GW1-2022-04893_Well Construction - GW1_20220525

WELL CONSTRucr N RECORD For ImmilUscONLY-
fhb fowl can tom,.us:d for sing la or mtdtipk%%ells,
L R'ell Contractor Infomlaiion:
14.N'ATER'LONES
John Eisenman ►Host To DF-SCRIPTION
«'ell Ctil%iaciar Nan><; ft. f6 �
4439A
NC Well ContiacrarCeniftcatioti Nutrber 15.OUTER CASING fror multi-eased a'eRsl OR LINER(if oontk2bk)
FROM I To I nIA11ETIiR- I THICKNESS MATFRtAI.
SAEDACCO Inc IL {a.
(:ar)T,:uii'-N rn,c 16.INNER CASING OR I BIND,( yaibene2l etuud4w
FROM TO I DWIFTER. THICKNESS \IATLMI.
2.�VdI Construction Pcr mit k: 0 �f'
40 ft. 2 qI SCH 40 PVC
Ulf allam lirable 1se11 plemrils(i e.Count..Slate.Variamr;fryectim ela) 0.
3:Well lise.(check well a.sc): 17.SCRECN
Water Supply Wilt FRO1t.. t-TO DIANF:n:17. SLOTSIrs: KS T11IC SS 1 'MATF:RI,u:
40 ft: 50 -fl. 1 2 i^ . .010 SCR 40 PVC
Lli1SIi tiltura! C1lvfunicipallhiblic
.DGcotherntal(HcatingrCoolintg.Suppt%,) OResidentialWiter$uppl}'(single) I
©hidustrial/Conimercial C)Rcsidcntial WaterSttpply(shard) iA GROUT
.FROM TO MATERLIL" -CdlPL\CF.VC\T\fETFI01).fA�tOI;�T.
❑Inicntion 34 ft. 0 ft. Portlamd Pour
hou-�Vatcr Supply Well:
mmoliiio'dng 011ccosery
Injection-�4'dl: ((. n..
❑Aquifer Rccharrgc 136roundwatcr Renicdiation 19.SANDIGRAVEL pAcK tie i4iliumblul
FRom in MATERIAL "IPJACF\IENT METHOD
❑AquifuSioragc and Rccovrty OSalinity H:irrici 50 A. 38 - SAND (#2
13 Arild fcrTcst lisiormMatcrDriinage
ff. ft.
❑Ex?crimcniafTechnology Mubsidcrwc Colttro! .o,DRILLING LOG(attach additional ntrcHs it ncccscan)
❑GLodi uiul(Closed Loop) FROM TO DESCRIr'r)ON leebr,asranc�,,wn`nx 41, tin.ifc.ilel
17CIeotlklttlal(dealing-Coolirr@Return) OOdkr,(te lainuiidcrP21Rematis) 0 (1. 50 ft. SANDY CLAY Prf:^-
(t. ifs^) �
4.Date Well(s)Compleftd: Well 1I)MMW-34A
(t. y 2 5 ?
Sa:Nri.�lt Ll►cutioot (t. it.
if.
Facilii),Ch1n rNnmc Facility IDn(ifappliablc) fl. ! ft. r a�rt�.•t'r�l +�vl�
3900.Electronics Drive Raleigh, NC Wake County.35., ft. tL
Ph}sical Addivss City.and Zip RE111AR!(5
Bentonite seal from 38-34ft
Canals i'A¢e1ld:urikAionNo.(M)
51).Catitudc and l.ungitntle in dcgrres/minute.sAccomisor.decimal degrees: 22.Certification:
(iracQ fkW,on:lat long k fldlicktd)
3/20/2022
Sigu)tuteaf r :emu Y.t,� ld .,.f — Datc
l
6.Is(am)the sells: XPennunent or- ElTcnr torah' � `Jvr. !• ; -,ssr'!rrGtieid {
7 O I H)•argnti,;;rFii(war. r• +af+•!. , r r.:E':••).vm7fuctcd in ui:•run.dncr
)6A 1 SA NGIC O'C- '-;u C,0:nO Iveif Coiis fr.ii rlNt Sraalar is toId Tbaf a
7:Is this a repair to an existing wellf oVeS. or 0No' rtry,p of rhk rcronl bisla•en pi!wided ro ih.lirll em-ner.
If M6 is o re lmir,fill(xtr kineert i e 11(-",;1,ln,71oa btfore.-Wrinn wul expleim themirure of rhr
re{nrir under 521 remaiks:+eettarroran the back argils form 23.Site dingram"or additional w`elil details:
You may,usc.ilk_back of thus page to ptot'ide additiord!n'ell site details or well
S.Nutuber of wells constructed• 1 colisti action del aits:;You ulay also attach additional pages if nLt Mary.
For findriple brJewhin of am-uvjrer tt,pfl%Welb ONM*b•if/I fir wmrc tonarrueBa,t.sort cart
sabnit�nrjorr,. SUIDMITTAL iNSTUCTIONS
9.Total well delidt below land stlrfucc. 50 (ft,) 24a For All Wd1s Subritil thili fdr n-srithiti 30 days of completion of hell
For n+alsiple wells list aft depil S if dil"renl(e;r(iinpr(e.3@201)'1111120,10)) construction to.the follotsing9
lO.Static water ICfeI belD{r'tap of casing: (fL) DiviAuu of Water RestiurcesJulurmntinn PraCessineg,Unit,
fJrvtler level es aburr msirig;0-ye"+" 1617 Mail Service Center{Raleigh.N(:'27691 1617
11.BoreboW diameter.8 (in) tab.For lnlcetit,rr-JI&lls ONLY-.' in addition to sending the forul to the address in
24n above. also submit a copy, &this form within 3O days of completion of[tell
12.«'ell eoustntction method: BSA construction to Alt follolsine:
(i.e.,auger.rosary,cable.dirrcrpush.etc.)
Df)iodon of Wutcr Rcsou recs,Underground Injection Control Program;
FOR WATER SUPPLY WBLLS ONLY: 163E Mail Ser)'ice Center.Raleigh,NC 27699-1636
l3a Yield(gpm
tic.For Water Supply&injection Wells
-
Also) MOOR!of tes .11so submit oIve-•cepy of this form within ;o daysof completion af`
13b,disinfection type: Amount ss-ell construction to the county' l)^atth department of thc:county w•la.re-
coasimcmd.
Form GW-1 Nonh Carolina DcNamem of Env irommu 5ttd NawraJ Resources—Division of Water Rratrtzz Rcs ucd August_013