GW1-2021-02749_Well Construction - GW1_20210404

WELL CONSTRUCTION RECORD (�� Fwlatemalvsct7Nly:
TM rumcain be oscd.for SIPgkor mwtmk rstns
1.Wdl Contractor information:
Jk ot ZoNts
Stefan Smith FROM pRSCRIF 101s,
Well contmotar Name fl. A.
3576A 1 fl
NC Wdl Cotmactor Ceniflcalion Nufter `S.OtTi`3?R CAX-SN G or fl3 rfsed:` ns OTt:1 R Rcab
FROM TO nIAMEM TrriCK-,VF88 I MATERIAL
SAEDACCO Inc 0 (L S. fL 2- lih SCH-40 PVC
FROM TO ILMP �
RNIfKilt}'It�Btflt
k nrlarss MATERIAL
2.Well Construction Permit# ft. It. 6t
List all opptirwUr writ permits ti r.Crnrnty.Stale.Lnrinrctr.11 ectivi rtr.)
3.Well Use(ebfleir weli lose); 17 5
iVacerSupi(tI Well: FROM TO 01AttsT111t ft0t8tV. Tfli(KM)Ss MATIMIAL
DAgxitlhTal ommlicipaymttblic 8' R• is, ft, 2- ta. .010 SCE-40 PVC
❑treot M=](tieatingtooling Supply) olkesidential Water snpply(single)
01ndustt al[Cornrmcdal DResidentiai Water Sttppty(simred) t9 QROt1T
FRO\t. 1]TO ATBRUL 1?RiFLACTMtL\'T On AM OVA
T
Ohri" ilou 0 ft: 4' ft Portland Pour
Non-Water Supply Well:
�Monitori ORtxtn
0 jectiotr well: fl. fm.
DAquiferltcchrirge QGimmdnmerRemediation tD St11HU rE 1"X f
PROM _ TK If rxP1,Aft liih9•M. 1 n
QAgaificrStorngc and Rcco%iely' OStilinity8amcr TQ W A
6' ft. 18' ft. Sand 2
0AquiferTtst astormmittcr D=inagc
0EVcrimcnindT=hwUW QStlbsidcnccCar#ml
� .DRn.�rr��;o�-�it.tl�:,iaaiti�,►,sts�f.��. ;
17Geothermal(Closed Loop) 07mcer FROM TO 0FAC.iVTIONt Ow.bitto tostrocR 0 0 r.mm-etreM
OGeothetmal(HeatitOCooling Retumn) OOtber(agilain under#21 Rentaft) o ft. 7, ft. Sand
7' fl. 11' fl, Clayey; sand a*
4.Date Well(s)Completed: 4-4-21 We117ANMN4 11' ft. 14' ft, Cemented Cemented sandy ,�,,7�•
Sa We"L(rcathm; 14' fL 18' (L Sandy silt
Former Circle R ft. rt. �r i
Fssitil}l ncrName Facility Wit(if app1juble) fl. fl, s,rCw Jy�ICti j , 'll
3000 Jefferson Davis Hwy, Sanford, NC, 27332 ft. ft
Frh}8ictii Addles,City,and Zip 2t.RCAi,a
Lee 2 foot bentonite seal from 4 to 6 feet.
Comsat Pateet Wtn rkwion'No,(1111N)
5b.latitude and Longitude in degrcicslmim iteslsceonds or decimal degrees: 'cation:Certift
(Ih,etl fletd;olrc t.•uttant is sidlltieta)
35.416309 N 79.229393 iy m. 3/19/2021
&;r-c�t—waLactor Dare
6.19(are)the wdl(): . Pett»anetn Or t7Temporar}' lis signlag Chit fame,I Newby tyro rha►the wrlkt)a»:twine)wnurtwed in awomm cr
WO 15A NCAC 02C.4100 or 15A NCAC IIZC.t?dtill Well Comstrwrim Stnadmds and Aat a
7.Is tbhr a repair town existing well: oVics or M ofrht.rr.nrrlturs o pror&lvt u,rl�»Fltrntnrr.
tf dtls Is ra reprdr.fill Mr k0twil urll c otwmaioa kVbaa orW and rxpfaM rbe narore of*
*
rryu r nam?rr#?1 mnarks ,»or.aa r1,c hart aJl rrh,.at 23.Site diagram or additional wel('detalls:
You may use the bark of this page to provide additional well site details or well
8.A'um>)crof rr ells oottstrrmcted: 1 consmction details, You may also atach additional pages if neces aty.
For or m�a ldpTe Injervkvt air arm-auger sWph writ ONITvit t do water eonsftelkal.vat can zt71t11t17't AL iNCfif1CT'IONC
9.Total well depth below land surfaee: 18 (�) 24a. Phr All Wells: Submit this fodn within 30 days of oomptetion of well
For d(lalple Wilt list ofi depAy(f d*rrat(eum)ofa-3ks2Dl o ad 2CRJWj c4mstnlction to the totlor'itw;
10.Statie+r°ater Intl helot+ton of casing: 7 _--_-- -__ (R,) Division of Water Resources,Information Processing unit,
if anarr lerN is obwr ttit(na,we"+" 1617 Mail Service Center,Raltigh.NC 27699-1617
11.Borehole diameter:8.25" (in.) 24b.For jn ftd &elic 0Nt LV: In addition to sending rite form to tale xdress in
24a above, also submit a copy of this Moral n."thin 30 days of completion of reell
12.We l,constmeflon method:HSA construction to the following:
(Le.sager.mutt',cable.din d posti,etc.)
Division of Water Resources,Dndergmund Injec to i Control Program,
FOR WATER SUPPLY WELLS ONLY 1636 MAH Service Center,Ralclgh,NC 276994636
13a.Vidd(Rpm) Alethod of test: 24c.For WitterSaUlr&Imeetlon+Ni'ells:
Also submit one cop),of this form within;ill days of completion of
13b.blsinfatian ty p>~ Amount- constnuction to the cormty hc mt.rillh dgmdm: of the comity where
constnict©d.
Farm G%Xf-t Nonb taetelm Delimtriml of Emitaiuizat and Nanoal Rcsomas-D'hiden of Ulster Revirm Rsi-Lscd August 2013