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GW1-2022-04896_Well Construction - GW1_20220525
WELL CONS'i'RUC-i'ION.RECORD For lrrmalUwONLY: This forin can tc ijwd for si mla or nndlipk%'ells i 1.Well Contractor Inforniation 14.WATER ZONES John Eisenman FROM To DF.ti(.'RtlllO\ WcIl Caitrictcr Kano rot. rot. 4439A NC\Vdl ContrattarCcni[icationNulrticr 15.OUTER CASING(ror Inullkased"ells►OR LINER(if ap ikahk) FROM I TO D1%%ICTiiR TIIICK"WsS- - NIA MAT. SAEDACCO Inc ft. I (I. i :ia. M.INNER CASING OR 711BING t$tolherroA)chiwd-lm O -FROM -TO 'M IFFUR: -I THICKNESS 'MATERIAL _ 2.%Veil Constivet ion.P&mit#: 0 ft. 29 go. 2 SCB 40 PVC Lirrull r.;�,lira(ih•r:rlf p.'beeitr(i-r.Cnu»fi•,SJu:r,lSriarce.•,�f}r�Uq�h-.) --'� 3 Wcll,Use(check well use): tv.s(REEN \\'atcrSupph.\Yell.; FROM' 1 TO- DIA31r.7 Rr SLOi517): i Tlil(is\FJS 1 MAWRlat. L7Aglicn!(iltaf LlAitinicipaGl'ItUlic 29 R. 39 `ft. 2 in.. ' .010 SCH'40 ( PVC 0Gcoiflern,01 Meat inglt'ooling Sul)pipp ©Residential Water Supply(single) rl tl: in. Dindumialfconunercial 011 sidmitiab Wa(cr Supph'(slumd) 1 TR.GROUT FRO}i 70 :?IATERWI: I EAfTL.10E51LtiT\IL'r110D&.1AIOIINT ❑IrriiLrtion 25 ff. 0 fL Portland ,Tremmie No nr,%Vater Su pply Wclh, - ! rot. ff. I �jVfol>itaring ORccoitry InjecNunAVcll: f.. IL QAgllirdr Rcchar.g ❑GrollndD;ilcr RCincdi ition 19.SANDIGRAVEL PACK lif applicable) FROM 70 EMPt.A(XMM T HITII0D ❑Ai)nifccSforrSc'irrdR covcry ❑SalinityBarricr. 39 rot. 27 rot. SAND l#2 ❑AcipifcrTest 175toimiatcrDiiinaggc rot. rot. ❑Ex cniTcntrd'fcchnolnny. ❑Sohsidcnc-c61idrol Ni.DRILLING LOG(lutich addilionul rheas if eceCWfli9 OGcotheinial(bused Loop) bTraccr I FROM I TO (tlr.bardneet,sa1m-k1, mRvay.Cie) ❑GM.knilal(Neathm/Coolive Rewtn) ❑Other(explain untler:P121 Reuiati;s) 0 It. 39 it, soil n. rot: 4:Date Wetl(s)Completed: 2-16-22 Well 1Ddn1W-33A fl. ff. 52.'\\ellLocation: ff. ft. F¢cilit},Chsi+rNumc Facility 1D�(ifdpplablc) ft. ft. AV 3900 Electronics Drive Raleigh, NC Wake County 35., ft. p Plnikal Aildrtss Cin'•and Zip 21.KL(ARKS Bentonite seal from 27-25ft Caciuh I'airel td_nli6wi oi:No,(PIN) 5h.Latitodc anal l:onotude in dcgrccslminutt:alscconds,or decimal dcgrecs: 22.Certification: OJAI ell field.prk ilt-401:8 ia'gidGckrd) f' - N \Y =-yam- _2/18/2022 5I�tutur 6.Is(are)tllc wcll(s)f XPermatient or ❑ emporuy. far artnti thuroan,:fir PE%°!,( y 5 „�� I r+7�JracJcd ire rtm'ronranc`c r iA 154,YGtG OIC=t�'��-C•e:(.i C Aak�Il e'i!ConcfRrr;kur$rar�fcuils caul t/air u 7.h this-a repair to an"tAsting)tell•- o Ves or- KNu cep»n;'rhis a•ronllrsai•.»pnndr ai rn the:irl1 rnr,i.•r. !f phis i{ra reivir.roll4-n,rlamai rerll rairnxaipq iirfonru:n.'v,l Turd eXploi,l rho°»nest.•r f(he reK..ir ardrr 021 reMarla arriiun or nut the bark cif thus form. 23.Site diagram or,additional well details: „ You liras•use ilie back°of this bulge Io provide additional well site details.or well, 8.Number of hells coiL41711cted: 1 cvirsMclion d to L' You,,mv aLso'attacli dditioirai pabes if uecemi. . FOr mairlplr briecrion Of arni-rrmrer snpp{e ieelra ONLY i0th rile some.cooIrrifedrol,}on curt s h»riei»efnrr,. SUBMITTaLIhCTUCTIONS 9.Total well depth bclal�land surface: 39 ({t,) .2{a.,FDr All Wells:. Sub»ri1 tlds,tome within 30 days of complcliori of-Well For,nalriple rrells'lisf rr1144rrhs rj riilSviJu terra pie-:ti,=0D'evk!2(e lGhy) Construction to the fo_ilolnir1g:' !O:Static niter levelbelolt tap oCcasiug (fL) Division of Walter Rc+iiurces;Informati.-n Processing Unit.. IG17.hlai[Slrtice Ccntcr;Ralcl fi,\C 2 76971617 1 n:uer r:rllsabcnerasiuq.»sc"+' � . f 1 r 11.13drehotc diametcr.8 (in) 24b.For hliecffno Well,;ONLY:',fit addition to.sending tha fom{to tiu.addresc in 24a above. also submit a cop}' of this.four will in,30 days of completion of well 12.\bell construction method: HSA constmetiml to tllc_folloni iug: (i.e.aug r.ra(ar}•,cable,dix�I posit,c(c,l Division of Water Resources'i Undet•l round Injection Control Pii) rate, FOR NVATER SUPPLY WELLS ONLY•- 16316 hiail Service Ccntcr.Raleigh,NC 27609-1636 1lcthod of test• l3a ti add( ) 23c.For Water Supply&injection Wells: g(rm Also submit o{ `copy Of this fo1111,1t1thill.?0 days OfC0111pleliolIo 13h:I)i�infeaKion qpe Anmunt•. sedi-construction to the county Health depanmarl ol`tlic.cwmn n111erC consinicud. Farm GW I" Nonh Carolina U:p:utneni of Enciromwitt and Natural Rewurces-Division of WnicuRe-oirom Revised August s01.1 i.