GW1-2022-10401_Well Construction - GW1_20221116

WELL CONSTR•UCTION`RECORU
�\ For Ir2cntal Use;ONI l':
T11is,form can In uscd.Cor single or.niubip3e n'clls"
.1:��'cll cont, reformation:.
14'AVATER'LONC%-
John Eisenman FROM Jo IDF_4CRIPiIU\
1Vclf 61461clol Nana:.
Yt. ft:
4439
NC\Veil Contracior-Cenifteation Niiinber 5 OUTEWCASiNG((or inullf-`6-i1401s)OR LINF,RYif is"lkabkl
FROM A TO 1 DIAMETF.n. THIC'KNFSS MATERIAL.
SAEDACCO Inc 0 ft:. 60 ft. 2" in. SCH-40 PVC
('iuilp:uq'NS,uc rlr:alNNErR'C'ASING OR`TUHINGt46eb lherinal c10ud-1rxrp),FROM �Yi TO DIAMETER I 711ICKNESS .MATER1.1L
2.Wcll_C:onsflvctinn.PciTilif#:
Li,rirlr«jiifirrthh'`re'edfrrrnmtr ji:c.Ca««t S''rr::Ti,rirtrcr.TI)EC7U1 rlCa' - - in.in.
3,Well lisc(chcckwell 6ej: 17:SCREEN
Water Supply Well: I FROM 'I TO DI NIFTT;R' I NLOTS17s: THiCKNINS I uATERI►l.
60 'ft. 75 f1. 2" im• 010 SCH-40 ++ PVC
rJAgriculttuat- ClhliinicipaV ib1'ic r 1
ClGcolhcrn)al(licatingf Coo linr Supply) iDRcsidctitial\'.rater Sit *h.(single).
0hidustrialfCouuticreml 011csidcntial Water Supph•(shared) h'18i-GROUT " G
• FROM TO MATERIAL. - •;I.FAMACEdIVNT3ICTI10Dh.40#101iNT
Qlrri^alion 0 lit.: S0 ft. Portland tremie
Non-Water Supply Well: h: 4.
®hlonitoring Oltcm-cry
Injection Well: n. n.
QAquiferRcchirgd QGroilndq`UcrRcillC-611ion' 19.SANDA3L%V.Ei=PAeCtif ipHcabtey _
` F'RUM 'TO M\TkRI:\L 6JIFt..\(F,\t i:NrH01f
QA�uifcrStoragcandRctiotcp' ❑Sllinin Bimc� 57 ll:. 75 ft. Sand #2
D-A ifcrTcst ❑Stori»i\+Icr priina�c ft. ft.
OF-cporiincntaI T&hnology ❑SitbsidcD:c Cbmtol
2n:DRILLING=!OG7attach`addiliunuL,ticctrifncccsarii- c .
Meoll+ermal(posed Loop")' ❑Tracer FROM TO 7 DE5C'RIPT 10%'Robr.1,40"v:,mfrl'nicl,mw.grAin a4iv.ar.l
DGeotheutul(laeatine+Cooling Remit) 0Otlwr(explain redder#2 i Rolla rl.b) 0 fi,_i 8 ft. clay
8 ff. 75 ft. rock
9.Date'Wrll(yjCortiplcted."10-17-22 %We11iD#MW-1
n. ft.
5a'.WL41 UicalGin:
ff. ff, NOV •a a 2
022
Facility,'OwncrNanie Faeilily,inx61i*applizablc)
n. 4 it' Intofcrlr;saen Pmcws4l�Urld
6717 Johnsdale Rd., Raleigh, NC, 27615
Phisi;aladdris Citp.ainlZip 31::REhIARFQ;,
Wake Bentonite seal from 50'-57ft
t'aruly,: R awel ldeWit`tuion No.(1`17�)
51i:I>►titude and Liinginrile in dCgitcs/uninufc�kecondc ni•decimal Ogrecs: 22:Ccnilicatioh-.
(il'uOil li.ld,o,a I:ti+lung N.%mdticicul)
10/29/2022
Sigrniur 0f I0.
G'f �• r
6.I5(am)the wdl(s): -Y&Cnnattent or .oTeinlioratw. Hl s74nbr rlrA(ar7� ilrivtnur rl,i ai¢'ardrnrc
miter'1101 NCdC O7.0 x :` f r r'( i� 'C.'4200 Well Crimrrriui<ut$titiakrnls toll tl nt rr
7.I�this 1 mpair to as cziStiDl;vvdl: �1`C`c. tlr ®No'.: ie�n iijrhis rerniY7 hri Urn pit vie i rn llrr:rvll o,rnrr•
irlhu tr«tejatlr,fll irroirifirrrl Weflearstnrrtivn jnfaro!trrin„arid ewpleht the nvaire of rlrn
a@ 23.Site diagram or additional Will detaih:rytctr m JrrF?l rrnmrPssrr,iort or cv file brns
You;ina?�:use die back of this page_to"provide additionil well she dhlails or%cell
8.Nulliberof wells ironArucle'd: 1 coistni'mou details: You may also'atlach additiolial pap5 if nccesss,n':
Far;t1?,U plr afeerlon ar nfet-fritter stirp?V ivdhs OjVLV yehh'the s«r«c cortsrruclion.yom ernr
sulunjr pnr jatrn. ,�u113D11"i"f AL.1NS1•IICT 5
9.Total Well depth belon''land:mirface: 75 (fr.).'141a.-For .all �lydlx:.. Siibriul lluis fond M(hin 3(►'Am"s of coinplelion of_n'cll
For,ir;hlpl w.*,llsHi!cell W40isi%rliff4enj(exa ple-3@20,9'.mul2Q10)) consiniciion to llic follo%%ing-
10.Static water level heloe'top,ofcming: (ft:) Dii`ision of Water Resoumc%,' ntormation PrikCs-Ang unit,;
if hear r level la,nbove camh.t.mie""- IG(7 Afuil Sct t lee Cenrrr,Italeigh;NC 27699-1617
l l:Bnrehute diametei 6° "(in) 246.For lei i e-lig ONLi '•.In addition to'sendinn file form ao dlcatddmm is
24a above.. also Submit a copy'of this 1`611d.)i•illlui..1O`ilays.of:collipleliowd utill
12.Well comtnuction Method:-Air :ronsiniciion fu file following:`
cabto.'direer push etc_}'
Division of water Resources;Underground-lujcctiim ContrTil Program.
FOR WATER.SUPPL.V WELLS ONT;Y:` Wei Nfnil Service=Center;Raleigh;NC 27699=1636;
L:t'}'ichl.(i�lnl) N1ctGnd of test: 21c..For Water Supply&injcilion Welh:
A1, 6.�suhiuit otie�copy.`of.this fomc.Miltin O'daysd''mpletioliof
well construction 16.thc.connqlicallh department of llic courity.wherc
b:Disinfcetion type:• - Amount: tOpdntCtttd.
FonuG\V-1 \orbCsioli,eiUpannxmo[Eimironnknlatui�autralResources lhviiionofWaterResoutz ReviscdA41ist•,o1.1