GW1-2022-06727_Well Construction - GW1_20220628

WELL CONSTRE1MON RECORD Fo7111tcr�ualU-CONEY:
This fmin can two Ucd for siflgk or nlultipiz wells
1.Well Contractor Information:
14.OVATE R ZONFS
John Eisenman FROM TU nricnuTR1N
%V01 Corsletclor Kann It,
ft. ft.
44�9A
NC Rrcll Contractor Ccnifcatioratvturt4cr 15.OUTER CASING[for ma[tl euised wells OR_L (if a Eicable)
FROM. TO DrV%1F,TFR T Tit MATERIAL
SAEDACCO Inc 0 (L 107 (L 6 ill. SCH 40 PVC
C;turlp can:Nunis 16.INNER CASING OR TUBING ireathermal direr 400►)
N/A FROM I TO D-MMETER THICKNESS NIATERLJLL
2,Well conoruetion Per alit M, 0 ft, 112 ft, 2 "e SCH 4 0 PVC
Listi4A,: rirhie gvurro ids fi_r.:Carntr,:Shirr,I:]rinse•,Py-CiYCn r1.-.
ft., ft. inr
3.Well IBC(check Well Inc): 17.SCREEN
WaterSupph•Well., FROM 1 .70 0rA7k1F.T1;:R s1.OTS17T T711('KNF7lti' I HATF.RIA1,
0AgrkuMErat 0tMuni6pallf'ttbii6. � 112 Tt. 122 ft, 2 io' .010 SCH 40 � PVC
OGcotlwm)al(HeatingCo©ling Supply) OResidential Water Supph'(single) :in• `
©hldustrialfConmiercial DResidemial duster Supph'(shared) �u ROUT Tb. .IAT6ttGtL- i gatrui sr r-Nrl rrllori s.,uotiNT
❑Itn�aUnn 102 ff. 3 fi AquaGuard jTremmie
Non-Water Supply Well:
7h101 itoring 11111ccoven• 3 R.,. 0 fl Portland pour
injection Well: rt.- ft
Cl,�tjuifer R�4har,c i 1rJK)AJ d%%11u Rcincdiadoll 19.SAND'GRA'V EL CALK iif t tli<:tttk) ! .
❑AijoilT�r g4ai-AAciovcic El SOnity}3dinicr' 122 R•` 108 fi• SAND #2
❑Agiiifcr Test C15tcmtn;ltcr Drtitiagc
R:. It.
❑Eylerimental Tcchnolo y []Subsidence Caldml
20.DRILLING LOG tallaeb additional skdi it occessan')
OGi o icrinal(CjuSt'C Loop) OTracer :6ROr1.4 To DESCRIPTION rinAsr,lirrthm.v AIntek
❑Georlietltlal{HcatiuestCuolitipRcturn). E10dier(explain uihier#21 Retnad:s) 0 it- 33 (L Silt, sand and clay
_. 33 ft- 36 fL PWR
J.Dilte'WeR(s)iQ6ntilrLtrd:- 3-11-22 We11110 MW-37C Bedrock
36 122
5:1 Alrill Gtcatiuo ft: ft. _
Corning Incorporated N/A t4 fL ,
Facility)UwrvrNanae Facghy Mi(ifappJicablc)
.I l 1 N 9 Q?
3900 Electronics Drive Raleigh, NC ft. Ft.
Phy seal.kddress Gin'.grxl Zip 21.RKRI RI►S 1M.A r• r.
Wake County 1715781482 108-102ft. bentonite seal
S:<taiuh' Pare[]14011311 ditm liu.(PIN)
9it,"�tit"de all - oln�itpdc in detiFresiininutesl3ccnnils nr decimal ttcglrc5: 22 Certification.fiIIIIc11-t'a:1d,t5IW IA`1ul�isVCWJCLN11)
35.832589 - --`
N -78.604500 W -jam � 3/13/2022.
bt n5[arsi o "-s:* .1 .0, - - -Date
y
6.Is(arc),the.well(# xPrrntatrcnl or []Term orart' (rr
Br s7 Writ.•rh r r.r. cmnrlruetrd ir-nrcornunce•
u'irit f S+t NC.SC 03C•';='• i d:fE"r:Y:.L=.tt�P Ille;f C onsrrrai.ri yr Srrirkhrrds and 0pu s er
7.hithfsarepairtuanexistipawelli 98'e'si- or ❑No nfifri 0301Y.ht•14111111•i&Wrryi&l:; Bruner,
l/this iR r rr�tvr:frl,nr 7.4f?f u,u 10 elf:e6 raferi}r4 iirfnrtruu?a!fivd e'xplairi rbe rwiviee ofrhe
reprir�trder6+_1 nrnurkr.areltar.or wr the InxiL u(6is form. 23.Site diagr;rnr at additional well]Retails.You 11*3 nse ilic back of this page to ptovide additional web si[e details or well
8.Number of welb coustrttcted: 1 ccinsttuctiuta dctaits. S'vuaia)'also altaclt udtiitiUuat pagt b if incessari.
For 16i[1Ptr i,Zjerfinn er nroi-iritrrr,to frrO,routfs Oj LY wi i rfie carnet construction,9o1,car4
zuimrir caie jinn: S T 1MiTTA1:([11ST T :]TONS
9.Ttti:il ir'elt depth betmT littid surf tee: 122 (f j,) 2aa. For All Wellsf' Suhndl tI�is form within 30 dacs of compleliod,of svell
Fnr,ni7riplr i ctlrlistrritdcpr&5 r)tirJra'fC,l7{(•.YlRr1�7t{-7 :r7!T•cuu'la I0?'S' constmctianto.thc foltoltiina:
IU.Stab[water level below lop of rasing (ft.) Division of Water Resaukes,tntormation Pru esaing Unit.
ll nmrtf ktr! r rrJiur r ctisir4�,use_"+`' 161.7 Blum!Service Center,Raleigh,YC 2 7 699-1 6 17
I1.Borehole diameter.12/6 (itn) 24b.Fn o inn Well OivLY:, in addition to sending III,,form to!lie address in
24a*Ve'_als�3 submit a copy of this fans within 30 days of completion of%till
12.W01 construction method:HSA/Air 4 0115IIlICtInI6 LD[Its fctlla5l usL:'
fi.c.auger.rotas)',cable.dixcl push etc:l
Division of Water Resources,Underground,injection Control ProcrAnt,
FORAWATERSUPPLY WELLS ONLY: T636 Mail Service Center,Raleillh,NC 27699-I636
Hit.Yield(gpm) NIcthoil of test-- 24c.For Water Supply&injection Wells!
Also subrii[ one.Copy of this fnfnl within 30 days of-c mplelionof
13b.Disinfection type: Amount; !cell constmction to the county health dellannrnl or the colinh•lvisem
coFLstritctcd.
Fenn Gttr-1. \7onh Carolina Ex-p trsxtrt of Ern imtuncia and Nararal kesour;:es-Uri iMon of NVniof Rma r[, Res•ised:august_Ni 13
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