GW1--02459_Well Construction - GW1_20240423

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• WELL:CONSTRUCTION F
. ,RECORD'. • • . cr intcpud tiScONLY: • ' ' .' . . • . ., • . .
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• This form can!lemma for'single o onntip}c Irons•.-. .
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It.‘VeliOntraietor .Infortnatinti: - • :
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• ,i;f1AVATERZONIES', . . .., ... . •. „ , . ' • .. • • .
Tyler Brown . - -. . • '• MOM-. ' 'TO ' •' - ; DESCRIPTION' - • ' • • '
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' Win to-116.dpi Nam* ' : - ' •' . . . . . . '• . .ft.i - R.; - . 1 'I . . .. . . , ' - '
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4 6 2•5A ' • . • - '('' I. . • • It.
NC • - 1 1.
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NC Well ContoctOrCattifmationNumber. . •• • ' ; • • "';•'15:"OUTIEWCASING'ifiiitiiiidWeirCdnCRs't OR LINERtirati'llik61&.
• •FRO)! ' TO ' DIANIETER- . THICKNESS; ' .MATERTAL• '. . -
-- -•. -SAEDACCO . - -
', . 0. 04, 8 • ft: 2" I. Iii.. SCE-40 PVC
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Company Num-. • . .• . • . '16'....INNERVASINGORilltIBIN•GlAnatbilinACkaired-lorijo):',,,'-.. ... . - • •
• . . ; . •FROM. - 'TO . ' DMAIETER., .,....THICKNESS ,,,... MATERIAL . •
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2.Well ttinitnittlein,OcEtnit#,•,•` - ' ': • • • - . - . - •ft. • '•ft, .. ;: -In.
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lisionwppilicabTe.14;11prhiri4(Le.County...SAW
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3.041 US9(ch1aclrwell'tic):• ' 7.1.7s SCREE' N: r -?. ''-'. . .. . . r,. ....''• . .. ' .
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' .%%I At e r SIllt P tt Well:..- '. -. • - ' - ' -.-- . • •• - ...
- • • mew -• To • .utaturritn ' St.orsin . Ttuturim I MATERIAL. . .
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, •... . . - , ' . . . . • ••13 ft. 13, :R. .2° • :M..; .010 • .SCH-40 PVC
• ElAgticuintrat, . • . •- . • .IlblItiniCipaiRublic.': ' - • , • • - . .
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CiGeothennal Meiningtooling.Stipiiii. -. CIResidentiat W0tev,50pnlkisinglei• . it. . ,it ':it1'.'
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tAidUSHiiiiid3R1111CfCial ' , • • .•'0 Rcsidcntiak.WateF:SOpply(Ai r!xi) .1*4"GR°uT!''
'PRONI '10 • • • 'MATERIAL. •. -ENIPLACEMiST hIETIRI)&ANIOUNT . ..
Oftrinntion . • • ' -• . - ' - '• • ' - - 0 ' ft. '2- ft, Portland - Pour . • ' .
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. - • Non-Water Supn_ly..Well: • -
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R11.4oliittitiog. , - :• '.IDRecovcrY- . . • . .
Injection Well: , ' ' - • - ' . ,
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•• • ofiqiiii-crititargc. . . •- . .0Groundleagei•Rteodtatict .. . . .,:19.-"SAND/G1tA.VEltiPACK Of alitdiCnbtcr.' -. -t-.- :-.---••-.,.-'-- -,-:,---:7 -
•FROM TO • - ' AtATEREAL • naint.r.C.EMENT rocrttoil
ElAnttifet.$1ota5c•and Rei.-orciy: . liS aiinily Hairier • •. 6 .'R. '13 . -ft. Filter'Sand ' #2 - • • - - •- ' • ClAtinifettCSt . .• . ' . . EISlottmvatct illmitian - ' . . . . •.
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• ' . ' .13E4igdin'enPi TWIT191-9-U. • P. $4130dePoOli'41:- . . . - ''-.10';:-.BRILLINGLOGInitictiMdiRtiOttn. I shciticir . , ni:-', - - • --' •-'-' '- : --•' - •
Opeothenual Closed Loop} • • .. DTracer. • ..Frail- - TO DESCRIPTION(color.kintlici.sott,owtc istx.Maiin time.ctr.1 . - •
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• . . EIGentitential(11eatineiCoolioilletum).• : •1:1011tor(eiplaitt under nt.Retnalks)., '. ."•-•l'•-. . . .
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• •-• - 4:.Ditte%IRIS)Conipleted:• -27 24 'Weil ID#141,77PO'Ts'- -....- • • ' - ! . . .
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S.a.Well Enotiora . . : • , r .. r, .. . ft.. ' ', "
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. ' Pieitrty..9nrrrNatie ' - ' . • FiclUity tp#6i-410010.. •
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•. . • 401 Aquarius Dr., Wilmington, NC, 28411 , ' „ • . . • •• ft.,. , ...ft.• , I., : , 1.),‘i,,j-."....03. .. ,. .. .
. . .PhStical:MgiF, s;'f.ity,..'"Pd Zi!'
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'' ; , ' Bentonte.seal 2'-6' i• ••• • • •
New Hanover
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. . 'County• - • •. •. •,•- . -. '. ,• . Parcel.10115.00 'No,(PIN) • . . . . . •
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" •. •51i,-1.4ttitudc and Longitude-in degrecSiminutesticionds'ardteirOill•degrecs;' - .i22.;c cror dii, •.. . ,, . '
EC..1 .111. • • "
. • - iltn•cji RCM,-onC.tittilinig:issittficic.#4 •" . .
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- -- 2/27/2024 .. • .,STItirMtt7.•OrCcittfini.W.iii Centmatar';' - Datc. . - • „ . , • •,
• ' • 6-Is h-tre).1111t:•,,vel10): Prelli4ttette or• ,PTelmilorOFY'- . • - -- ' •ity.liphig.driv fepir.l'itirelly tkrtify.iht.a.-air ire*isTr.v(wfre),einairire.ted in
tractrizince
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Wilh 15.ii NCAC 02C.WOO or I.1,1.Ntif C.92 ;020 Weil COnstnniiion§kumgdr41§,<Piii Au'fl
7,.ts this a:repair to an.eximbag.weili. Dikv or •Kt N0.. -: :' . • Agn.obilisr.ro-ii.d hirs•, -,,litovidedf6:3641-11,{!li rivii,,..r. •. .
if ibis Lea iCtynr fill irarknoiti.i-iriffecroorroirdon.tifOriomlort itadaygrliit4141 oluitire'of tile. - ' •', • ' - " ' . ... i' •'•
. . • iepaiikzinder#21 r revi.2i4.i.stiiiim ei-on.th ,t)iwi.csollfiii.fornt.'.. ' . 1 23.Site diagram or additionatwell dCtinZair ' . . . . " • "
You may use the back:Of-this page to ittorid.....addRionnE veil'site.details:or twit
8.filen:her of ktrlh.cOnitructed: 1 - • • consttuetion tleialts• You itay'ittsd:tittacii adtlititinal pages if itecessiirk • '
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I1iiette fco:Ilnigfierlmf or ami-*irLer sip#y*trfooxlildt rhcsrnCcortatrnfont.)Latt comm
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INT$I'LletIONS , • - '
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9.Mttat twit-depth heti*land surface:- • 13 . . . • - (00 24:L•Fur-Alt Wen Submit.this Tann'within 30 days cif completion of Well - • •
Far araliofr-itiiItlisr riii doilas 11Affereht(mMonte,:.?@..200."ond2@ 1110)' C9npli1)ction;($(Ito follovving: ' l
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10.Static iwker levet beton,fop Of rasing:- :• , -. .-- -(ft.) - .- - Divishin of- Water ResourreS,InformatithiPturessing Unit, • . - ,
...• If wqh.fr krip..,.L.r alit.9v valipx axe i.'+" 1617 Mail Service e.:0,0terRalei 01,Ne 27699-1617 ,
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et.Borehote diameter:6" . .• '9%) . NU.fun Infection Welts ONLY:'In addition to sending the fomt to.the address.in,
' • . . 240-above. also submit a.copy:of thiS,butt within.30'days of completion of twit
• 124 SVelteonstructiOn method':Rote-sonic . • , • 0311sEtudiati to the foilowino: .' • - •
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- . - tic nags.tot*,cable ditactpasb..mc.f -. • . • ' •
• RIvislon of SVater..iteseorceS,iindergound Injection contrOl•Prngwa tt.
• 'FOR-WATER SUPP1:.Y WE1.1.$0N1.14• - . • • - 4636 Mail•servire:Center,Raleigh,Ne.2699-1636 .
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. . I • . .'.Itc.For Water•Sunplv&Injection'Wetke . .
134411dd(gnin) NICtitod of Wit: . •
• . . . . . • - Also tatititit one,coke of- this.:fonni within_30 days of comnletiott of • "
well-construction to thc•county health department of the coimtv where-
lb.-Disinfection inite:. ' : • Amount: ., -
• l•constructed, •
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Fano GW-,I,• • . Monhemolina N-Indio:111.ot Entimmucnt nag Natural ftcsources-DIali Ion Of Water Ri4tattots - Revised August 1413.
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