GW1-2021-00488_Well Construction - GW1_20210210

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NN ELL CO'N'STRCCTION RECORD (GN4-1) r-i,te-coal tine only
I.Nell Contractor Information: L_
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Joseph Bailey —MOrERroNEa
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B & K Well Drilling Inc ERo I UI NET ER TI1 1r h Vt SS +IaTEm>L—�
— "l 1 10 s Zia �SDR 21 PVC
pzm.Vemc �/^ 16fNNER G\SING0RTLBLNG(g1 hermaldosed-loapl
l•// rR0+1 TO DIaNETtN _TIiICR\FJS _%IATERI L
\fell Construction Vermit= _ R R.
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3 Rell Lse(check well use): ----
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1KaterJppllsNl1: IRml_fro DiAslerin stirslze_4nncR flss Ti. TeRIAL
4 r ulmr I n u 'Pub c R II.
othan 1He _C. _ spp:.) r[a lk 1 Supph 1 I_ t1. n.� - _ -
L .0 Ynal Camt :ei Rrti,l Al Supply E e IS GROLT _
LAA A. JJIJGPE) FRO+I TO +1 QERILL_E)IYL+CE+tE+T+tETNOD4 NWL>T
Ir Ieanon PP
-�, Q 20 a. Bentonite Pour
Non Warer Su h N'eli: -- -- i
_M"ri,rmg I.6cccaer:
njecoon Nell:
4gmrer rt'- = t c._�at N nedlalloc 195AND'(r][I PACK dfapocable) —
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-:Erperim 1111echr.nleE+ L �- S'.en: /=mvol
GeodlerDa IC ose¢Ltiopl Trace. 20.DRILLINGLOC latta:b addin sel he�s`1
I FRUV TO DESCRI TI N nlor I tl o 1 cock nR e1d
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J.Date Nelh,)Completed AAell Mt: _— �ft. I 0 ft.
u. rt. //W✓ 104/�7 S�
5a Nell1 Location
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odd ss.Ct, and d.p 21 REM.RKS
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gib.Latitude and longitude in degrees;minuteaeconds nr decimal
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6. Is1an•.l the welpn: rmanem or Clemporan
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-.Is this a repair to an e¢isting well: _Aes or �
and s n_ ,,.n,no . 1i _ � _ 13.Site diagram o,additional well details:
S.For Geoprobe/DPI or Closed-Loop Geothermal F ells ha'•mu the scone Yo may use the ba k of dds p ,;c h.proeide add nonal well co rmaion info
mslrvclion.on D: IGAlI ceded. In dlcalc T Of AL N[JAfBER of u ells dd'See Oser'nIR larks BosiA'ou macalso ttach additional pa tiifnecessary.
"1J SUBMITTAL INSTRUCTIONS
9.Total well depth beloD land surface IffI Submit this G\\ I within 90 class tit Nell completion per the foliose+g:
1.
�dnpl 1.n:rcnlerr _�_� »l
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343 Fnr, All Neils O �mai t col to D,,is,l,r, of Alacr R sou ra (DWR).
10.Ste tic wa ter lesel below top ofcasing: 40 _ _Ift.1 Irt"Inaoon PTocessl Unit 'VISC.Raleigh.NC-7699-161'
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6 1/18 lib Fnr miecnp \k n e�p o\\R uR+ .roved lnleaion COnlrtil ttLc1
II Borehole of am el,r: Iin.l po a 1635Nf]C Ra,. n_�( ac 'l.:3b
12t Nell construction method Air Rotary- — __4,.For\tiater Supply and Open Loo Geothermal Return N ells: l:tips 10 Ih:
c. o cab L.der r csP.uc) ooumy environmental heallh cep '[clam of the,Inlr y where installed
FOR W�ATFR SLPPLM'WELLS ONLY: '_ld.For Water Nells producing user 100,000 GPD: t op) IO Du'R_CCPCUA
� Air Lift Perna Proelam,1611 MSC.Rlll I'll_�i__76e9_loi I
13a.Nield jgpml Method of test
Chloe. Tabs 1 1/2 Lb�
136.Disinfection hire: :\mount:
-tin 'WataPC-o Rc' .ad h rr301?
Po:m GW-I ticr.'n Ca'-. D Pannianl t e. �_,. l „1 na m