GW1--07365_Well Construction - GW1_20231113

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.% WELL•CONSTRUCTION-RECORD . .. .,_
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i., FOr INornot Litt;pNI,Y:: I
Twei•rotitt C011.bc.uscl fir.site*or multigk Was. ' •
1.Well.cOntrtetor Info/illation:. • - • • "
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- 'LLiv-A.TERIoNits. • . ( -• .
Stefan Smith mast-. 10 DFSCRIPTION
• WOE CFFitatelti4r44- . ft: * ft.
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3576A
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NCAVel1Coolrador CWIllkation Number' ,35'.'•OUTER•CING-tfifithirttliCaied-iii-DOOR LINER:110W rititilell- .
• FROM' TO -- .. DIAMETER.- . THICKNESS : MATERIAL . .
• SAEDACCO . . . 0 . ft., 13 • ft!- 2 I I lit. SCH-40 • • PVC -. .-
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Convaar Nat4-. ' " - '. : .U11NNftRCASINIORTVQING fiittal doi•ed-10.41
mast . TO ---- D/A1MTAER---- CE.INE.1111. MATERIAL
2,..WaitODS017e1011.PC11114 li:
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1.0 at opilimbht ifittPetpitt (Eft:.Couht}c.31al. ,;Votitoree.frfalfcif;<1•17.)' • •
• :ft.- • ' ft.
. . ... . .. . . . . • it -. •-•Wc11 115 01?,01c*.01!11.01 . ' • ,17.SCREEN- .. • •
Witter:Supply Will:; .. - .FROM.. . TO - ntaanntat: St0T Sin: THICKNESS MATERIAL ,
. . . 13 ft. 23 FL. 2 'la! :010 SCH-40 PVC. • -
ElAgriculitga1. . . . rijOinidipalOblie:. 1.•
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- 'inGeatheimat(licatingtOolinkStIPPO:. ditesidential.W it it. .41
ater.SUpPlk(single) ' • • : .
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Mt dustrialiComntercial . • • - - • ,:t11•.-,-GROUT• ...... -
0Residential Water (shared) . ,• —
. . FROM. . %10. . MATERIAL. I ENIPLACEMENT IIIKIIIOM AMOUNT
El IniglItian . . . ._ • • -• • • . • ' • • 0- :ft.': 9 -ft.- Portland Pour
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NotiWister Supply Welk' . . - -.
.; • • . ' . ft:, - .
- ' 1tivlottilOring . .EjRcetn'clY ' ' : .
Injection Welt:. - - • . • . rt.. ft. '
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. 1:1MIllifC113Ccliargo ' Otionntiwalet Rciteditition . • .i19.?SANINGRA.VELPACICOraitiblibfol`?- - --.-,-- . • •-• . -.-. . ,..;--- .
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• . ClAtitiftci:10.1.07itii:1 Rccoii .L!oali tf 4, •,-.i; ' — " •
nityl3Rrie -FROM •TO' • 3 tATERrAL, - •RAIEI,ACEMENT Mt:THOR • •• •
• •_- •- •.•• • - . 12 - ft. 24 ft. Pilte'r ;Sand #2'
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CI AgnifeiTeit. 171SiOintirateePritinago: .
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..,_... • It. ' , ft. • 11 • •
CE.tpdaiatitl Tc4hriO1c0. • f=*thsittome.Catidnal.
:.20.0RILLIING,LOG Wittaelfadditionitl Omits'if rtt6wir'v1 . i •
- •• i:i ..!einitentr.ti(Otised Loop) triacer- . :FROM..'• TO - DESCRIPTION togir harciactl,wohlicti troc.-witill
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EIGNUltennai(HeatingiC.00lineRetum)- I:Other teploin.untler.#21•Retuoths) _ 0 ft.", 24 - . (I, .sand-; • . . .
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• • • ft., 'ft. H' ' • t 7 77,:..(7 7.-.7.-, -._,. i"..•.‘.:.:-',.'
4:Date Wet1().'COmpleted: 9/21/23 'Welt wing-34. • •
• It: • ft:
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:4:'Well Losatiotit
ft. ft. 1, NOV 1 :3 ZUZ3
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Creosote Wood.Treating Facility . .. . ft.- - .It:- I' 1-•-•=--z,..--,---•'•;,-,•,1 P;•.-r7.•71,7-.'.. 9 lira -
• tiOlity,Vvax.rigaiu ' . F=Pii0010.614)*** • ' -
f,t, . ft. . . . .
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120 Quality Drive, Navassa, NC,.28451 ' ' ft: ' .ft,. . . ' - •
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-1'19*.itriMbli:05;CitY--.44 40
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Brunswick • . ' 3 foot bentonite seal from 9 to'12 feet.
County• . • • ' Nreel Iclenpfialion W .(FIN) .
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Aii.LatitUdend'firtgiinde in dcgrcesittiiimtestsecOnds inF dechital-degree*. 22,ecrtitkmion::
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otat 1-144,04 14104 ts•iatiat4t4) . ,
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' :4(4,6'31 .
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9/29/2023 . .. . .
. •34.2996989 - -N 77.9979810 • W ; A , d •- ..
. . . .sipst.7 of Ce Tiled Weil co=TAM ,' ' Data
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6.Is(ire)tlievid10111. VFenitaitent or oTemporary ity riiehrig ttrit Aim...?lierel,y cerilly:lull its.Felfi.s.)war terra ainsiruar4 do:kefirdedicr leiti/f M.ArCAC 02C;01:00 Or 154 NCAC92C.0299 ll'ell CottiMictitUf Standards told that ir
7.lathis.a rtjtaii-lb ad.kiiitit-IttIV.04: CVO' :Or PS0. . •viip:Of gar‘ieettird kik bt'Cll proyidc41 iii i!ii!well disti4;r.'
If th(s:Isp 4,411:.jilt Or kuPuil well iwassivaleni luf:grfpu11Onswitf aNpf,qhf rho,..elorare of As
• - 'repair rad&021'ielnarhi':sectittra oi,d,i the boil of tIdx forts:. - -23:$1te.d4gt•Aut:or.attain,*will details: ,- • . .
You tnay.use the intek'df this page in-procidoiddifiOnal,Well Site:details:or Wal • ,
8.•Nuntheired wells eonstrueted: 1 • • • : ' . ccustiudicht delimits;YOnittay alsOattaeit'adilitiOnalp'ages if iteeesSatii. •
For tithlti*h6crioutit ang-Utirer supply iv Op.flNLY.Uitli rly.sainf constriktliot,3011
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• iidonit dOefomi.. . ' stiBNirrrarANsTuc.rioNs - :, • .• . . •
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9,.1.tottit treit ilepfli lietoklitud stirfiteei- 23 • . - ' 04). :240..Fur-MI Waist- Stihmil this formn whin 30 tW •of:coittptethao'Orwell
For heal:Ole.iiiqftlist alldeptlis(filOrria larappk-3021kr and:0 1047) ' coast iiittioti.tti I he tollotriug:
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' ill Statec:water fei..e$.helot top.of-Calingr • 04 tit‘.1.iiini af-Wgtin.ReOulec64nfornuitian litieessing Unit,,
flit level ls idiiive&Lau:4 visa +" . . EGEl,Itiail,StiiicC Ct.ii!tc'T,Raleigh,7it'27699-1017 .
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11,BorehOle diameter:6• On.) .211b.:rill,rtireiort ct wopt ONLY: In addition to•sendiRg the form to the admires in
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24n-abca..6,also sidnitit a..cOpy-of this...faun within 30-days of-CORIpleI1011 of itit
12.Well tmusumetioit method:'sonic . . . constnietiou to,the following.::
(i.e.atig.kroiaty,cal*,..,dircet posh..d.c. - • 11 . .
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. Divbion of NYafer ke$Ottrees,Underground -ound Injection COottn1Pingram,
FOR WATER SUPPLY WELLS ONLY:: • 1636 Mail Sercke Center,Raleigh,NC 216594636 •
: - lie.ForWater•Supplv&Initte.tfou w'oht.11orcdWT!) • kreibuiofNit: i e' i - ihin,1 'ca•s illso submit On copy of tins within of completion of
of•. .
13h..litsinfeetiein type l .Annput: .well:coitimietion to the county health-department-pi'the,county t where
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Farm 0W-1. NonAeotolhia,0,-.Tattmentof Eartronmeni and Natural RegillieLS 1-DIVIS1011 Oi.Water.Eia..4* Revised Atgual2913.
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