GW1-2022-06731_Well Construction - GW1_20220628

WELL CONS`rRUC CON RECORD
For Inirnutl tJsc�ONLY:
This Fonn can ba im&d FbT Muela cr maltipk wdis.
I.R'cllC ntr trtor Infortnation:
t�.tYATEit xt7N ES
John Eisenman FRONT _ r[7 DFS['attPnt)�
wptl l'.ararlctor t-anrg.
rt. rt.
4439A
NC�Fcll Cbntrtl ia`r Ccrliftcatiall Niuiiicr 15.OUTER CASING frnr mitIll-6ard We1153 OR LIIYER lif a tkabkl
FROM. TO Dr.�titurm Tit NTATERTAL
SAEDACCO Inc 0 ft.. 81 (L 6 11L SCH 40 PVC
(`nns71:ug�[vanu Id.INNER CASING OR 771BING' eothermal eWsed-loo 1
FRONT TO DULUETER. I THICKNESS. I 31ATERTAL
2,tit clI Can 6t;tinn PciTllit lr: N/A 0 R. 91 ft. 2 SCH 40 PVC
iistOR an plicuble Isc,'l primitr,(L%Coarnh•.Slate.1.-aviarrx•Ital3��,r.c)
fi
3,R'cll,[6sc{chCcl:Nrcl1 U5C): I�.SCREEN,... - - 'FRONT. Df.-L1rF.TF:R ".OT$i7i Tltl('K\FlS' J.NIATFRIAL
«Ater'Supple Well:- g1 "ft: 101 :f6. 2 an O10 SCH 40 PVC
Cl agrkultit W 0hltinieipa-DPW.ic.
Mothennal(HeadngXooling Supply) Olke idential Vater S.iipp y(single) ri• ft ia•
❑IDdustfialrConuticrcial OResidential water Supply(shated) 18.GROUT"
'.FRONT --TO. DTATERLAL E.lIPL10ENTENT.1ilMOD&ANIOUNT-
OTriia'tion 84 ft.. 0 fL Portland Tremmie
Non-Water 5uliply Well:
®hlopitoring. ORcco1-cry .
Injection�Y�tt: � ri:
PAgli'Ifcr Rcchars;c C]Groundwnlcr R0ni'CdiW,10 dtia:me)
14.SAND1t:ItAYEL PACK 1if
- - i4'RI)717, '11) '1LiTF,RLrt1. VNIPLAO-AWNT hltiTHOn
❑AtjtiifcrSEoTgc-a><1ltcc�a�vy 17Sa11nin li�ii ct - 101 ft.: 8i3 N: SAND' 42
❑AquiferTesi ❑5Imw%,atcrDr,#n,�i�,c:
�Eetimcnl�l Ttchnii[cln OStrbsiticncc Cnlitml
20.'DRILLING LOG f attach additional sbedi if mcssmt
❑Gebiltemiul.(C-I etiLam)) ElTracer _FRONT. TD DFsSCRIPT7Ur(tivbr,hlrtld�ci,p,dpi+KkA ainvre.i#.l
❑crooiltemlat(HeaunLp?GnoliueRetum) ❑Oil►erler'p 0 ft., 45 (t ISaprolite / PWR
45 ft. 101 (L Bedrock t,
# Date W►:11(s?Contplgcil: 2-22-22 Well ID#- MW-33C ft:
J
Corning Incorporated N/A
ri; rt:
FaciTil}r�iAn cT1usl Eacilit?'ID (ilsppllxibls) :ft.: ft. Irj' " " " ' "� ;tng Ufli:
3900 Electronics Drive - Raleigh, NC ft...ft.
PtnsT^it1 adde71.Citj nttd Zip 21.REM11ARt..
Wake County 1715781482 Bentonite .seal from 84 to 88ft.
(11111ty" _(PL1l)
5h.T atttudc and l ongifiidc to i1c�IreslmirutcstsanndSor dcctm Ililttxs: 22;i'ettificadoei:
(tf atoll!x•Id,Cie!:I:tt'1uu�-1v Sacf 1iCi�ul} •
35.832589 78.604500 % ==l =__ - 2/22/2022
Slgrtatcilr ury 7 ti:v,e _ _ Daw
6.Is(ar).the well(s) �":: ati or ❑MPerinent Teniporati'
J74 57s1171,}.a1�2T 1+4•a,Y Lf .!r,� J n,.s_I�Xie)tvradnrCiei/rlr rrctiardtrnce
liita}JSA,VCfLG P:TL'.'x-� l' t.k� ,at•(7�(!�a Hr11 err±tsdizntiar Ctcarktrrr�'sernd;rlkitci
r Ls.th�5atYttair to an.e istiltl;�velli. Z ix ,Dr 1ffi iVo ' {Rr71.(If(Ilai'f(Ci/fr�laa4' •Pal(Ja17arl/�rA'JIH 111111'lll'IIPP,
i#xbis.jx ra d!e narare Gf the
rrpairirarler 5e2i-rrrrrurks.+i:�7rara er-rui tL4 bri�.af PPrn frariir. .23.Site dliiigraiiro additional%:e dletail%,
You-II ay-use._"e bac*o This path•to:pro�ide sddllitina!it'el1 site dl tails.or ti°zll
S.'Icnttillerd5f.ificlls tl)1LlttIlCleil 1 c6nstm:[iai►rte[aits. 5'ou:illar a1sa::dUaclrudtfitiottal p1S s if ilei essan'.
pore nlpl4y at lfs ONLY i lj rfie.sa wie coifstrMlrur,,
rad}anitas»e farv?. SCTRNIITTrfiL.'INST[TGTTONS;
9.Tfi4ul Fell dell!!!be1413'i:ittil3tlrfa (; 101 (R,) 2aa.. For All %'claw: . Snhndl this fnrni iviibi€i M dot Ls' of caniptetidiri oP rwell
Fcwfnarl ple1+'ells'lisr'nf!ne rdslXdl evtni{exaaaal?lc-,i ?I30'eaud2 !fdkl'}' Con5tltcti0n(�thefi�llohIn�:..
10.Static water level belo,w lop of rasing: _ (ft.) Dii•isiun of Wa C:
tcr Resoprceit,hilbrmatipn,-Prucessing Unti,
17
if uw;er h adJ L ullradc ctiisiaav use"+" 16 Nlail.Service etiter,Raleighi.NC 27699-1617
11.13orebole diameter.12/6 (in) '.a6. ONLY: In addition to sending Qk foinl to ilia address in
242fabore. also submit a copy of this flail withilt ',d dal;s of t nipletion of hell.
12,-Well(x►Rstritctl4tr InCt114d' HSA/Air. COIlStmt tioii E0[Ite f0HoA''1ll2:
(I.c.im.- missy,cable:ducat pusil,cdc.l
Division of Water Resources,Vnderground i4palon Gontivii Prograltl,
FOR WATER SUPPLY WELLS ONLY' i636 Ali fit Seffice'Center.Raleigh.:NC 27699-1636
13a Yield(gpm). hlctltod of tc5t' 2'le-For Abater Supply&injection Wells:
Also Submit One. cope of this fon i c f.il within 30 days o
lab.Disinfection tnpc: Amount• well,constniction Ed the county hcalth dlepanmenf or the county•whcM
conslnlctsd-
Pan,,G4d-t Nonh Carulura M-p rnn=t of Em it artnienl Uixision of%Vnicr Rf---mro-- Pwised:fig-Zia 1:1
I