GW1--03342_Well Construction - GW1_20230512

i
WELL CONSTRUCTION RECORD � ForhucnlnitiscONLY.
'ibis form can be used far singlo or nmllip)c)VOIS
L.Well Contractor Information:
14.%VATERZONES t .
Rich Lemire FROM TO nE-ICRIPTION
%%'cllCor4mctorNam ft. A. i
2593A fL ft.
NC WeI1 ContntaorCcnificstimi Nun_bcr _KOUTER CA-IrNG(fni•.Inu11142ied W01s10R L1KER ftf a i'ticabk
FROM TO 0G416ETER TIIIC[iNF55 MAITATAL
SAEDACCO Inc 0 ft. 25 fL 2" in. I SCH-40 PVC
Conilruty Name i6sINNER CASINGOR TUBlNG'(eoihernut cloud4
oii 10 .'
FROM TO M►AiFTER THICKNESS MATERIAL
2.�F'elt Construction Pel•mit#: NSA ur.
1.isr+rll spplir uble wee pencils(ic.Cotrntr.S+re,Uarkarce.fry,-LUC t,ar:J -- --
ft, ft, in,
3.WcIt Vw(clt"k well use): t7 sr..ReeN_
Water Supply Well: FROM TO DIA.METF.R I SI.OTS17i: I TtfIC1iYE7-sS I MATRRIM,
UAg-iculturdl riMunicipatiPublic 25 ft, 35 ft. 2" im .010 SCH-40 PVC
©Geothemrdl(fieitiII&CCooling Supply) DResidemial Water Supply(single) ft. (L
phfdustrialJCoaultcRial QRcsidcatial Water Supply(sltltrtl) -13 O GROUT
FRM TO >f,\TERLIL EN:I:p EME\T\tET110�Q AMOUNT
❑hn alitln 0 ft. 18 ft. PORTLAND TREMMIE
Non-Water Supply Well:
®Monitoring ❑Rcco►rq• ft. ft.
Injecfiou Well; ft. fL
QAquifcr Rccharge Q610y1114matcr Rcmcdiadan 4 SANDiGILt\+ELTACK fir h'i ilicabtel':'- -
FROM TO +1G►YERGtI. F:MPI.AC:E�aFVY Ml:r1101r.•
QAgtaifcrS(ordgc and Rccmcr}' ❑Salinil}'li,nicr 23 ft, 35 ft, SAND #2
QAyllifcrTcsl ❑Stomnwaterbrtina c
ft, ft.
❑Experfnrctual Tcchnolog►• ❑Sidmidcrice Comral
'120.DRILLIIFG'LOG fatlucti`additiriria136cet3 if iicccssnti 1-
❑GLothemml(ClusedLoop) ❑Tracer FROM TO DFSCRIPTIONIcnbr.hard"C,,,lrrlj'I,trl{tY x.^ 'n i+c.NGI
❑Geothentral(1_leatinpCooli11e Return) []Other(ex laid udder#21 Retuacks) 0 fL 16 ft. RED SILTY CLAY
16 ft, 35 fL GREEN SAPROLITE
4.Date Well(}Completed: 2-13-2023 Well ID#MW-43A
Sa.Hrell t.trcation: fS..-'! +
ft. ft.
Corning Glass Works N/A fL fL MAY 2
Facilitl'Mrt'lerName Facility lih(ifappli:nblc) ft,
3900 Electronics Drive, RALEIGH, NC, 27604
Fll)sicalAddrss.City-and Zip -.2L-Rr1%1ARKS'-
WAKE N/A BENTONITE FROM 21 TO 23-
(:anul Partel Id ni iftCaion No.(PIN)
ih.laeitildc Mud Longitude in degrt'cs/minutcs/swcond,*or decimal degrees: 22.Certification:
(Ifnctl fikid,ow,IaMong is mdiicknl)
35.830758 N -78.603564 %V t1 j �/ �,� 2/19/2023
SignaturrofCcni iVellCoutrzinar Dale
G.[s(a1r)the r►'cll(s}; �Pennanent or ❑Temporan'
Uv rJ4nJ11g lirir(irnrr.1 irrrrht•rrrlify rhrr the u•r•1l(.ri t,T:.r IF,rn•J cewirrruc•rerl itr nrvnl.rnre
11;011 154 NC1C VC.010?or 13.1 NCAC 02C.0,190 115-11 C rrnsrrrrcN[ur Srurylrrrals rilel rlarr u
7.Is this a repair to an esicting►►•ell: OYes tor KNo rgq'iThis rernnJhav&-al pr4m.04-4 mMm,nrll moler.
If Ws is a n-pair,fill cm?lVvlm'veil ro+u'Nui Non in/nremr-hot wit a prom the mamee of Me
repcirrmrier321 remorkv.+rruao or cm rite hork c rmir form. 23.Site diagrant or additional►Tell details:
YOU may'use file back of this page to provide additional►cell site details or well
S.Number of welts construLted: 1 constructi0l►details. You may also adlach additional pages if uLcessury.
For laalrlpk J,4eerhm em orm-nmav rul+ph trelfs O+M)N6 rhr san?Eco+rsfrurflu+r.yt:+r vein
.rnl+nr."r one form SUBMITTAL INS'TUCTIONS
9.Total well depth below land surface: 35 (ft.) 24a. For All Wells: Subntil this farm ►vithin 30 days of completion of iwell
FornothiplenettlfsraNtenetsrfQiJir<+orertrapfr ,t��17t?'tuu/? JIY?'i con5lnrctiontolltefollowing:
tU.Static water level below top of rasing; 28.49 (ty} Diwisiun of Water Resuurces,Information Prucessin.Unit.
/f,rtuee level Js rebore rash+;,am +^ 1617 Mail Service Center,R:Ilcigh,NC 27699-1617
11.Snreholc diamctee 8.25° 24b.Enr In(SS.1(nnLVelli ONLY: IR addition to sending lite form to the address in
24a above. also submit a copy of[this folul within 30 days of completion of troll
12.Well►'opstrtctiou method:AUGER colisltuclioll to the followilm:
(i.e.sneer.rotary,cable direct push ctc.I
Division of Water Resources.,Qnderground Injection Coutrol Pivar-ani,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Celier.Raleigh,NC 27699-1636
13;i,11dd(gplll) Method of test: 24r-For Water Supply&Injection Wells:
Also submit one copy of this fonir within ;o days ofcomplelion of
13h.Disinfietion tvpe:_ Anmunt: ►►volt eonstmetinn to the county health dcpanmmil or the county t►•laere
- — cortstmctcd.
Form CMI-t Nonb Catalina EX-pc amem of Ern rroturmR and Natural Resources-Dit'sion of Wake Fle=-olrcm Revised AuMust_ur I:a