GW1-2022-04895_Well Construction - GW1_20220525

WELL CONSTRUCTION RECORD �\ For ImmlUwONLY:
This Onfi can b:used far.;3in�laor inidiiok wells'
1.R'ell Cutitnictor-Infonnatiori:
14,WATER ZONES
John Eiseman FROM 1 71) - OVSCRIPMOS -
%V01C.tiudrlctrrlracm: ft. ft.
4439A
NC;tirll Conlractor.CenificatiolaNutl4cr 15.OUTER CASING ffoi inuilt-(s"wepsl OR LINER(if a licabk)
FROM. To. Of.%MF,TER TfncFNV..ss. MATERIAL-
SAEDACCO Inc 0 tl. 47 it. 6 irl. SCH 40 PVC
(oilgl:utj�:,nM' 16.INNER CASING OR TUBING ikeeikrrrial dosed-Imp
FROV TO FIRMETER' TUICKNESS MATERIAL
2..%Veil Constructionpertoit#: 0 ft, 51 (!: 2 SCH 40 PVC
fist ail a mlimNe krdpr"irrrt r,ri c.County:Srrr'c,trari irac<•:!I}reCJ[rT rlc l'
fl. ft: in.
3.Wdl U, (check well usc): 17:SCREEN
Water Suppk Wi4 FRO11 I TO :nUlft:<7T:R ;LOT$1IX TfflCf(SI'N_% 1=UATERIAT, J.
51 ft. 61 ft, 2 ..IF,; :010 SCH 40 PVC
❑Agricultural r NfulkipaliNblic
iJGotherrnal(kicatiny Zoo ling'SuIvIv) ©Residential WaterSupply(single) tt 11. in•
C)hidusttialfcoulowd-at ORcsidcntial Witet Supph=(sbarrd), FRO GROUT 70 NL\TFRt\L�I EMPL\CF\!€ST 3lETIlOtI 1:A4IOt NT
❑leri' lion 43 ft. 0 m Portlemd �Tremmie
Ran-Water Supply WO:
A. ff.
�hfanitorin5 G7Rccmrr?• -
InjectionWcll;
i]Agtilfcr Recharge ❑Groundm;licr Rcnlcdiation I9.SAND1GRAML IWO-
70FRt\ L:' IiSIPt�\('T;\I F.ST'\tt:TFlOn
ClArinrfer Storigc afld Rgcocer}' ❑S'tllnitj,Airricc 61 �ft:. 49 ff. SAND #2
!]Agnifi r"TcSt 11Sloriimatcr Dfamigc
ft: ft.
❑Experimcnial Tcchnolog• oSabsidewc Control
20.DRiLLING LOG(arfich additional!ibeds if neeessaryl
0Geotlwintal.(ClusedLoop). ❑Tracer, haidn6t.'wx`nnkh pr. ainwc,w.!
❑Geothennal(leatiol,Cooliug Return) D Oil ier(Cxplaitt under A.1 I Remarks) 47 ft. 61 -ft... rock
• u. � ft:
4.Dote Well(s)Cou►ple(ed: 2-17-22 Well iD#MW-3311
Sa:llach, aicatioo: tt: ft:
tr. tt:
F�:i&tyYOii•rcrNmlli�: Fatilih iD..(it`�pli;,itilc} ft. ft.
I
3900_Electronics.Drive Raleigh;. NC Wake County 35., , tt- p, "(' 6-
Msral.ait&,S.Citi and-ZiQ" .21.REMARKS
5-2622
Sentonite seal from 49-'1 �
Cctiuluj, P,itCl Idzni fiCdioli Nm(PI\) ,y ,,r'TK'
{h.I atim call i ongit►ulein dc_�clminutcsl4ccondc or.dcclmal rlcgrce3: 22:E'crtiticnN(tn: ^ ,
{ifiinit fa;W,1p►:L•,r%lolrg is crdtici_iiQ
2/18/2022
6.1stla the-Well(s): %1Pennanent •or..:oTemporan'. r 4rl�t
6h s grtir,g ahu for,o, 4,a( .r�.�.fs�ri.�..ayt.•g.--1.nrV7rueted nr n't'vrrlcrinc•
111;4-I M MCA 02C ;41.;020 Well constr7e176(ur Skurf,]rds and Aver(r
7.[s.this,#It pylr t0 an a\1511n};{\'CIL ❑1C� _Ur $INrI . rap AJ rfur reron bras l c�.j rnnuG d re?ilrr rndl d,inrr.
fJrhfs.ha rcgi(ir fiRth+ Gr(rilta is rtd ions nririnra hifervirrion arld r_kpbaq fhe mrmee"f rlra
rr arrxmj-cr92l Sitc diagntnrur additional welldet ibo
1 eu`n13F use ihe;back of this pagL,to ptocide.tdditiotiaC%eil site details or Drell
S.Nifmber of~yells consti'rlrted: l co»stmclinn details.-S'�u iila�'also iittttcft usiJitiottal:pagt�if tr.�essag.
For,iaielrtf4e kjfwl)n yr a7ui-u;ofer isppli rarlls Oaf!Y ii ldl'rhr ur,ree eanslructiwr;sear C,iaa
sauanrecracforrrr: S 1 tr<iITT4 .'INS9 T' TIONSS
9.Total Hell depth bioWi land mirfac, 61 ( )_lair. For All�1`ells` -Sitbnut !tits,-form tyithin�0=d ys of contplc[ion oC Fell
For,riulrl fiC,idlslisle:rloeplr rrdifferrru and2u IM) construction 16 the,falloning;'
10.Static-Water Neel.below top of ca.'iin�. - (ft,) Uiri.�ton of NVats.r Rmourcer,Information Prucessing Unit;
Ifisdw'lti-rlhs Iwi-rcasing.Pu"` " iG1Th1iuilScriiccCrntcr,161,ci{;br Nt:27699-1 6 17-
It l3orchnlr diamctrr:l2/6 (in,) 24b.F—ar-bliation L ONT Y to addition to sending th `omi to tbe'address in
24aabove, also subotit a:Cop\.of;this f0111i Rithit!0 da}S of,completibii of I ll
12 Well consttvetimimethod: HSA/Air constmctialktoilt:foiloiviilet-
{i.c.3u�r rMasy:cable-direct posh cts.) Division of Water.Rcsourccs,,*ndegr r6und Injection Control Pnig6lll,
FOR:Wrl7'ER SGPPLi'_RILLS ONLY:.
1636 hfail Service C�ntcr,Raleigh,NC 276'04636
13a 1 add(dim) licthod of test: 24e--For Water Supply&'injection Wells!
Also sifbnnt one'copy of this foniL iN 1111in.31),days of cotilpletiolt of
136:Disinfection hpci amiroat: Ivell constnsctiun' a the cortmy hcenfth deparimcnt o[litc county w1k4n:
- constructed.
FurmGw-1 North`CarolinaFetwtmemofEmimuncnt and Nataril Resources-Dii•ii ion of\VwerRmcmrcm Reels d,lgiist_*ul3
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