GW1-2022-04908_Well Construction - GW1_20220525

WELL CONSTRUCTION-RECORD FcrlrtcmAukoNLV:
This rornicanN owd ror`sing{cor inollink,wells
I.Well Contractor Inforfnationi
14.WATER ZONLS
John Eisenman FRONT TO ADESCRIrI ION
%VC11 Col-Actcoi Nam IT. ft.
4439A
NC\VcI1Co(rtrtctorCc(tific5liohNun'bcr iS.OUTER CASING froi�(nulikasrdxcRoOR LINER III tkrbk)
FRONT TD TI NIMR T1nCKN71111; MATERIAL
SAEDACCO Inc 0 it. 81 ft.. 6 in. SCH 40 PVC
Voigmny MOW 16.INNER CASING OR T UDING I irorleruoau cknc:d-roa-ji _
FRONT I TO I DL&N1ETFR TTIICAAESS NIATTRIAL
2.Wcll Construe ti an 1`0mit#s 0 ft. 91 rt.. 2 m SCH 40 PVC
ir`ir all�Iniirublr,:��lf prntzit{li_c.Cnunf}•;S:+r:r;1 nrimrce,Irya-Orn r)r.'.l
tt. f1, in.
X,Welt,USe'(chcd:ticllusc): 17.SCREEN
WatcrSupp{}Well: FRO FRONT 1 To DIANIETYR i SLOTSvs: TnuChNlls I VATt:R1.AL
OAeficulitiril UNfunicipal,I'ublic, 91 ff. ( 101 tt: 2 in .010 $CH 40 i PVC
Mot ber al-dicatinglCoolingSupply); 0Rcsidouial Water Supply tsingle) fL ' ft.
OlndustriallCo)nnicTcial C1Rssid:il[ial\3'atceSupply(shalzYl} 18.ROUT FRONT 1To. sraTERusI. EN1P1_10ENIENTN1ETItoulFAVmiNr
❑Im 'uion 84 -it. 0 tt. Portlatnd �Tremmie
Ngt1-Water Supply\Well: .
ft. ft.:
�MonitorinG l7ltccowry
Injection Well: ft. A.
DAquifcr Recharge E106undnater Rcui¢diation 19:SANDMILILVEL PACs:tit avidicablel
'NLl'lt;R1AI. t:N1 PI.A(3:N1i;NT Mtl'nOU
O,Agoifcr5orugc and Rccotcn ❑Safinit} Barrier. 101 (1., 88 it. SAND #2'
QAquifct-Tcst 0S1ormw-,ncr Druimjgg
ft. ft.
bExperimcntal Tcchnolog,'. 05absidcm:dCatlrtnl
20.DRILLING 1AC(attach additio),al tkccts rn if necan)
oQothenlwl(Clused Loop) OTrtcer FRONT 1.70 DFSCRII!nON lt.br.kanlnc.+:'r,iYn,cl.INrw.r-rain mtc 0c.)
❑Cii'OIhCI1l1aL(}LCam11alC6iina,Retum) (]Other(explain i nML-r P2l Remarks) ! 0 .fr.. 43 ft., silt :3and� clay
43 it. 1101 ft. rock
4.Date Wells)Completed: 2-22-22 Well iD#MW-33C
It. It.
Sa:.Wc11 Lt►catinti: (t. h: a PC
ft. ft. � - -•
FacilihrQtcncr�talnC Facility IDP(i f applimblc) h. ft. MAY
3900 Electronics Drive Raleigh, NC.Wake County 35.,
f In sianf Address:City.and Zip 21_RC 4V,RILLS
Hentonite seal from 88ft-84 '"d'r 1i MKT[k i`j`RO.-'jr�;gp,7 Ujqj i
01111111,• Mire]WnlifrcMionNo,(PIN)
Sb.Latitude auil Iaingitude in dcgrecslm nutcslscconds or decimal de1;TT CS: 22,CcriferaHiln:
(ft ell fold,wx I:1001ro is'tEMO-ra)
' - 2/22/2022
Dale
6.-li(are)themell(s) MPenmanent or c7Temlioran
By�igni.),a:hv lot.., rlp
Ir'i!AlS.•1:\'C.1CO:C•'�-+'�,j:•..�iCn'��.:C,U4,7)1'r'f1.Ct�ns+rr+rlitwSrrrrylurrfciinJrl�s).<(
7.Ls this a repair to an existing.h ell' O Ves-or: K No. rt)vr grrhi.r ri rv+nl tirir 1,rn f mr•irb r ro)ti.in 11+a,L•r,
1/1hls'it r replir;fill c.)r Ennis.)evil r crurnrr iron infoi N.fion end rrlilohr the ohmer of rite
rcrmirur, cr9'/nrnarkesraum or rvr r/n Lrrt r�lihis fnrnr .23.Site diagram or additional wdl tletaitY:.
You may.use Cite back of this{ragiito provide additioltiil\ti•ell site details or ta�ell
8.Number of ticlly eotulrurted 1 constriction details. You nlay.alxi atiach zdditioiml pabK if ntxessan:
Fgr ntidlil:le iigj ah.)n iir nrui»ucer n,nhly:.)'ells 0iVIA"witl,d same ci.))tstrurthm.Ytm can
submit rate fork.). S 1BhfInAt_.iNS1'LMONS_
9.Total nell depth fieloti'-landxirface• 101 (ft,) 24a.,-For All Wells:. Sublidl this form within 30 days of contplctiogof Shell
For m:rhlpfewrllsli.srrlldephrfldifleri-mr carerple.3C, tP)'wP.l2@1041•) copstn)ction,(atltc'folloti►ingi
I0.Static=,vale.)Icrelbeloly tap of rnsing.: (fL) Division of Water Re.s'aurces,Information Processing.Unit,
)f+ru:ri(reel iy 1617 Mail Service 6ritcr.Ralcigh,NC 276994617
11.Borehole diameter 12/6 (►a) tab.Fnr folectinn.NVON ONLY' in addition to sending the form to ilia addiw in
24a above..also subunit a copy of this.fbitu within.zo days' of completion.of well
12.W01 construction method:BSA/Air roust d ; ig.
(I.e.auger.ro!*,cable.direct pusli c(c.)
Division of Water Resources.Underground injection Contri l Program,
FOR WKYER SUPPLY NNIELLS.ONLY: 1636 MAI Service(:enter.Raleigh.NC 27699.1636
24r.
I3a Yield(fipnr) Method of,tcst For�'i atcr Supply.47nlcrtiam 11'd15:
Also submit one copy of This form ►lithiu,.0 daysofcompletionof
331b.UisinfiYt{ou type;. Amount: well constn Ilion to ilic county I>calth depanmcnt or the countywhere
cottstlicicd,.
Fanti G%V•, Non11 Carolina Dcpanarnt of Enciromom and;vaturd Resources-Division of\\'atcrR( otrcll- devised:l(rgtw._KI LT