GW1-2022-06735_Well Construction - GW1_20220628

WELL CONSTRUCTION RECORD FnrirtcmalLrwONLY:
This form can t10 used for single er lnulliplc Wells
1.Well Contractor Information:
M WATER'LANES
John Eisenman FROM 1r0I DR-X-RIPr1ON
%Fell Coraratior Nan: ft. ft,
4439A ft. ft.
NC Rrd3 Contractor Certification Nimber I5.OUTER CASING rror mnlli-cascd wells)OR Lil`lER fit a ticabk)
1 FROM TO DL1W{ETER T111Cr{`'E55 NILATERIAL
SAEDACCO Inc 0 ft. 65 A. 6 in. SCH 40 PVC
Cnngruay'lt�rru 16.INNER CLING OR TUBING ealbermal cloud-fixim
FRONT j TO D101IF.TER THICKNESS I MATERML
2.Well Construction Pelurit#: N/A 0 A. 70 ft, 2 SCH 40 PVC
liar all rl.)3 roke moll penmitr(ex.Cnwih•.Stim%I•.uiawe.I'1'et-6cn air.)
ft. It. m-
3.Well Use(check well use): I7.-4(,RfJEN
Water Supph•Well: I FRO'M 1 70 DIAMF:TFR %LOT SI7S: Tlrlcli?iF1s I MATERIAL
DAg6im.1tutal ONI.unicipaUT'abCtc 70 ft: ` 80 ft. 2 in, 010 SCH 46 I PVC
OGeothernlal llica(ing,'Coolin Supply) ORkidential Water Supply(single)
0industrialrContniercial DResidential Water Supply(skirr:d) !F1GROUT
RO.1 TO IIATBRLel I H11PL%CE1tI2NT li>TTIOD S.1170GNT
❑Irri'cation ' 62 ft. 3 rL AquaGuard ITremmie
Non-Water Supply}Yell:
3 ft.. 0 ft. Portland pour
C:}141c1nitorinr ❑Rcco�-cq•
Injection Well: n. rL
•Aquifcr Rcch-,irGe C1Gi011ndwa4cr Rcntcdi,miati 14..S`.vNDl(:RA►'EL PACK lit a 1 lkabte)
FROM TO :JLITFIRW.11 F:SIP1AMMENT MI-MOD
❑Aquifcr Storigc and Rcco}'cry ❑Silinity Barrier 80 ft.. 67 f1. SAND #2
❑Agiiifei Test ❑Sp6rdii-;atcr aminaagg
ft. ft.
❑Experinuntal Tcchnology ❑subsiaencc Coldfil
1 20.DRILLING LOG(attach additional sheets if necessar')
❑Geolhonnal(Closed Loop) OTracer FRONT T[T wi1'nwko n vitc cko
❑Gentth&jIlal iHe2tiltt1.+42001iu_e Mom) ❑Odtzr Iexplain under 921 Retuaris)J
0 ft. 80 It. Silt, sand and clay
ft. ft.
4.Date Well(s)Conlptoled, 3-18-22 WetllDf MW-34B
rt. rL
aa.Well lincatitin: ft,
Corning Incorporated N/A ft. ff tactility,011 mrNa.wc: Factlity-iD"0174pplkoblc? ft, ft. ®-I`U N 9$&-2-O'Z�
3900 Electronics Drive Raleigh, NC ft. fI. lf1;O+�� C1 r' "°� "'
Phy'k a]Addiast City'and Si
p 21.REhIARIL
Wake County 1715781482 Bentonite seal 67-63ft.
(:nuraly P.3MCI lrL••nufu:1liun No,(PIN)
ih.Liwtud.c and I.nngitrulc in de gmcslminutrslscegndsair"decimal dcj;rccs: 22.Certification.Of wen iv_td,Dare lat-long is;sunII R111)
35.832589 -78.604500 �� = rx -~y 3_/20/2022
Daic
6.is(ate)the well`s)r M {
Pentianent or oTein onry
Ih avgrdh�rlr�foa,rL^r`•, r.r; rt�•!i; ':r.�`-hid)n..a r,:erc1.ermyrn,rled ire rrcearr,ance
wi;ir 15A XCAC 02C:' -1 7-CA C.9:N1 Well CouStRlrfinn Srew4ards and dual a
7.Ls this a repair to an eeisting well: Yes. or XNo rgkr 0frili;re:„rrl bars fn'.rn pmr04-41.ro i6e,,iti it rimier.
lfINS'h.0 repiir,fill q'lf koovra wei(CarU7J11irlOrl lirfr rolrII.'Ulr acrid explobi rile navire of riir.
repair render 621 remark-xxvcleaa or rue Me hcrk of Mis form. 23.Site diagr anvor additional well details:
You niay use ilia back of this page to provide additional well site details or(sell
8.Number of wells eo"irtictcd• 1 Lonstrucliou details. You Ina+'aLo-attach additional pi&-s if necessan%
For rtualrll.•e ir:jerrlom or rlrw=n'af8r rupr*r wi•Ifi ONLY wirfr dor same caustraericat.}e:er iuo
Naomir Caw jinn. ,SUBMITTAL INSTUCTiONS.
9.Total well depth MOIVIAnd surface: 80 (ft,} 24a. For Ail Wells: Subudi this foml within 3(1 days of completion of well
For atr;ai iphr hells list ref/dmpihr it difkeem{exmjltblr=3Q209,ZIM 2@ MY?) eonstmction to lair following-.
IU.Static water level below lop of casing: (ft.) Dii•isiun of Water Resources,Information Processing Unit,
1f aurrr lesel is abome cuiihr,use'"+" 1617 Mail Service Center,Raleigh,NC 2 7 699-16 17
11.Borehole diameten 12/6 (in.) tab.For b►lrctirlu"Welly ONLI': In addition[o sending Ilbo form to the address in
24a niiat'e. also saliotit a copy of[Iris forul within 30 days of completionl of well
12.Well,coustrlection method: HSA/Mud• constmetiotb t0 the rollowilw:
(i.c.anger unary,cable.dimcl prlstti.c[c.t
Division of Water Resources,Undcrgraund injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh,NC.27699-1636
13a.Yield(1Tm) \letirod of test. 24c.For Water Supply&-Injection Wells:
Also subrni[ one copy of [his form within 30 days ofeempletion of
;yell corLs[niction to [lie county health deparlmcni of the cminte whcr>
13b.DisinfcYtion type; �Itnuunt
coamictcd.
Fonu GW-I `xonh Carolina fhparrn car of Ern Irvine.m alit vmrrrJ Resources-bivuiorr of Aatcr 8t-mrc) fee,ised Aqust-N)P
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