GW1--00036_Well Construction - GW1_20231218

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WELL CONSTRUCTION RECORD FOr/mental Dsc pNLY:•This•form con be used fot.Single or tnaltipk Wells-
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1.'4Vell•COntrttetuir Information: . . . . . .
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i'ti:,WATER;ZONES .-"• .. • '• • .
John Eisenman Fla0M. TO • DESCIttP1M8
Welt Coisruclor•Nome. R. ft, . I' I
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4439-A' • I
;'/&.011TERCASING•tfiiilitilikigiirtitilsVOR LltiEltlif.iiii itleabkV• ,_
Nc Weil Contracthr Certifutution/turner • EROS! • ' TO - - 0 nrAturrun. THICKNESS NIAIERIAL SAEDACCO .Ht . , ft.. -. . I :10.
Company Name. ' • • .16.-114NER.CASINGDR,TUBINGligeotberinaleloied.4jtf',!'.' . - _
•FRONI .. TO . DIAMETER- - ITHCLNESS - SIATERIAL
2.'‘Ife1i tonitrtittiOn tierrnit lit , 0 ft, 35 ft.- 2 I '.hi. SCH--4 0 PVC. . .
Lid itil 47,cyip"aible 33-0I p5Orrit1(fr.Corloy,..5or..34,111rarlarxr,frorectidi,ric..).
Ilt• • ' ft.
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3.Well llise--(Citech Well tise)t ... • . 1'7,:SCIIIF.EN _ . , . . . _
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Water Stipply Well:• 7 mon TO 'DIAMETER .SLOT SIZE THICKNESS- ° NIATERMI,
• 35 •ft.' 1 50 -'ft; 2 .ii, 1610 SCH-40 PVC
ElAgt(Culiniai . . 01.qiinicipaligtthlic'
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. . OCteiititemtat(lieMingleboling.Ripply) 13Residential Watir.StupPlY(single) .1.1' ''.•!..: , ' - ''r
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. . ClIndustrialiConuttercial
CIRcsidemial Wt4er'SliPO4:-(sim.4dY• ' IigtOUT'L.TO-.- - 7-51ATER IAL•. • 4'EMPLA CESILN- TMEM OD,gL,.L.N titoN,r
CI Irrigation" o , -.ft.: 2 9. , It. Portland Pour. •
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- - NO n-Witter Su ppiy'Weld: • . . , . , .. . . . . ,_ . . .. . . . ..... ..
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Monitoring InRecasuly - - • • , ._. .•• Injection Welt: . - ft. - ft:
ElPs.puifcrilcOtarge, - 1:161oundrratcr Rentettiatioo c.1.92SAND/G.n.AVELTACKtillipitlieabto?'
• • • . . ...- , •-.sulom TO • nf,t.TRIttat, ttstri:Emmi strrnon •
.,'. 1-3;littifdirtOrige.UndRccily4ty. .tiSalituity Harriet'
. . ... .... . ,. .. • . .... ,.. .7 33. R.• 50 R. gaud' " • #2
. . . El Aquifciteit . E3Stoinntate(broitipao .
• : . . . ...• . . : fi.• ' •ft.. 1, - " . .
. 6S:petinicataiTrehatitaff.. - - DSttbSittcace:Cottirtil .
•••, - . . -:-211:DRILLING LOG faItteh•lidditianl Skits,if nceeSsaitl- - - -. " -• .
' • Octea tit01111:11.(citi$ed Loop) .
.. . • ..1:1Tracer FRO.M-- TO - DESCRIPTION(color.Imrdnett,stiulAmck Om wen(4.k.ti.41.
0G20IllelMal(IlealineiCool.indRetum). - IDthher(explain onder.#21lietnalks) 0 . .n.. 50 - ft; clUyl: . .
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• 4..iiaM Wiell(s)contPletoult ii•-17-23 •'Well ID#Pz-8 . . . — - '
•ft. ri. • k.-..;:,;.:.:-.' ---, -,____, . .
• ,„ ! '."f, 7•::- - .71 ... . . . . .
Sa,Well Lneatititi: .ft. ft, - .-"4-:; *,1/'"i;...,'"17'''•
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Former Clay Mine Site ' ft.,. ft, DEL 1 8
Fac6tUrrNatue Facility Ifni'Of apptiphici ---
ft. lic
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1751 Colon Rd., Sanford, NC, 27330 ft. . ft, ' Dv,•,',','''''f* C:14,---,3r 1 r, , •
vt.,:p• ,, -,-;-ii,../
• ritYs.r4A4disi•aLY:-.00 4' ,2 LREMARKS- • _ o
Lee .
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• Bentonite seal from 29,r33'
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Couttly NICCI tchninacation No,(t>iNt) 1'
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5if.;LittiM tie uul Longitude hi de.greeifniinute:N/sedinds n'r-rieeitnal•riegriiieS: •22:Certitleation: 1 •
anon 4etd;ooit latdotits•sairiett0 ' . - - '- ' . . I. ,
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N 12/4/2023
.Sigiummr•>-',i--;4-".,:t..4„,•,-,:.'ti- ',.,1!,dtar..a.C-----. --."-•''''''. -------. —.- Date . . .
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6.Is(are.).the'well(s)t 111Peintanent or oTemporary kr..siinbig.;AU feriii474.V1..4..q.:4AXire,fit=evirairucted Irk A:twordraire
• • •with 151•ArAC 02c i%C .tC.O2OO-ItW1.(7200•Well coirsItoction Srarkterpfs wit13131r a
7,IS this a repair•fo an eustinit Willt DIAN .or il No vogr_of mi,-icon/?no&en iiii3vided.i.the lirietiltaiir.
If th(sIs a reixik,lid qir kniii3v will anionviorri Igkonalion oar/6.#*the marare of the
ii,,,,hyir tor:10 021:ri'marks'sin or in rim bat iif this fame '-23.•$ite diam'am•or additiond it ell delails: -. .
You may,use the.back of this page:to provide•additionat well site details or Well -
B.NnutherOf weilS On,strticted: 1 - .
•Conshuction delaidi, You may alSo.uttlach additional pages if necessary.
For nub.*ir(feviion Lir non-miter supply IIT1.1:s ONLY 311r1I the satoe twostruillon,yOlt eon
F161111(th..111 fore. SUBMITTAL fitiSTUCTIONA'
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• 0.Tittil it It depth lietoiv land sashed 50 , (iv.) .20. For Alt Wills Submit this form within 30 days-of cOiuptctiOtt.of•tyall
For malripfri;TIlqisr art depths IT itifferay(exan.ipte-3@2Ofr and.20100) ' '" 'constrOttion to the folloWing; I
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I%Static water level below top of easing: . (il.) DIthilin qf Water Risen ticeS,Informlition Protiessing Unit,,'
if woke kvig 13'iriJove cosi%am'"-1-" . /617 IIistil.Stilice'rteitter,Raleigh,Nt-27699-117
1 1..Barehore diameter:67 - • Oa.) .24b;Far In itelion Weill ONLY:,:Irtadrlition to.sentling the form to the address in
24a above.also•Sub Mit a•copy of,Lids Tenn within 30 days of completion of Welt
12:-Welieottstntetion method:Air Rotary cousnuction to-the f011oWingt•
(i.e.auei-,i,ottry,etihtc,direct push.etc4
. Division Of‘Siater ilesou roes,'I UnderOoutid Injetiott CantrniPritgrant,
• FORWATERSUPPIS WELLS ONLY: ' 1636.Mall Serried Center,Raleigh.NC 2769,4636
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24e.For Water Sopplv.&Infection.Wells:
13a,Yield'(giftn) _ ',Iridium]of test:
- Also.submit one copy of this form within.';o:sloy of cOttiOletibit.of
13h.Disinfection ftypet Amount:. wctl-constmetiOn to the-county hdolth deportment of the county where
constrocted. 1 -
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Farm.GW-1. Noah Carolina Depanmentof Euviamment and Natural Resources-DUis Ion of Water'Rmearozs RevisedAugust 20 IA
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