GW1--02283_Well Construction - GW1_20240409

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• SWELL CONSTRUCTION'RECORD Fin[Mental McONLY:
This form can be used for single or nuiltipte netts' '
1..Well Contrtccor iiformation: . .
- - Ls.WATEtz•ZONES
• - Chris Ruffer. FROM TO DFS(,RLPr1ONI •
' 15enCOIMMIDT.Nanw . ft, ft. I
4223A ft. fr: • I
NC Wen Contmelor Ceti iflcatioaiNtuijier • •• ' ';J5.OUTER CASING(ror utti=easedie'efislOR•LiNER(if tia ucahk)-
FROM TO ' Dn METER ' TRIM--NESS- sIATEATAL
SAEDACCO . . • - ft.- • ft. .ttl . •
Caap:wy tvamo ' - . .16.INNER CASING OR TUBING(geothcrtn'2l dosed-loop) .. •
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. •Foos~ ' To• • DIAMETER. i THICKNESS MATERIAL .
2.Well Construction Pe1'init#: 0 •-R: 15' . it: 2. - . end, H sc -40 PVC •
• list aft rip ikable wolf peamih•fiat.County,Staac,.Uariarxa frOctiOrl rice;J' •
•R: ft. lit;
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3.Welt Use(chcd:writ ucc): . '. ' . • 17.SCREEN
Water Well: FtiOM.- .1 TO .-. .•DIAMETER StOTSI7i; TIIICKNtss. .MATP.RIAl, • ,
.GAgnicultutal OMunicipal/Public' _ 15 • ft. I.25 fL 2 in :1020 SCH-40 PVC
' 1GeatlieMtal(Heatingi'CooiingSupply) OResidential Water Supply(single) 2 - ft. fn. , .
• ®indusifial/Conuticfcial • ' ®Residential Water Supply(shared) FROM© 70 MATERIAL EMPrACEMENTslEfllODSAMOUNT
Elk-doatiah - 0 • .ft. 8 ' •f4 Portland Pour '
Neu-Water Supply Well::
®,Monitoring ORccovcty . . ,
Injection Well ft.' ' ft " ` .
1:1AgnifcrRcctiarge V V ❑t iautidwaicr Rc uediation 19.SANDIGRAVELPACK( tII1Iicabte)' ` ' -
•PRQM - To Arm-mum. -i. • I SIPLACtAIENT M1:T110D
PAgttit r-StOTagc and RecovetY . ' 17Salinity Harrier - . ' . 13 .11. 28 ft.. Sand , #3
. ❑AgiiifcrTcst. • : CIStortmtatcrDrtinage ft. rt. . .
OEgacrinacntal Te l:n(log . .• • IJSubsidcncc Controi ' - . . ._. . .
• • 2a.DRILLING LOG(altach-udditional:stieels if nccessan•l V • '
OGeolhenna1(Closed Loop) OTracer FROM : TO DESCRIPTION(wbr.Uaidnc,l t'otektrtle.!r'sin sin. u.)
• DGeotheintat(Heatiug'Coolitie Realm) : OUtlwr(e phtnt under#21 Remarks) :ft. ft.
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4.Date Wells)Coniplcted: 3-14-2024 .Nell iD#25W-68-
fL' ft..1 . .
5a Well Lttcatinn: ftL See Ga�yyi Notes . I,
4c ""'
Cintas' ft ft. • I M ,
.Facilit)�t ittoerNmnc. . Facility IDk(ifapplicablc)
R, ft: A �.p 7n24
610 Woody Dr., Graham, NC, .27253 . . R. ft. -
• .. • PhstedAddicss-City,and Zip- 21.REARKS I In"_ s:wwn; :'.... � j(r •?i'
Alamance • • . Bentonite seal from 8-13' (;WOJ't QG
Pcel lezIat.11ion Nu.(PIN)
Sb.I,atitudc"alid Longitude in dcgrcec/minutes/seconds ar decimal degrees: 22.Certification:
(ituell&td,one LaUtoug is suf(icitid) . '
T•• , W • Chris 'Buffer 3/14/2024
' • . ' , Signitur.:ofCcnifrcd{VcltCanaactar Oats'
. 6.Is(are)the vt'ell(s):.1lPerina/1ent. .or• DTemporaty By'signing this font,1 I-mebp err*char she ii eII s)w-or(urn)coersnased In accordant
with 15rt NCAC 02C.0100 or l5A NGiC 02C.0200 ni41 Conirniaton SrarArriis and Mai a
7.Lc this a repair tit an existing went* IJYmt or ®No e.prof'hit word*hosI-nr prey i.fcr(tadifi'urn rni?irr..
If thfs'is o repair:fill are knrinii will corurnrcrfoa lnforrrarrion and riplahi the nnrure of the ' I, '
. repair nil-der P2lrcmarlrsemennron the bail of~hitform. 23 Site diagram or additional i ill deftut
You may use the back of this page to.pioVide additional well site details or well •
S.Nmnberof wells oousfrTicted: 1 . • constiuctimidetaits. You-may aLSo attach additional pages if necessary. ' •
Poi'.naltlplelnjectlmi orrrnn-u'arersappli!wells.ONLY wall rho sinner cornsmucriorr,}'ea era
saymit ono form. SIIBl11 ITT AL iNSTUCT►ONS. I• ,
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9.Total well.depth boow land surface: 25 (ft.) '21a. Fnr All Yells:-Submit this•font within-30 days of completion of.well
For mrilrlpicivolls liar di trophy ffdf(leiero(e.nanipfr-.? 200'and2esl(Ka) ' . - • constnactionto the follnning; i; ,
10.Static water level below top of casing:•• --(ft..) Division of Water Resources,Infirrmation Pnicessing Unit,
Ora level Is above cuafial;area"+" 1617 Afail Service Center,Raleigh;NC 27699-1617 .
- 11.Borehole diameter.6" - (in.) 24h.For infection Welts'ONLY: in addition to sending the fomt to the address in •
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.24a above.also sibluil a.copy of this form within 30 days of completion of well
• 12.Well constrttction'method:Sonic • - - coustmttion to the following: ,
(Lc:auger.ro(aiy,cabtc.direct rust~-etc.) - ;
' 'Division of Water Resources;Underground Injection Control Program;
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center Raleigh,NC 27699.1636
i3a Yield(firm) Method bf test: ?4c--For-Vatcr Supply&injection Wells:
Also submit One copy of this fomi'within 30 days of completion of
13h.Disinfeetian hype: Amount: wctl constriction to the county health Idejrartmrnt of the county.where
• - constructed.
Fang GW-L North Carolina Depaatmcnt.of Environment and Natural Resources-Divi loaofWalciRetau Revised Atgu t r9ft