GW1-2022-04898_Well Construction - GW1_20220525

WILL CONSTItUC'CION RECORD Fer'irlcmil Use ONLi':
• Ttts'f.�rin can f>ti,used Car.sidgtc ar rmthiylc x'clls. "
1.-VcllContrUctor.lnformation:
iJ.WATER'LONCS
John Eiseman FROM TO. 0FSCRIP11014,
%VC-11 CorItrictnr Nana
4439A
NC\Veil CdtarictorCedification'Nulrber 15.OUTER CASING tfoi mute cruJ ncNs10R LiNER(if a tic9bkl
FROM TO DTAtiI mat - 77nCFSE55 NATFRIAI.
SAEDACCO Inc 0 It. 55 ft. 6 iu: I SCH 40 PVC
C�itq+uiti!Same 16:INNER CASING'ORTUBING1 innct�rmalckisedaar )
FROM 70 I)MMET15t` I rIfi—c SER5. 51ATFRIAL
2.\Nell ConsttTrctinn"Pei nlif 9: 0 ft. L165 h. 12 ia. SCH 40 PVC
r.irruircn,ri�abr•urrrpciv�vodrr�-�.cornrn•,.S.ir:c;anrinrrrc,ir3$i�c�ttc:j f6 fl. i�-
3.-Vdl;Usc(checl:well use): 17:SCREEN
Witter Supply.Well:
,. FROM 70 D1A%TKTT:R . SIATS173: I 'rH1C'HNtS1 1 st.ATF:Rrat:
riAgticultural MunicilmN'tlblic; 65 ft."� 75 ft. 2 in•' On SCH 40 I PVC
OCCothcmlal(TicatingiCoolinz Suppl}°) ®Rcsidcntial\Ya(crSuppl) (single) ft: ft. im
ObldustrialfConuucrcial 0Rcsidential Water:Supply(shared) FRO IRO TO d1ATFRL\l. I EMPLACE3tLVT sIE1TI0U d.A*,fOG\T
❑lrri ration 58 ft. 3 ft. AquaGuard �Tremmie
Non--Water Supply Well:-
ft.. '
Mb44niioring' ❑Rcca\rT?' 3 0 ft. Portland pour
Injection-Well: ft. ft
QAgaifet.Rcchargc l7Groundisatcr_Rcmcdiation 19.SANMGRAVEL PACK ftf rdKablcl-
- -tr RC1V 70 '11 A'ri:RLAI. F:A1PI�ffF_\rF:\T\IFTIIOI/�
❑Aquifer Storngc and Recover 05alinity Birricr 75 ft. 62 ft. SAND #2
11 Agaifcr Test ❑5lotmw itcrD nima"
tt. fi.
OExncriountal Tcchnolo& OStrbsidcn:c Control
20•DRILLING LOG(attach addilional nheets if neceasan)
❑Cr oihemed(Closed Loop) i7Tracer FROM :.TO IDF.SGRnT14N faobr•4an1m,.:y R'nwAh a n:rr.tttl
❑Geothennrl(HeatinerCooline Return) l7Other(explain under P2[Rentad s) 0 A. 4 it. silt sand clay
4 ft.. 75 ft: ROCK
4.Date WCU(N)Completed: 3-11-22 Well IDOMW-35B
ft. ft.
5a:-Vd1 G►cadun: It. 1(. b r
F--
fl. ft. - c.�
Far(!((}',Dian rNam Facilit}TDB{ifappliablc} ft. ft. MAY Fr c-029
3900 Electronics Drive Raleigh,. NC Wake County 35., , , ft. ft.
PII}Skit]Addmss Ciy.and Zip 1 t2l.RlM1IAR1tiS
62-58 bentonite seal " ' +�+rev e r rry rL Jv ry I iiK i
Canuty PinCI 1&111 fi=160u Na.(PIN.)
Ili.lAtitude`and 1.6ngitttde in'tlegr•eccs/minutcsl3cconds Dr decimal degrees: 22,Certification:
{iChcq fr<Id,orc fatrloirr;is sriflici:rA1
N --` '� J� 3/13/2022^
Si�rut IM r� I v Date
6.B(ere)the-wcll(s): %+Permanent or. oTentporan• lurE� r fs r �T !r ,
B�'signor. rhtr fu,:r. r . er,rf� ._ r n r.e::/.or�trucred in s-egrncne>
wi7q!Sri NGtGO'C-';t+'� -r•Cn4ri� dl'n:(F!7lii'fJ Ccntsrrrrititnr Srnnfcrrisa,ldrl va
7.Lip this.a repair tO an eai%tin( \vdl: %Yis or 11N4 rct�,:q;rtrir.ee,ird tuts fhre,ruirrirf•r1 r:;rwr en Jl:nr,u r,
Ilihis if a rep0r,foil cw.krunn iirforwrlio r.m,rl oplain rh4r,&:rr.re r f the
rrlxairwrJrc 82!rrarurfixseeRua ur wi rL,.brd'i n(tiih form.. 23.Site diagram or additional\Yell details:
You may-use-11k back of This page`:io provide additional well site details or well
8.Number of wells constructed• 1 construction details: You otav alsd'allacll uddtdonal pa3*C•S if IritiessaR'-
For rnuJilple mjeetimi or noa-rr:roe'r nmr>h i,Wlr ONLY wadi the vrme coosfruMen.y'ou cars.
suunrironr jnnn. -SUBMITTAL-iNSTLTCTIONS
9.Total well depth below land surfaces 75 (fLt 24a. For All Wells Sub»dI.thii form within 30 days of completion of well
Fornrahtplrnrrlrritr�lldcpttulfcfijirriir(rar7a{+r�-`7c:OP urur.2H!(k7}' .constmctionto the folloRln7:
10.Static water level below sup of easing: (ft.) D►vuiod uf.Water Resources,Information Processing Unit,
if n'aav lrvri is abore ar,sing,use"+ 1617 h1Aii St nice Center,Raleigh,NC 27699-1617
11.Borebole diameter.12/6 (in.) 241).Far inlcetlon Wells ONLY:' In addition to sending the fort to tit^,address in
24a above. a Is.subntil a copN• of;this form within 30 days of completion of uel1
12.Well construction method:HSA/Air constriction to Ilse following:
(Le.atigm rc4ar}.:cablc..duce(push ctc.I
Division of Water Rciourcest Uadergmund Injection Control Program,
FORNYATER SUPPLY SWELLS ONLY: 1636 Mail Sen•ice Center.Raleigh,NC 27699-1636
t3;1 Yidd(gpm) Method of test• 21c.For Water SuMv&injcctio'n 6Vclls:
Also sutintiFon:cope of this fopn,.withiu 30 days ofcompletion of
136.Disinfection type:, Amount: well constmklion to the county itrnllh departmatt or the county'where
coaslrictcd. i
Faun GW.1 Nonh Carolina D1 pwtn�;M of Em'iroium nand`auuaJResources-D vkion of 1Vaier.Rmatrm Rca'iscJ:tugttsE_VJ13