GW1--02430_Well Construction - GW1_20240422

WELL CONSTRUCTION•RECORD ' Fur,II¢cnwluscONLY;
This faun can be used for single or nadtipk wells'• • I
I.Well CoutrnctorIfiformation: .
- ftI %VAtERZONFS
Brian Ewing _. . ... ,_ . - • FROM TO 'DESCRIPTION.
Well Coraraclot Name. • • ft.' ft. 1 : . '
4240—B. . • ft.. ft.
NC:Well CanimdarCcniforatioil Nutibcr IS.OUTER CASING-(for.moil[-case I ct]sl`OR,LINER(f ap•'flcoblci, - •
FROM TO '• DIAMETER. TFIICKNESS. \rATERIAL•
SAEDACCO . . . . . ..IL- IL.• l.1a.• .
Company Name .. I6.1INNER'CASING OR TUBING(teothermal dosed-loop) • •
TRIMNESSFROM. TO- DIAMETER. TRIMNESS MATERIAL
3.Weil ConstructinuPc'fait#: 0 R. 8 ft. 1" Fill. SCx-40 PVC
Lis' oilarptlicable*ell penrits.(i c.County.State,Variarrce.infectifssi rte.) • . . , • •
ft. rt.• ,is .
3.Well,Use(checicviell use) - • 17tSt:RELN
FROM . TO •DIAMETR 5t.orsiZ IcNF . I MATRRIA1, . .«aterSupplgWC11:
ClAgriculttltal. 1:1Municipa....ic 8 ft. 18 R. 1 ill. ()it? sex-4o PVC
CIGeotlleinlal(HealingtCooling Supply) ®Residential Water Supply(single) It lc io.
.®industria1Conlnlcrcial . ®Residential�Vater;Su 'aBiGROUT"
.. RPh'(shared) FRO&! . TO • -.1f MMI. EMPIACEMEIT•MEtiIOD&AMOUNT
❑hipation . . . . . . ft. . ,• . .
' •NonAVatcr Supply Vdl .
• ft. ft.
®Monitoring DRccoyety _ • _ • ' -
InJectfonWell:- . . .R.• ft. -
I lAquifcr Recharge• C3Otoundnaicr Retlicdiation .•19.'SANDIGRAVEL PACK(if appllc4h10)' -
. . 'FROM TO' - 'M,.7FRRIAI: • • ' EMPLACEMENT METUUOI
- 17Aip ifcr Storage and Rccovct3 175alinity Baltic!'. . • • 6 f. 18 rt.. FILTER SAND• # 2 ,
❑Aguifcr Test, - : ClSloiuontcr•Dr i uige
-R. fi. •
AE rperimentsl Twbnnto, IJSubsidenec"Conttol- '
• 2o:DRILLiNG'LOG(attach additional sbcetsiF-nccessarvl ' • •
DQeothennul(Closed Loop) • . OTracer. . .FROM TO DESCItiflION(cobr.-hanlneac fonwkktlr rosin Ate.de.) .
•
bGeotltenual(HeatingiCdolineReturn) UOiher(explalit under.A21Rettiaths) D ._tt- 5 ft . FILL SILT AND SAND •
5 .ft.• 10 IL SILTY SAND . ' •
. 4.Date Wcf(s)Completed:•3-28-24 ,well IDmTMW-2 .
•
.10 :ft. 18 IL SILT CLAY MOIST TO WET
So:Well Gmattan: • .ft. ft.-. —. ,
" n ;
Former Edgecomtlbe Genco Plant R. R, • F.
4,....lv.r. �(; t--.
Factlity,Oiuncr.Nnmc Facility IDa O f applicable) . • • R. ft. - APR .2 2 2G 24
• 6358.Battleboro.Rd., Battleboro,.NC 27809 , .Edgecombe R, fL. . .
County; NC; 27809 . Plg3icnlAddress,COY.anti Zip• -2t:RE6tAltliS ltY`.C+:; •:::: ?' :: . 'a ' 1),z
BENTONITE SEAL 4 TO 6' .-l.i'.'i4.:11.:L.)+J
- . Gm* Iarcc1 Itktilitic;illui No,(PIN}
Sb.I:atitude and longitude in degrcerlminutcs/seconds or decimal degrees. 21 CctliticaHone
• (lfart]field,of .lattloita IR Stdliokid)• . . .
N .. . NY ri Ewing__ _
• ••
4/3/2024
• • frd Signitumc of Ccni Wcll Coalractar- •- • • Data
•
• 6.Is.(are)the well(s):.ElPermauent or 10Temporar
. 1lr signing thin-form,1 frerrL}'certify thank.11'rl4SJ 15T13'I{Irliq GYfAYlNCIC(f 1R Altt'OmtlmliY"
. 'frith 1 SA NCAC 02C,01no or 15A NOW 02C.,d201?Will Coustr et(ar Srarrdards and Mai a • .
7.L this a repair to ancldstingwell: , 17Ycs or 111No ccpv.of Mit rrrnrd has lirraprovirkd(gtlr.'smllfruiter, -
lfihls'is a waft':fall am knoluiu lrsdlcwr)3lrocrioa beforauuran and explain the torture of the •
•repair Linder 021 iemark •Srcii a o'r ivy die beak fedi s loan. . 23.Site diagram or atttlttional well details: _ .
• 'You may.use the back of this page to.proEide additional well site details or Welt
• 8.Number of wells constrnictcd: 1 . . . . . • construction details. You May also attack additiottaf pages if necessary_ '
• Far-nwlydplelrjeetloltor,o.i-]rarer supply Ire/Is ONLY totth the same conitrui'ttou,you ma
submit one form. $Uf16TITTA L iNST[1CTiONS •
- 9.Total[well depth below hod surface: •18 (ft.) •24a.'For Aft Wells:,-Submit this faint within'30 days of completion of[Fell
For maltiple'wells-list all ileprhr lid i'elo(erastplr-30209'and 20000) • Constntction to the following-, j
•
1(1.Static water level below tap of caslugy• .(0L) Division of Water Resout'ce:Y,,Information Processing Unit,
if miter hve1Isabove cash,;;use"+" - 1617 Mail Service Center,Raleigh,NC 27649-1:617
-I t.Borehole diameter 2.25 '(tn.) 24b.For-In lectioti Wells ONLY: in addition-to sending the fomt to the address-in
.24a above.also submit a copy of this toll within 30 dayss of,completiau of well •
12.Well eoostnrctiou method: DRIVEN • •- constni ttoll to the folloWbtg:
(Lc:auger.'rattly,cable,dint/pissh.etc.) . . : •
. ' Divisloit of Water Resources;.Undergrouud Infection Control Program;
FOR WATER SUPPLY'WELLS ONLY: • •• 1636 Malt Service*Cecilcr;Raleigh,NC 27699.1636 •
i• .! . -
13a Yield(l ltnt) • Method of test: • •
24e.For'Water Supplw.tic Inicciloo Wells:
Also submit one copy of this fonniivitllin 30 daysofcotupletion.of
•13h.Disinfection type: _ Amount: . , well constmction to the county health;department of the.county.whom •
. - . constnicted. I
FoirgG19-1 . Nodlt Carolina DcpudittoID of Erwitnruocat and Natural Resources—Division of Water Resatrom .Rcilsed Atgust:NFl3