GW1--03608_Well Construction - GW1_20240613

WELL CONSTRUCTION RECORD � F rInternal Use ONLY.
.
This form can be!mod for single or multiple..ells
I.Well Contractor information: \\A.
I
14.WA1RR mats
Brian Ewing /ROM TO j oti(RIPttuv
tv,11 t'nrtrtctnr K.mw
ft. ft. it
4240-B ft. ft. i
�< it.,l t nlr.,exir(cnifwalloll bee 15.OUTER CASING(for aiultkatrd neRs)OR LINER(if icabk)
/ROM TO DCsSETFR THICKNTSS NATTMAI
SAEDACCO ft. (I. ia.
Ii,INNER CASING OR T URING j1uelhernal clwe/4a111
FROM TO DL MMETER THICKNESS MA TTQIAL
2.tire((('onstiuiti n Permit F: 0 ft. 8 fR 1 fr. SCH-40 PVC
Lost all awls.dhf.•s oil promo,it...County.Sorer,Variance.hen ften rm.!
3,Well I se(check well tlae):
FRO‘I I n ' DOOM TER SCOTSIUU _ TNICKiPSs I M.RTPR141.
WatcrNnpph Nell: 8 ft 23 II. 1 hr. .010 SCH-40 PVC
OAgt i.nitnlal °M►nicipall'Public
°Geothermal 4Heating/Cooling Supply) °Residential Water Supply(single) fL I ft in.
°Industrial/Commercial °Residential WaterSupply-(shared) IL MOVE,/ROM TO MATERIAL EMPLACEMENT METTIOD is AMOUNT ,
°Irrigation fL f4
Nag-Water Supply.Well: n. ft
®Monttonns; ❑Recover -
injection Well: ft. • rt.
El Aquifer Recharge ❑Groundwater Rei ncdi:aion It sANO4.RAVEL PACK of applicable)
°Aquifer Storage antiRccovrn ❑Salinity.Harrier ttRQN In j y1 a rrRr41. F'MPt.4CFyu Nr MFTHOn
6 ft. 23 Ii. FILTER SAND 8 2
°Aquifer Test ❑Slomnaater Drainage
ft, It.
❑Experimental Technology ❑Subsidence('nftlrol
Ill.DRILLING LOG(attach additional sheets if aecewsars I
DGcotltctinai(Closed Loop ❑Tracer ' IRON TO OFSCRI►noN Ruhr,h.ron.•..,.,ion...-t.npcsr sin...,•,...I
❑Gcuthetn tal 4Heaniie Cooling Return) ❑Other(explain under#21 Remarls) 0 ft. 5 h, FILL SILT AND SAND
5 ft. 15 ft. SILT CLAY MOIST
4.Date Waa(s)Completed: 5-14-24 Well 1DllTMW-4
15 fL 20 R SILTY ILTY SAND
Sa.Well location: 20 rt. 23 01. WET SILTY SAND/CLAY
W. Cumberland St. PCE Site rt, h,
Factliry On-ncr Naar Faeiliq iDO(if applicable) R fl. i- r••• JLtl
'IL
1200 West Cumberland St., Dunn, NC , 28334 n. ft.
Flown]Address fin.and Zip 2l.REMARKS J V R 1 5 2024
Harnett BENTONITE SEAL 4 TO 6'
fount. PaicelIdenutiicationNo (MIhtf01'thc:M "r-4►M:'s Unit
Sb.Latitude and Longitude in deTnTs/minutrslscennds or decimal degrees: 22.Certification-
flfwcllfsld not I:n•long..,,,ii, test -
N W Brian Ewing 5/30/2024
Simone of Certified Well Contractor I
6.ik(are)the well(s): ❑Permanent or ICTemporary
Bt signing Mu form.I hereby certify that the twigs!war(,rare)tv attnwted in arrordmrre
HIM I SA NCAC 02C,OlfkT or 15A NCAC o2C,0200 Well Conannrtion Standards and that is
7.Is this a repair to au existing well: ❑Yes or IG No ropy of thin record has been provided In the Iwl owner.
f/chis,t a repair,fill,nit etymon or11..nt,1„ntia11 isrfory araat.ale!rrp1.ar,t rh,tiara...of far
repair under 12I remarks seviian or tat the bark of this!inns. 23.Site diagram or additional well details:
Yon mat use the back of this pcilte to provide additional wen site details or well
8.Number of wells constructed: 1 .onsini lion details. You inay also attach additional pages if necessary.
for mrinpk lrijen?ftal in anal-water.upp!r wells ONLY n',rh file'WM,C nstrUPti.Nl ..:a<oI,
Ashur now farm. SUBMITTAL INSTUCTIONS
9.Total well depth below lewd surface: 23 (ft.) 24a. For AR Wells: Submit this form within 3tl days of completion of well
For multiple wells list all depths if different tera.rhple-3@200 and 201001 constniction to the following
iI.Stark water ksd below lop of caning: (ft.) Division of Water Resources,information Processing I nit.
1617 Mail Service(•cater,Raleigh,NC 27699-1617
I I.Borehole diameter:2.25" (in.) 2-lb.for Injotlon Wells ONLY: In addition to sending the form to the address in
2aaabose. also submit a copy of this form within 30 days of completion of well
12.Well construction method: DRIVEN cousinicttoo to the follow iiig
tic.auger.rai).cable.direct push cic 1
DKision of Water Resources,Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Sen-Ice Center.Raleigh.NC 27699-1636
13a Yield twill _ . of test: ' lie.For\i Ater.uppls tic Injection Wells:
Also submit one coin of this form within iu des s of completion of
lib.Disinfection ispe: Au .O well constmctton to the coimta health dclxrnnsent of the cotton n where
constructed
Form GW-I North Carolina Deportment of Em uuuunnii aid Natural Resources-Di.neon of Water Reoirtm Re.iced.August loll