GW1--07712_Well Construction - GW1_20231122

WELL.CONSTRUCTION RECORD"
Faa'eternal tJsc ONLY:
'this form caii be used for single or multiple a w•els•
i
Il.�Vcll.Crjntr lcNc Iit irtnatiott:
=IJr1VAT11RZONES. . 1-. . "
Stefan Smith FROM. TO ' DESCRIPTION
W¢ll Cariltaelor Nanis., ft. rt. I ; •
3576A • A. (t:
NG Well CantracforCcrii catightNultflcr '3S OUTER•CASiNG'Ifitilriull lisc`dkelisiORLINER:HI:4Vlicablel'• . - .
FROM TO - DIAMETER TIrCE.NES5 MATERIAL.
SAEDACCO 0 (4 6 ft. 2 I , iii. SCH-40 . PVC
ConutyName, :
gr 36.INNER EASING OR VBtNG`1geiliherm:rtEGnsed-IoO .-_. '
• FROM -TO DucKETER TUICR.N'ESS . MATERIAL
2A Il"Constmctirin Perth it#: R. ft. 1 ' "
Lift 1r11 applicable welt pe}mit(i_r,.Countv.'Srom,V ariarrrr,1615 ,4;err) • fr., tt. [m
J.FV'elt lit (cheer:i•cll use); •:c7 SGtuu:N ..
Water SnliJlly Well: FROM- TO UTAMFTER ' SLOT SI7.i: TILICi/NESS MATERIAL
CIAO-cultural. OMiiuicipal/Public. 6 ft. 16 ft.. 2 in 010 SCH-40 PVC
11Geothennal(Heating/CoolingS l•) DResideiitial•Water S0• 0. fL. fn.
�1?5 PPiS'(single)
tAi GROUT-..-._.,
®TtidusuialfCoumtercial DResidential Watee�Suppls'(slrtred) Filorr TO. araTiTlLVL I EMPLACEMENT METHOD&AMOUNT
Dlrrigation. . . 0 ft. 3 fL Portland Pour
Neu-Water Supply Welt: . . . . . .
R. ft,
6dMcnitoring - E311;ccov'cty .
. , . .
• injection Wed: ft. fL ,
CIA-quire-I"Rcdiargc AGi=lutu r'lwatcRemediation twsAmlcft,wEb•Pectcorui,ttucanter, -.. _- -- = - - - ..
- • "FROM TO ' M,tTFJ UAr. •IAIPIACEMENTMLTndu
DAgilifcr:Storage arlt Reco%cry' (]Salinity Rainer• 5 It 16 ft. Sand' 2 '
. . I7 Aquifer Tat DStoiitimatcrarainagc ft. ft.
Oe.iperimcnlalTcchnvly ASLiflsidcncdt oitlml ;,;R;DR➢L MG'.OG7atiach-additionaI'sbceis-ifeeecssnn•l "
OGeotlttmral(CltisedLoop) OTrdcer. FROM- TO nr,SCRIPTIONNOir.aanfucn.eurl+,cr#hDt,-erpnaro.carl
OGeotltennal(Ileating/Coollug Return) DOtller(explaiu under tt2t-Retuarias) 0 .ft„ 4 ft, • Silt;sand -
4 ft. 16 fL Sand;.
4,Date Well(s).Conlpleted:•10-24-23 Well ID#RI-MW08
'ft. ft.
5u:Well Location: .ft., ft. : 's, G`, . t
-Greenville Utilities Commission ft.- ft.- 1I -7
Facility.Owocr•Narne FacilitylD#(tfapplieable), H.
- ft, N.OY-2 , `•0� -
801 Mumford Rd., Greenville, NC, 27834. • . . ft., ft. • " In..;;Tr.=-:"n i--' ,^.r,,4;.,. , h
P I -Mat Andress,Cit•:aitd Zi - ••
4 s Szt:RsnrwktcT -%, ...; ,
Pitt 2 foot bentonite seal from 3 to 5'
Comity 1 Prcc1114dolirceryriDu No.(PIN)
511,"1 ittitudeand.Longimdein degrees/minutes/Seconds ordceun.il degrees: 22.Ccnifieation:
(if inelt 1retd,one talnolry is'srdflekrd)
6(0119.
35.631372 N 77.363346 W j6' i 11/8/2023
Sim 7ofCeallcd Well coatmetori Date
6.is(are)the:vieIl(s): SiPerLnanent of OTeufporaty
try ylgnbq ih faim,.l hereby a ertifv[brit the n•ellf4 kur(flee[)004114C1 d Ju;acVerea re.
riv"rh 151 Nate 02C.9100 or tSA NC4C 02C.0200 Weil Coustrvailwi Sraodards end Au:d
7.Is this a alv MirAt an ezistigetwelli Oyes rir ®No toprofrhlr iceoird bo[sbeen provided rodeo oil rimier,
Ifthts.le'o ri,twir.fee,*Jirwfi i ledd ofingruction hrforoiodoti'aid fapl in rhr'mow of rise -
relJair fordo l,'2I:remarks'serlrun or on the bark of rhir form. 23.Site diagram or additin nut tt;elt lletttit3:
• You nma).use tie,bach of this page to-provide-additional well site details:or well
S.Number"of Wells constructed: 1 • consiruetlou details. You inat'iti.6•alacli additional pages if necessary.
For irufriphi ht(ecrioo ar urel-1,errer rupply owl's l's ONLY ii with rhdsame constritefeotl,,con Ar1J i
submit uric fora. SUBMITTAL iNSTITCTiONS t'
r
9.Total Welt depth[Mac land stirfsee: 16 . (ff.) 244.For Att Wells: Subunit this form within 30 days of comptctidu of well
For nratlrlpldice!ls'lraralldeg&(/dtfferrru(erarnpte-.P@2(KI'ant 1.2e100) 'con;fnldtionto the following:
➢(J.Static*titer level below top of easitiits 4) Divisiuu of Water Rcrciurrces,Iuforniatiah Processing Unit,
lfwaarr lava!Js ebore corl'o;,Ore"+" 1617 Mail.Seilieg[Center,Raleigh,NC-27699-1617
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11,Borehole diameter:8•"25" an.) 24b.For itsleetlgn WeLIl ONLY: iln addition to'sending the formto the address in
240abe..also submit a copy of this him within 30-da►'s'of completion of Well
12.Wclicansttitctiofi method:HSA _ construction tektite followine:• i •
• (Le.auger,rr tary,cable,'direct post[.etc:) .
Division of Water Resources,Underground Injection Control,Peiigr m,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Servvicer ,inter,Raleigh.NC 27699-1636
13;b Yield-Wm) `fathead of test: 24e.For Water Supply 44:Injection Welts:.
" Also submit one'copy of this forth tritbin'30.day�sofcompletion.of
13b.Disinfection type: Amount: well constniction.to the county Health deportment of tile.calmly where
constnutcd,
Pants GtV-t Noah Carolina Depcu went of Eos'iontn_xnt and Natural Remoutces-Dlvisbnof Rated tint ro4 •Revised August 2013
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