GW1-2021-02606_Well Construction - GW1_20210404

. WELL CONSTRt)MON RECORD FwlW=lUscONi~Y:
nis farm wn be used for sin&or mn fqk nos
1.Well ContrMorfalormallorr
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NC Atoll ComrectorCondbutionNlu tv 2021 15.OUTER C1t�1NfT ffor'`iltiralr5ed�e111 'g17I�DTf2t At"Il'b
�� 1351►t FROM Jim DTAIMVIER T"TMIXess 7MAMRtAt.
SABDACCO Inc �rrro�' :Ce 0 fL 31 tt. 1" id. SCE-40 PVC
Gantpnnyttame tk-T INTA X00''' & tserT Al Itised4al
FROM TO DIA,%IVTER I Tf1tckNT.SS MAIIERiAL
2.Well Csln.stroctWn Permit ft. (L hL
fret idimpl mmo wrll pe"W"tlr.Cnunrp,Suer,Variarww.7roecHnq fir.)
n. d. rm.
3.Wellilse(ehmic well asc): 1:
Water Supply Well: FROM 70 D1019TER: $t t ?z -"IT t deTiTW I MATRRIA1.
0A91kUlttlral CJMtlnieipavPubllc 3 ft 13' fr. 1" ia' 010 SCH-40 PVC
l7Geothetmal(ReatinglCooling Suppl}) DResidentini Water Suppb,(single) A, rL
13 MusttialfGoninvAial ©Residenwi Grater Supply(sixited) FROM- TO DIATI;RtAt. Mf•ItiOD AMOUNT
Dimpation
Non-Water Supply Well;
f1. tt.
limanitori QRccm
In ection Well: A. fu
0AgniferAccN1rgo 0diouodnaterRrAttedatioTT 19 S A14 No
rROM I TO MATERIAL T!TA rvrbrrTrl n
t]Aoftr Stwnc and R=vW 13S81injt).13ar>3Cr 11 R. 131 ft. FILTER SAND #2
[]Aquifer Tes OStommetrr ihaimgc
ft. It,
C]EVzrin=tRl7cehnot 0subsidmcColftl 20,;IIR11:1,tist lA� tack ctditt+mlilstatCts tai sT9e
OGeo betml(CiosedLaop) OTraeff FROM TO DTSCRTrTTU?t(eowl.t3trin ftw R o*tl
DGootbemrai(Heasi It Retum) a0ther jewlain wider#21 Remaiks 0 ft. 131 fL Sand
ft.` A.
4.Date Well(s)C0Ulpleted: 3/10/21 WdIID#TTf2
n. n.
SA-Wetl 1AICAtlMn:
UPS Customer Center ft, fL
Facaif} ncr flame Facility fib(if spplkabie) A. ft,
2815 Carolina Beach Rd, Wilmington, NC, 28412 th n
Pit-jul Adders&City.and•Lip 2t '• `S '
New Hanover Temporary well
Coaaly Patcei ldemlficauaoNo,(lttla)
Sb*l utitbde And L6TTA tiadc in degmcitmimTtxslscconds or decimal de grecr. 22.Ctrlirkstion:
(it well Jktd;one billotg 1%WI s,km)
N W 3/22/2021
Sisrata oft mliiod win comma DWI:
6.Is(ere)the well(g): OPennanent or zTemporary
4. 18+b++t;rM1b Jorm,l dre►gby t'erhfs^Mm:dre urlN!s1 trrtr(atibr/rorstrrrufterl6e'oeebrdanre
udth 1 fA NCACO2C,0100 or 13A NCAC OZC:02W 411e11 Gonstiuctdnn standards and duet a
7.Is this a relmir to an existing well t7Yes or MNo rOM4gfdlktwonf has bran prnruitrd to;hr writ owwr.
If Ali lx a a petr.Jill am kapim well roewntedal btformwim mud cVlain rho natore of ar.
rowir wider#?I mina d x xrai n or fin d1t hurt of this fora. 23.Site diagram or additional well details:
You may use the bark of this page to pfoA ide additional well site derails or well
S.Numberof wells constructed: 1 conouttian detalts. You may also atiach additional pages if owessaty.
For nrct r*iti/€emW ornPA-i weer svf plr imlij ONLY,44th die snare oonsiru fien.you am
sub+nfr one forea SUBAIMAL
9.Total welt depth below land surfacer 13 ( ) 2Aa. Par At Wells: Submit this form vddrin'10 dates of completion of well
f'nrawltiple wwh ust alMepakT fjddJ;rrent( nR>Div 3 2rN1`aid?k+10r) constniction to the foilonigg;
i .
10.Static water hec`el below top of casing: (D,) Division of Water Ruiurem li formation processing Unit.
if vi'd teat!is dNwe Cdaln;.:uu"+" 1617!!Mail Serriee Center,RAIric ,NC 276➢9-1617
Rrercholc tliamCter:2.25" {in) 24b.kDl laftgRa V_Q ONLY:.i In addition to sending the 16tin to ilea addles in
?Za aboT`e also sttbttlit a Dopy of this tbtnt within 30 days of completion of ut:il
IL Well ConsiMetton method:DRIVEN conStNCtion to the thQuttiing,
(i.e.anger,r*jy,cubit dnecr posh.cte:l
Dh ision of Water Resod r+ces Underpnund Injection Control Program,
FOR WATER SUPPLY WELLS ONLY 1636 Melt Senice Centtr.Rideigir/NC17699.1636
13a.V144(pro) Methad of test Ile.For Water Srtjfpl�&Mntaction gals:
Also submit one cop)° of this fohn'A%ithir►30 daps of coftletion of
33b.Dishill ion tl1Te: Amount:, well constnution to the counm health dronme n of the catnip wh=
constntctod.
Farm MY.t Nortb Carolina Dqx n nm of Emitonnim and Samar lkawwocs—,Dhisba of!!rata Rein rOft Rc%-b ed At Vig 2013