GW1-2022-05477_Well Construction - GW1_20220601

WELL CONSTRUC:'ITION RECORD For Norval Uw ONLY:
This form milbe used for sinrlc or tnultiplc rasps
1.Well Contractor information:
t.r �'�:{-r>�rc•zorvls.
John Eisenman FROM To DFticRIPTiON,
A`all Comrador Natag fr. ft,
v
4439A ft. fL
NC Well Cantralnar Cori ifialt ion Nnnihcr 1S.OUTERCAS[NG'furiaiiHlsaa9edl: eFls'IORLI[�R(ita
FROM TO p6ANISTER TFIICKN3ESS 3tAM AT
SAEDACCO Inc 0 (L 10 ft. 2" in. SCH-40 PVC
ConV;my Nanrc a6`INNER:CASINGORiTUti1NG' moilcrrnufe&ised hifi'
FROM TO DIAMETER THICKNESS MATERIAL
1 Well Construction PCIMIlt R: ft. ft. 6L
Usf all,71.yalicrrvfr.wrllprnreits(Le.Comity-Stan.Wnriarrcr,fryec6m eir.) ft fl, in.
3.Well Use(checl:well use): PZ SCRh!N::
Water Supptr•Well: FROM TO MANIF:TF,R SLOTSIM I• Tltl"NFKS 1 HATMAI,
CIAgrkultural ONfunicipaRlublic 10 ft. 25 ft. 2" in, .010 SCH-40 PVC
❑Gewhemal(HeadnWCooling Supply) iJResidenti.•tl Water Supply(single) fr. fL in,
QludustriaUCotiuttercial QResidential Water SaPply'(spitted) °--18:GROUT,`,
FRONT TO NUTERM EMPLACEWI M MMOD&ANIOUNtT
❑l 0 ft. 5 M Portland Pour
Non-Water Supply Well;Monitoffing ❑Rccoverq R. R.
injection Well: rt. fL
0A1luifcrRecharge ❑OmundM.11crRcmcdimion -M.SANDIGRAVEL'PACK(if liilkable)'.
FROM To N1A'rF..REi 1, VNIP11160\1ENTHET61011
❑Agot6ir Storage and Recovery ❑Salinity Barrier 8 R. 25 (1, SAND #2
❑AquifcrTest ❑5tonnwatcrDr,6imagg ft. fL
❑Experimental Ta chuohigy ❑Srillsidcncc Comral
20-DR1CUlnGI:OG7>iitachaddililinalsficNs'ifteccciisari•t,:.• '
❑Gmhet n t[(Closed Loup) ❑Tricer FROM TO pt:SCMMON((nbr,k rnhem,v-111mek lr rt. &e.cit.)
❑Geothenral MeatingrCoolitip Moto) ❑Oilier(eme Ialn under#21 Rettads) 0 (L 25 rL sand clay
ft. (L
:4.Date Wetl(s)Completed: 4-28-22 Well iDOW-10 rL rL 1-w'f k
Sa.WellLocation: ft V~ � V r 7J
fL
Circle X 4660 IL fL ,, E
Facility,43nmrNantc Facilily1Dk(if applicable) -- - ----
1513 E. lith St., Siler City, NC, 27399 R. fl [p q rsrrs,(O►pracm'-T o Link
ft. ft,
Physi:td Addrss-City-and Zip =,2t'-RE6rAHEiS".
Chatham Bentonite seal: 5-8'
Caronrl)' Farce]IdCmtirk allow Na.f. IM !
sb.!attitude and Longitude in dcvVesiminutcs/seconds or decimal degrees: 22.Certification:
(if%NCH fold,011L IatAlong is slc(iIL'1�711}
N W = - 5/l/2022
Siemulrz•of:are:~,+::. .1;i- -- -
6.is(are)the tr•cll(s): EPerntaueut or ❑Tetra Rrrar}' = — zy qU• 4 �y
1 My s.gnb.g+r4ir iva,r,`^r .It . ,N, tf :°•"S,c:;;a:•. s L:r:.a.2ro7nre7Er1 in rrcxcn}eturo
n'ilia I fri NC,tC rarC.•�-�=��l:�.i;7L:S.,;%.'.t..11 tut)1{i'If Caustrnfiuu Suuylunls+raid rlufr tl
7.Isthi-ranep3irtoanraistinwwell: i7Yiw or NNu 2'(IfTOlfJld9'rtfil}flaftt'LMFIIIIl41'1(fj'JIf/h4r'11'llrllCl!i'r.
Iffhfs it a rrfxdr,f'i rxir htanrtr n•rif cn+,ynr liarf Nrjurox:r.'rv1 mod csp6ih1 rbe oararr'of rfie
repair rardrr 021 rrruarkr sre iou or rm Me hack of dds furor. 23,Site diagram or additional well details:
You may use the back of U1is page to provide additionat!cell site details of%veil
S.Number of„ells Lonstnected:1 - construction details. You luaV also attach additional pages if n:•cessary.
Fur,mlifirde lr(ierrina are rxa'1-11rrree sfgrlrly wells ONLY skid!Abe same-rtrrtaMfrefitnr.col rise,
.tafburirane form. SUBMIT"PAL iNSTU .TIONC
9.Total well depdt below land surface: 25 ((1,) 2•la. Par All Wells: Subndl this form within 30 days of complctiou of n-cll
For itta ftipfe n HIs h.,1 rr(f drparha•iJ d40i'r011 2@ 14V) construction to the foliori'lrar
Itl.Static eater level below top of casing: ((Y,4 Division of Water Resources,Infiirmation Processing Unit,
if noeer level is rtbove rasi+ag.ose '+ 1617 Mail Set-vice(_enter,Raleigh.NC 27699-1617
l 1.Burchok diameter:6" (in.) 2Jb.Ur hrieeflon Wells ONLY: In addition to sending ilk fomi to the address in
243 above. also subunit a copy of this form s{-itbilt to daps of completion of utll
12.Well canstnlction method:Air Rotary Construction to the following.,
Re.anger.rotary.cable.ding posts etc.I
Division of Water Rcsotirces,Underground Injection Control Progrant,
FOR WATER SUPPLY WELLS ONLY: 1636 Nfait Service Center.Raleigh,NC 27699-I636
13a.field(gpnr) Method of test: 24c.For Water Supply&Injection°Wells-
Also submit Oil--copy of this fomi within 30 daysofcompletionof
13b.Disinfection type: _ Amount- we[]construction to the county,health department of the county wherc
- --- -- -..- -- constructed.
Fonn GW-I Nonh Camliwt U.p utirear of&n itwuriew aid Nantnl RCSOtrrees-Diersion of Wader Rlmaircm Revised:W UA-1191?