GW1--02516_Well Construction - GW1_20240422

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WELL CONSTRUCTION:RECORD • 'Fmr{ttctrui➢usc.l3NLl':
This farm out be usct#for sttrg1e or tnultipk,ncHls
1.NYcll Coutr.i tor'Inforlrt:itiou: • ' . .. - .. . .. .. •• •' .
IJ:WATER,ZONES - , . ;
John Eisenman ' . FRO 1.- In .• i DE$CRIFtioN•' ' . . .�
11 t R Cii(star Mant4.. .
4439 . •. ft, • �� : •
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1 OUTER.CA;SiNG•tfiielindl easeiliietlsl�Olt'LiNER{if:"ati flcabtkY'
NC Well doMmctor�Cctiifica HORN-umber :
FROM •i Trl. '. . 'DIAMETER • THICE NESS:: :MATERIAL;' -
ft' I. ft. [, tE.
SAEDACCO
ti�aiat;uii f,ritti< 1 i INNER CASING OR TUIIING'(S,eothennal okiseii.fatli ";_.• - •
FROM • •TO• .'DL4AIETER- TUICKNESS• •SrA1£RIAL
2.Weit Constrpctrnn Pei'ntit i; WM0401509 •• 0''. ft: •14 1r:: 2" 'lit— SCH
40 • • PVC
l ut jrf(rfiptiurbff-v-,if prnrt s.ii r.Cr)irit} Sil.110,lilruairr.T7y'?L'p'121 flit,)
3 Wc11 i}hc{ hi:wcla use); [ N I7:5 k1 . t'
Water Supply.Rrc1i` __ FROst • i•TO • Dt.ma T}R sLOTStr.. Tinex.tir ti 1 IMATEtia n. ' .
14' -(t.• 24 ft. '2" In .;, 010 SCH-40 PVC
.DDAgnienitural . . 11Mtmidipal1PAtll)ic . . . . .
DGeotltenitat IfieatingfCooliug Supply) ©Residential Water Supply(cwglo) . .ft.• . ft I in. - -I ,
CIlndnstrial/C'onmtercial DRcsidcntialWatcf Supply(sham l) FR1 Mt • : • `
- FRarr. ' Tb' arATstatril. i ettPl�icisi€'\T3fErlionJi..itihlotiNr
❑hnpatiun .. . . • . .• .. 0 tt 9', ft, Portland I Pour .
Noti.W tter Supply-Well: .
lidivtonitorin. l7Rcctfa crg ft fti • 1
Injection V►t'ell:- • ft. • f4•
12'A quiferltcstiiir c POW') . It."SANDIERAVLLLRACK-(ifariiillelibtel.
. •E•RO57` `1rr .. . .1rh'rt:RrAt •. . . E:SiPl.A[I•iiE\TMIrUln .
CJAgttifcr Storiifc.0its1ltco,•ci}' i7Salinity 13irricr 12 It: :24 'R.'' Sand #2
ElAtptifcrTest - DSlonim'aterDni naac
s
'. . ' .
. . ' •
ft ft. . ,
' DEvNintcn1;tl.Tn.hn0IOg} • DSuhlrIc.; c COw4nJl ' • ,
•20?.DRIL1inGLOG(uitach'nddifoa I hrdsiinecessnni ; •
DGr odtemutl(Clused Loop) .DTtacer . .FROM. •' ..TU' ' DESCRIPTION febvr:l,sn irit nrtk btk mai i tio.e. .1 '
OGeetlt nuare lea[ntg'Cooline Return). • DOtlter texpiuui uiader 011,1 Reto iii ) :. •ft, • -f!, ; 7 F • 1=
e • • • • •
4.DotWell(ss)CuitlpICled: 3-13-24 ' .WeIIID#MW-l44 . ' , , • -
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f(. . • rt, - . . : APH 2: 2: 2024 -.
Si,Well Lrication: ft.- ft
Former Tarheel Army Missile Plant NC7210020544. . , - - ft. ' - ' 'ft.. j - 4.
Faciiiil,OOwticrNatuc• ' • Facility 1 (ifappliwublc)' ft.: . . rt.; .
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201 N. Graham Hopedale. Rd., Burlington, NC, 27.217 . . • R. • ' •• 114 •
'. Plnsteiil Adldr ss_Cit}.and Zip 2.1:Rk:MARKs • .. W - .
Alamance. 139757, .. . ' bentonite seal from 9-12,'
Citeruiy 13iirccr 10-iItit'ti 111i)0Np,(L'II'i) I
5b.I4ltifrdc';ind 1:.ongititrle in detrcU5/minutes/scconds in ticcimal:detrecs:
22,Cct tilYc,ltiitri; I
(iftiCl9(iild;SttLlatfl4ugl> trflieiJmll
36..0989808 „ N , ..79.40.75889- • W
� — 4/8/2024 •
Si Ltur Of rT v�,y -_ Dais
6.Is(ire)the ell(s). SiPerrtiaornt or .❑Tettiporur% ift s gniitg rtsjba,q I. : aef 4'. :f ;; ei.i i. trirzrf,ircial u.m'eori/mtti
WO154 NCAC Ind•x-*'-:.-- ,,.a c>re::w£? .02(10 lt'rif Co'isrracnion Sruriderr4is<cliff thu it
7.futhu a repilirto•ancMstinl;ti'cit; - D.'u. .or ONo . .. • c4i3,0;/11.r nvon$hrr's$7.cri iutiirr••d ra,1 m 6:0mtirdti iar. .. .
• II ilds fs•a repair,f1h oar 4oim well cow maim IiVorewriOn and 6:plain rite ngr trc,of die 'i • : -,
rtrcfrarid rcif rrWarA si-ridair or.iui ifie hr.:l•cf tIirs form 23:Sife dlia};ralnor additionitt tl'ell get;lils: •
You ttiay use•tloe back of.this pia to pratide:adt:iltionml'nell site deiails,or tsell,
8 ttuittbLrofrscllseeonstrittcted: 1. • • consatuetiuitdela'ifs..Youniayalso-.ifiou;tddifittiunlpages'ifnt.e5Sdry•
For ntithip c lt;hrrlon or srm IA.0er supply-welts w eltt ONLY urdh rile myrrh.c ursirrrtdlim on co
. ss6.1.ttiic.eic/ti'0, SUIT 1LTTAL TUCTTONS
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9.Tot 11 Felt depth below I rnd surface 2.4 ' - • ' . (ft.) '21a.•l!ur All Wells Submit dus Turin withen'3q_dam of croitpictiori`ot:welt-
Fariiraadrip ii'crlr'ltir rrittrepflss if dif erivir(aa-at/01 :,3@21kr-wid2@ tOOT ' • . . .tin5tnictiprt to iltelkiltolciita;
itt Static,mates IC%Lt belutt'top of Musing: . • . . . . ((t.) .Di. isiun of Water.RcsOurtes,In frrrna ;Pru tipnLtssinl;Unit; ' .
ff nu.'e:r di'r.,l 1S above tvislag,44.."4-" 1617 hlail'Scry ee(tuI tici,
l aleiih, 1L27G99-IG17
11.Bortlittle iliametu8.25" Ott.) 2-lb,.for fiifcenp Welk ONLY: In addition to sending the form to the address in
' 24a above.. also submit a cop of this'flirt-a withal 30.days of coutpletioni of teal l
12.Verdi'.uatrctrtiction Iriethod:.HSA • . • • .- • • COn5irueti►irl to,tlue:fo11oWing: •
(Le alter.ralurj?,cable.ducel pusls etc) •
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Dic'ision of'`Water iter Resources,Un dergeoUud fitieetiori Control Pr g alrr,
FOR.WATERSOPLl'WELLS ONLY: • 163te Nail$e1rilee Ceriter,Raleigh,NC.27699=1636 •
2,4c.For Muter Supply&lnleciedn Wells:
13;1 Yi lii(itltnr) . 3vlrilititl'nftcst: Also submit one,copy of this fnmll Within.30"days:ofcotilplelioti of
13b Disitif�xtenn•n`pcf W r#tnocot` well conctnictinn to the cairnty ltcallti:dcpaaini;nt 0f the colinti+.ti ke. rn
- _. cprstnlcted.
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Sam Glv,t tN-ailhCataIlrts Mpuiigirent.uf.Eliviiiigiitli5 Slid Natli..tl Rest-forces-.D,ivistoitofWate.r-R atroes Rc+'iscd August_`a13