GW1-2022-04906_Well Construction - GW1_20220525

WELL CONSTROC"i m.RECORD For lracmal Use ONLY:
This foa((can be used for singlo or multiple sails'
i s We11 Cut trtt:tor Information:
ld.H'A'TER'LONtS
John Eiserunan FROM TO DrSCRIP110N
4439A ft. ft.
NC Wcli Contrrftor CcniGcation Nn(r6cr i5,OUTER CASING(for arulikased rvcgs)OR LiNER tifatinlica
FROST I To titvarTrm Tr11CKSF.S4 MATERIAL
3AEDACCO Inc 0 fl.. 100 ft. 6 ia. SCH 40 PVC
Canupomj°N:+rnr _16.1NNER_C_ASING OR I MING 1 goFl�a:rn+al cknrd400 e
FROM TO DUAtETVR TIIiCK.ECS I MATERM
?.\Yell Constrttctioti Permit#: 0 R. 112 n. 2 -ia- SCH 40 PVC
i i,i uP nlry+Ilcshhc tirlf prrmitt(i.r.f OunR.Slryh•,Vuriurrcr.Iry crl rn':i "�
ft. fQ in.
3.\1'01,1316c{chat:well use): 17.SCREEN
WaterSupply�Well: FRusi I nr' nualxTr:R: st.orsuzs TRUK�Fas I.HATERI�I.
❑Aftiicult6tal 11vlunicipaVT'u16iic 112 ft. ! 122 h. 2 i" 010 SCS 40 PVC
D-Gcotttcmial(IleatinlgCooling Supply) ❑Residential Water Suppl)'(single) fl. rt..
dhrdustrialfConmicrcial C1Rcsidcntial Water Supply(slued") 18,ROAN To MATERL►1: l E%1M%CESIENT 1M THOD&AMOUNT
131riielttion 106 ft. 0 ft. Portland lTremmie
Non-Water.Supoly\Nell:
ft. it.
Qi Mbni(Sring ORecnvcry
lnjecUun\Yetl: fl. rr.
❑Aquifer Recharge E1Gipnridi aicr itcowdiation 19.SANDIGRAVEL PACK(if J dnubtc)
t'ROS1- '1 Ct- 1 MAT RRLSI. ' ES1rL�(:1:V ENT HF=rR(ln
❑Aquifer Siorigoard Recovery 0-Salinity Barrier. 122 fr.-1 110 ff. SAND #2
❑AgitifcrTO OStormnatcrDmin gg
It. ft.
❑E Vcrimcntal Technology uSubsidcax Control-
20.DRILLING LAG la(lach additional slu'tls if nmrs"n l
1313 olliennal(Closed Loop) 'Mri= FROM TO OFSCRII110\fcubr.6an/orN.>,dl'rnrMh .^ems n wr.<sal
❑GLothenrtal(NcatinelCooling Return) ❑Other(explain un&4 921 Retnaria) 0 A. 39 n. soil
39 ft; 142 ft. pwr
4.Dete Wcll(s)Gomplctcd: 2-22-22 Well ID#MW-39A 42 rt 122 ft. rock
ia.Well Location:- ft.. ft.
ft. rr: /t�/_
FacililyOrercrNnmc Facilti}'1D {iEappliablc) 11.- fl. MHI 2 5_?02�
3900 Electronics Drive Raleigh, NC Wake.County 35., ft, fl. i3 <� q-rry
Ph}'sical r 44.ss.Cite-and Zip 21.REMARKS
aBentonite seal from 110-10i6�.a color jc i r1 L(Ji::r9'3Ulll
('onny Farrel id2nlifre.7lioir No.(PIN) I
5h.Latitude and,1.6nfiitude in dcgrreslminutcslsccrimis nr.decimal(Icgrccs: 22 CcrtitecaHun:
(irmell rod,oi►L•t0nrkt i s(rllici:nl}
2/22/2022
SICL17ltnC Of 4•: ( !n? ! - DaIC
6.is(•are)(hewell(a): XPernanenl or. oTlmporary- 1A.srgni,i (cr..`f='iIC:• fir( J f'�'Y ..�.^� �%.vr�rruc7cxlurcc'rarrdiaic'r
srir4 l frt A'G(C 0?C.±;�,<'�=-1 i�Crt�.i:a..0:0!1 1{i'f!Cons(rrrtrion Srruatarrfs urr<f tls.0 ei
7.Lcthilsarepairtoancdatingwell: rOVes or MNo.- ft1+yofrhls.rergnllroshc.'nphzrli•drn;i5eei11r.Rnrr.
if rhos'i a iep dr,fill twi;e`.rralsr(writ consinwfion lnforourrlon oral explah thenarure r f rhr
repair urrJrr#21 remur&s sec iian or ran the bark of this frmn• 23.She diagram or additional well details:
You wav'use"live,00,of this page to ptovideaddilional%veil site details-or well
S.Number of wells constructed: 1 dmsttuct on details: You nua�'also attadtad(titintl rl p r�n5 if uL�essan.
For nruliirle hVealan or am-u:iter rup1dr�rrlL:U��'!1'nnrli rkr some cnnsrn(diM.y'OJA Cun -
submlt our hrmi: SUiIMITTAI,.INSTLICTiONS
9.Total it'dldepth below'land surface. 122 ((t,) 2la.Fur all.11'dls: Submit this Yonn within 311 does of completion of well
For)Riihipfe hells liar fit;derihs If 4ihi'nmr(rri rr pf<-T�•:00"<uul2�!(k�} construction to the following:.
10.Static water level below top of Casing: oft.) Dir'isiun.of Water_Resources,lnfornation Proccssim,Unit.
if+roar lrvel tv gbore caw ;o m"+' 1617 Mail Service Center.Ralciglu;NC 27699-1617'
11.Borcdolc dNmctci l2/6 (in) 24b.Fnr:inicctinn Well ONLY:, In addition to sendipg:tlk,font_to thesddress in
24aabove also sub-flit a-copy of this form within M days of completion of well
I2.Well construction metliod: BSA/Air construction to llw folio%%ine:
(i.o.aupm ratan'.cable:dircct'irostL c(o.l
Division of Water Reroutes.Uridergrilund inJeclion Control Program,
FOR-WATER SUPPLY WELLS ONLY: 1636 Atail Service Center,Ralci;h.NC 2 7699-1636
24e For Water Supply,eS inireti(in Wells:
13a,field ftm) Method of test:
Also sublilii.one c0v of-this foini,within.3o days of Completion of
13b.Disinfitition tv e: Amount- _ well construction to the county Health-depannicnt of the county-whcre
construved,
Form GW-1 Nonh Carolina N-pamncnr of Enviromn:(o and Narucrl Resources-Dicsion of Waia Rsnotrcm itevised AuguA_1013