettiOdt DPT tolistmettoii io the failosirtilv: 1 I '
(1.e,pigcr.reIta#,..entrle::ditett iosh.:gts} • . . . . . •,.
OivIkticiti•efArgter ii.qou meg,VII dergeotittd Injection ciantrOltilignun,
FOR WATERS,UPFLY-WELI,S.ON1.X:'' 1636 kat Serviceitentei-,Raleigh f NC 27699-1636
. . . 2,4e,Fot Witt&Supply&Injer.Iitici Wats:
1,4,14rit)(Ittint) '.‘ktilnii of telt:
Also Obiiiit otte.'ebieOf tiii •fiittit:WINO..30 ClaYS of eettuOletion of
13h.Iliiiitt:•eihni,typet. Aninitati • well.censituction Atn.the county health dcpaittnint of7 the county whett• '
. 'Consintry1
Fanti.GW71. NoSit CamIina Eklimusentof tocitompoit and N4fira!Aesoutees-Aivt;toe OFIVoter Et eatrc•m itcy.iscd Attgust...2tt1:t