GW1-2022-06741_Well Construction - GW1_20220628

WELL CONSTRUCTION (RECORD Far hlantalLrsc.ONLY:
This form can b.used for single or multiple.)'ells
1.Well Contractor Information:
14.1VATER ZONES
John Eisenman FROM it) OF:S('RIPTION
1Vcll Corartclor Name
4439A
NC Well Cuntriclor Ccnifn,th an Nrtnbcr t5.OUTER CASING(for laulii-cawd ncflst OR LINER tit a Rcabk
FRONI TO OLANfETFR I Ttil"NESS MATERIAL
SAEDACCO Inc 0 fL 64 ft. 6 ie. I CH 40 PVC
Varnpuuti lvarttc 16.INNER CASING OR TUBING fReatherinal closed-0loo i
FRONT I TO I M&NIFTER 111ICICNESS I NIATERL'kL
2.«'ell Construction PCrnTit N: N/A 0 ft, 70 ft. 2 i11 SCH 40 PVC
1111 u11 arg•,rirable v;v11 pe'smirs fi-e.Cou»r,.•.Stain,lbrinarr,lr);qugn ri,.)'
3.«Cll-Use,(chccl:�cll a5e): 17:5CRlEN
Watcr SOphl►'Well-,
FRONT To 131AITETF•it tiLOTSIZE TNIC'1KNrJ5 NIATFRIAL
❑Agricnitiiral ONItinicipatTitbiic. 70 R: 80 ft, 2 Bn` .010 SCH 40 PVC,
occotheT=14-Heating/Coolin_t Supply) DR,.idemial Water Stipp ly(single)
DlndustrialrConititercial ❑Residential Watcr Supph'(shared) 18.GROUT
-FRONT— TO NMTERUd EN(PLAC£NILNTNt£T110D&AN10G'NT
❑ltli�atran 64 ft. 0 rL Portland Tremmie
Non-Wafer Supply Well: ft.: Ft.
f7dTVlpnitoring ❑RccoveTy
Injection Well:, ft. (L
❑Aquifer Recharge" Qdrouritinntcr Rclnrrdia(ipil 19.SANDIGItAVEL PACKIif a a/liu,ble)
FRONT TC) I aurrF itrAI. I NIPI:AC""ENT METDOn
❑rlgltifCr Stor tgc aiii Rccovc y ❑Saliniq'&ImCr 80 ft. 1 67 N. SAND #2
❑Agiiifci T-6t ❑5loirrmatciortinago, ft:
)= fi.
❑ .yrt:litncni:tl Technology' OSubsidcll d Contml '"
20.DRELLiNG LOG(allach additional sheets if weeswn•)
dGeothennal(ClosedLoop) ❑Traeer _Fnou TO DESCRiPTiOMmior,lardneti.willlmekh ri.nc.iit.l
0Geoiltzmlal'(Heaiin0'Cuo1io_p Muni) ❑Other(explain thider 921 Retttarls) o ft. 5 rL Saprolite
5 ft., 80 ft.. PWR
4.DateNetl(s)Conipl6ied. 3/25/22 W'epiD+ MW-36B
M rL
5a:W01 L11c3tilm. rt. rL tr 4�
Corning Incorporated NIA
Facility.;ai�ncrNtlnic EactlitrIDT(ifagpli.able) ft, It.
3900 Electronics Drive Raleigh,NC t._ ft.
0 ^ r '•. i1Ri:
Ph5§i:ul Address.'City.turd Zip '21.RENIARZq
Wake County 1715781482 bentonite seal from 64-67ft.
Caanly IxAtrel hh nibrimmlion No.(PIN) i
SIT,t*tifude and,LOngftude in tlegrccslmintitcslsccbnds or decimal degrees" 22:CcrtificatillQ:"
or',UII f�Id;61rL,I.•tt+l0129.3s S1dlick111)
35.832589 N 78.604500 "r' f' _ ___ -- --_ 4/20/2022
Date l
6,is an the n'ell s: NPermatient tie -❑Tear racy' l��
(• ) (,) H}•aig»ri,�ibis fu„r,, �:'A�•�,if. ,� ,ra��rr;.r-✓�
� ''- !r:::ex' a r.o rurulnr(7er1 irr-nzorrrm,re
nirh15,1,VC+tGok-•';_' 7;: :(ism t'„0�(1�WeilCviutrairinnSievidardi mid rluasa
7.is thix a mpair iD an existing well.. OVcs- or ®Nu. "c ri)nfdui r�r i,n't r,v.�far„r,ntt'id,rr i�'»� tiiti ll r»t,u'r.
Jf fbis'i a rtrxirr,fir,ivi bwoiWi ieWlt•ommiefivei htf9ru4nion anir twplohi the mrara of d'tc
jvpaj.r(t rr 021 reM4ft-d'rt)&v ar on the hail-f f r11h forur. 23.Site dhil;ram:or additional well detaiti:
Ye'n niay'.uss.flti'Mick of this page f'u piovide additional well site details:of a-ell
mc
S.Number of,wells consirtteted• 1 consttioitdetaik You way ahw attach addifioital-pages if nwessart':"
For,naararFlr rt7�e rrr{ e*t'rarvi-tr'caier t>ppl wells ONLY)i'iih rfie s rP4 consrrudion,yea etia
r i(i»tir am fri,r:,. SUBMITTAL iNtiTLTCTiONS
9.Total-well&pth below land surface: 80 (ff,) _24a. For All Wells., Suhiiei this form icilhin 3ill"days of completion of isell
Fvr in nhipfe ict'Us list rrrrrrrrrr s ri di Brew(r,T4TlNj k_3t8,e P0'and 2@ JMVf trinsiinctian fn fllc fiii[ottinJ;:
ill.Static water level helow(tap of casing,. oft-)
bidftiiun of,'Water Resources.lnfllrnllltl O' Pruccs,l101!Unit,
1f Yrufdr ri trrr!r r"bot'c eu5irag. '"+" 1617 Alan Strsice Center,Raleigh,NC-27699-1617
11.Borehole diameter.12/6 (in.) 24b.For ioiftrtinu Welly ONLY, In addition to sending Qtc forth to ilie address in
24aab&e. also snbtidt a copy of t►is font within 34 days of completion of we11
12,Well construction Method, HSA/Air cvmImetion to dte.following:
1'i.e.augyr:rout)•,cable.direct push efc.) I
Division ofRater Reiouri:6,,Undergr'otnid injection Control Proggru(l,
FOR NVATER SUPPLY WELLS ONLY: 1636 Mail Scrsice iCenier,Raleigh,NC 27699-1636
13X VicJd(gpm) Method of test! 24c.For Watcr Supply&Injeectiou Welts.
AISd submit one co}rr of this form within 30 daysofcomoletionof
131r.Disinkttiun hype: Amount well canslntctiott to the county I filth department ot`ttre County wlscm
ctta4lnlcted-
Fonn CAV-t Noah Carolina f3¢parinxtit of Em irouriclu and Natural Resources-Division DI'\%raiCr Ramwces Re,'Ucd Aiigmt Kr11