GW1--06144_Well Construction - GW1_20241014

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WELL CONSTRUCTION RECORD \\ " For
This form canbc used for singlear-tnrrltipkniEs I
1.Well Contraettlr Information: V • I .
/4.WATER ZONES-. . ,
Tyler Brown " " Fttost TO • DESCRIPrtt)N
' WellConrlmgorNinie R. R, I I
4625 rt. rt.. • I I .
NC•Wd!Conna¢ratCcni1tcntionNwtlrer 'IS:OUTER CAS ING(rorm utllitisidne0s)OR-LINER(tfai flcab1e) •-
• Mom TO , : • DIAMETER- THICKNESS' MATERIAL
SAEDACCO • ft., R., In.
Conrpauay Name • ' . .16:-.INNER CASING OR TUBING(geothermal erased-Ionp1',',;' '
•' FROM. •_To _-_ ottatrTSR ,THICKNESS 11MATERIAL
2,Wc11.ConstructionPertnit>r: 0 R. 6 It.- 2" SCB-40 PVC • '
l ru rdl apprticrrble wit prrnrits.li c.Coamnvr Sraa•;.Vnriaiwe,1I fe'a9nrt exc.);
•R.• R. in,' .
3.Wcll.Use(clicvkwdluce1: I7:SCRct:N
•
Water Supply Well: • - ." :' FROrt TO .-DI.METER stOTStu: TIUCKN1SS. I S)AT11UAM,
Cli\Sticultitrat ❑MunicipaliPEbtic 6 ft. 16' R; 2" in 010 SCH-40 PVC
©Geothermal(Heatingr'Cooliag Supply) ®Residential Water Supply(single) ft. (L in, . .
®IndustrialfConunctcial CiResidemtfal\VaterSupply(sugared), a GROUT• _. ; •
FROM' . TO - " '.MATEREAL - - EMPLACEM6TME1HOD 4AMODNT
❑➢mention- . ' . . . .' 0 fr. "3" ' ft. Portland pour
Non-WatcrSupp,lp�ell:, .
®Monitoring - . . DRccoseiy. ' . R. ft."
Injection Wed:- - . . R." q„ '
' clAquifer Recharges l7Gjotlidw ticr Rcmcdiation- •19 SANDIGRAVEL PACK(it:Oldi.il.kt• - . : '
'mom' ' ' TO' 'MATRRL14 • ENIPLACI\UNTA nToon •
❑AquiferStortgertnd Rccovcty ❑Salinity Barrier a - ft. 16 ft. Sand f 2 .
❑AquifcrTest, ❑Stonnitiatcr Drainage 7
• ft. ft: .
❑Eq,erinlental Teelinotog' ❑Subsidence Control
. •'20:DRILLING LOG(sltacli.additional sheetsifncccssarvl '
❑Geotherrual(Closed Loop) ElTricer. • -PROM - to DESCRIPTION hubr.hantac,i,wn'nkklrasr.gsaa.rre.der
. ❑Geotlieuuat(Healing:Caoling Return) ❑Other(e rplain under 421 Retnaltsl .o R• 5 . R, - . . .
" . 5 "IL. 10 • it. t.T� w
4:Bate FVetl(I)Coulpleted: 9/3/24 Well Il)itNW-2. 10 R, 16 ft. ,-N.�.-,.S.:.,,c : ;r' . .
• 5a.Well Lucatlum it, ft .
- 0CT r' .G 2024
Former Variety. Pickup R. ft ■
FacilityiOnncrilmoc. .FactiityLDP..(ifapplicablc) R.e� ft. • 1T - _ -`
875 US-70 W., Garner, NC, 27529' :R, ft,_ - • , .L'"'-:-'-;:r
' Plnsical Address.City.and Zip It.RIAIARKs . .
•
Wake Bentonite seal from 3-4'!•' . •
•
Caaiuty . - Pareel!dcntiricction-No,(PIN)
ib..Latitirdeatid Longitude in degrces/minutcslscennds or decimal degrees' 22,Ccttifratioii, . . I
(If troltfield,ors lat,7oug ig sadllcknt)" f
N NY. � _ / /,,.?—~ 9/25/2024
• SiiniI i:•ofCcitifled Well Contractor Date
•
• 6.blare)the wells):.Z1Permautemt or 1:Temporary •By;signhag Mir fans.'I irerebp(entry dirt:ho well(s)war(nwsJ ctmrtr cried ht.ac orrImrce
• with(5A NG4C OW,0I0.9 or'1SA NCCIC 02C.0201)W U Constrri.rlar Staa ands and dxrr a - '
7.L.this a repair to an existing well: DYes• or l No egirofMak record has lhienprevided"tarbe n.,11reaer.
If ihls'ir a ii palr:fill EAR 1ao,iz well caarnarctfon iuformmton and r.tpiahr the nature of rhe
rsprirnr der•$3l remarks srcrian ar ad the brut fed*form. . 23.Site:diagram or additional Well,dettits:"You-may use the back of this page'to.provide additional well site details or well
8.Number of wells constructed: 1 • --• - construction details. You•slay also auaelt additional pages if necessary.
. Far'tnulrtplc hafeeilon eir non-were supple•welts ONLY'with rlae same eanitettetion,\bar MO I
sabmtr'am fomi.- SUBMITTAL INSTUCT1ONS
9:Total well depth below land surfaice: 30 ((p.) 2.1a. For ALL Welk.'Subnut this'boon within 36 days of completion of welt
For malripfci.dls list tiff deprhsIfdt�t'ereat(exarnp(r-3ri209'oar/2@xoo) construction(odic Rationing: - • -
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tn.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit,
Unmet level is above eashtg,ale"+" 1617 Malt Service Center,Raleigh,NC-277699=1617"
I1,Borehole diameter,8.25" . (in,) 24Ib.FITInfeetiou Weill ONLY: In addition to sending the form to the address in
2.4a above.also submit a copy of this,form within 30 days of.completion of well
12.Well cOnstitt.ctiou"Method:BSA couslmctimt cork following:
(Lc.anger.rotary, direct glish etc.) r '• 1
'Division of Water Resources,Uudergmund InJectiou•Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mali Service Cent I r,Raleigh,NC 27699.1636E
13a Yield(gppm) Method of test: 2•Ie.For Water Supply&IntcctfualWettc:
Also-subulit one copy of this fotui Within 36 days of conlpletion.of
lilt.Disinfection(pet Amount: well construction to the comity fu filth deportment of the county:where
constructed.
. - Foiw Gt.t Noult Cow.lira Dpanutcni of Env iroruis to and Natural Resources—Di:islon ofWater Rr_orrees Revised August:ol3