HomeMy WebLinkAboutGW1--05966_Well Construction - GW1_20230912 s
WELL coNstRUCTION-RECORD For liitcynal Uso.o.NI,17:
This faun can b used for single or multiple wells
1.1WelltOntnielor Information: .
IE:WAIER ZONIS' . - ., •.'. ' •• ••.Robert Miller . FROM-. 10 1 DESCRIPTION
I.YCII Contriicter Nama ft. ft.
ft. ri.
2675
:1 .OUTER CASING ant.multi-rased nein OR LINER III alp Doak)
NC Well Contractor Certification Nunbcr
' smos1'. TO DIAMETER THICKNESS: -,MATERIAL .
SAEDACCO 0 ,(1. 30' ft. 4" ' :in. SCH 40 PVC
(:oinpinly-N3ine 16.INNER CASING OR TUBING liciabermal eimed-loop) "
.FROM TO :et:AMETEK THICKNESS MATERIAL
2..iwc:11.,toiistiiiCti;n•lictiott fit- • 0." ft: 'in. - -
tin al;alinIkailir.well'iiriiriits(ix.Countyrive.'1'orionee.ItYerdari,eic.0 i
rt.- ft. 1n,
. — . , • ... .
3.•Well lisr.( firel:ii:111.1-50:' 17.SCREEN
,:FROM TO DIAMETER• SLOT SIM THICKNESS I NIATERI AI.
WHICTSUDDly Weil: 30..O. 60' It 4 " ,16, '.020 SCA 40 I PVC
0 Agn:01111ral: EINIUnidipalihiblit:
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,fi.. .
OGeotticmial(leatingt ooling Supply). OResidernial Water Supply(s)ngle). I 1
18.GROUT • - . .
0 industribl/Commercial CIRcsidential Water Supply(sluted)
• .FROM TO • MA'TERIAI.- i ENIPIACEMENT NIETHOD&ANIOUNT
°Irrigation- 0 !1.. 25' ft 4 Portland I pour
Non-Water Supply Well:
ft. - • 1
Olshinitoring Mean-cry ..
Injection Well: . n. ft.
I .
•
Cl Aquifer Recharge- OGinilothralec itelitediatioir '19.SAN Mil/MEL PACK{if applicable)
. • . ..• . ,,• - .. ' • ' — ' 'FROM 10 . MATERIAL IPLACEMENT METHOD
0Aqtirf.rStonicinRci.ocn 1:ISalinity Rainer ,
28' ft. 60' b. Silica. sand 6/20
, .
1D AqiiirdrTest.. 0$1orminiler Dinh:age 'ft.. II,
.
pExperimanal to.'hooloa CSohsidencc Cpairof . . , . . _ ._ . .
'2a.DRII.LING LOG(Much additional sheets'If necessary) ' ••
bGeotliconal(Closed Loop) OTracer -FROM• TO DESCRIPTION logo.ImnInvit.tg.IVnick Imir:p•ain..be,tic,)
.
' Eldeothennal(lleatingeCooli lig'Return). 01Other(explain under 021-ketnaiks) 0 it. 20' ft. Brown silt
1 20' ft. 60' ft. I Rock ' . r::::, '---(4', 1
4:Dateltell(s)ecinipletial: 7-21-2023 %velum.,Dw-3 1 •%. —4.„,•:—..i V
.fi., ft;
Sa:WdtLoratifin:-
- "' . 1!* . SEP i 2 2023
_.,_
Facility!Oaner . . ft.-_Nans: Facility im(u1 aPPlicible)' • - , 1 :,- Iiikr:71"01-VITY/In.1%9).447.reVra-
04,4W43G
1420 Concord Parkway South Concord,.NC 28027, Concord, II . ft.
N•C•• P ill)sk.111.1Ntldrt5..City,and Zip ' 21.REMARKS - -
4 'r„ie4142; 3' bentonite seal from 25'to 28'
Coinly. PAttel Itkiiiiii4II km No.-(PIN)
.1 1
. .
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5ii.Littit1HIC.:-atidl.ongiiude in tlegree:s/minatestieeands or deeimal degrees •
- 22.Certification:
iitocit field;0114 latlooaj is..siill)cloim
N W ..6,, "?4,-,e,,.._,,.y71,,. ..,,, .. 7/23/2023
.Signitureofi.':::::ey:vr.f.e_. ..:ie.:, ..••,,•'‘,'(•!"--- Dale
6.1s(are)the Isell(s): .10Permanefit • or- 0Tempontry By signing'Mir;aim:1'hereby rertif;tiiiii Ike-W(14s)wax isirre,1 thiirmuced in.aorardantv
WO 15ANCJI6 02C.0 I M or 1.5,1,NC.4c-02C.0209 Weil eonirior don Sriaaanls said that a
7:I,s.this a repair to an existing sell Vs'es- -pi RINo. colt,of Ofif.reconf 6g0 been prT'idY4t.rii she soil owner.
, thidi is 0 rePn1r;fill oat 41i1.$11 well conk unction iwiirrnaihni 04111:sfitizi.n thenorareof the: ,. '
rer air urarr 021,rirmarki:Nertiar:or c.vi the boa.tit tlii.i firm. 23.Site diagram'or,additional well detalLs:
YOu tnaY use ilie.back of this pagel to.juovidefaidditional sell site details,or-Well
8 rc imber of livils con.structetl: 1 -constmetion details'. You May also iiitach additional polies if necessary.
For nudtipk inj.e.rio;fei:r-ooP,i-wa,ter supikly:wills ONLY yid,rlic sorr c!nstritition,:wit on, • -. . - - : ,:.--,
.sulniiir OFF form. ' .' suivkiirrAl.INSTUCTIONS .,
. . ,.. • . . ,
9.tOtal*ell depth belts land iiirface: 60' 00. 24a. Fur Ali.Wells: submil tItiSl'Onn witbid30'day*of completion of isell
Pot aratriple weth:lir#11 depths lidiffive..al(airanOtr.3€.2097 0451.20.,Mon coRtnictign to the folloning:. ' ,
. . .. ; ; - - . ••
10.Static:water level Delos top of easiinv.40:. O.) Diiiiiiini of Water Res:nees,Information Pratt-ming Unit:
if water Itlielk abort.,i'asing:ass"+". 16175111a Senice-CeilLer,Raleigh,NC 276994617-
...
II.Borehole diameter:8" (in.) .24 b.For In lection Wells ONLY ;.to addition to sending the Nip to the-addti.,,&sin
245 ainWe. also submit'a copy of(this fonn.within 30 dayS of conipletion of well
.. . ... .. ..
12;Welt construction:method:Air .conknichoii to thc.followour, 1
(Ie.:au-I:cr.roiaiy.cable.direct nush..etc.r, - . - . . . ., • • 1. . _
Div ision'of Water Resilu ries;Underground inletHim Cthitnil Plogi-ant,.-
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center;Raleigh,NC 27699-1636
24c.Fife WiteEitiriply siC 1 nic'vtioil Wells:
13a.•-lifild(Om) -Method of test:
Also..§nbOat.one'copy' of this'Amin,,sSitti O daySof completion or.
13h Disinfe ell!.conStinciion'id the county Ite'nlih depanneml of time con:Ay where
. rtion typ e: w
,,,, Atriounti•., I
constructed.
Fotiopwr..f • Noith Carolina Depimment of Environment and Natural Resources-3:list ion of Water ilmistro . Revised Atgust 2013 -
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