GW1-2022-06736_Well Construction - GW1_20220628

WELL CONSTRUCTION RECORD FarlrtcraalUioONLY:
Ths farm can be aisetl fuT sinric or mail iplc tee€)s
1.Well Contractor Information:
iJ.WAVER 1.nNE.S
John Eisenman FROM 1 T(1 I OE-501IPTION
Nell commclor i•.ame
4439A ft. (L
NC NVell Cortimcior Ccnificalion Nimber 15,OUTER CASING(for amilkased stcflsl OR LINER fit a (Icable)
1 FROM TO DCA.tit1ETGR TMCKNE55 )7ATERTA4
SAEDACCO Inc fL fl. ia.
Cml:p:my Milne id.INNER CASING OR BING ffi eo :rmall closed4c-o 1
bTtQN TU
I `I TO DU"ITTER I THICKNESS I NIATERIAL
2.Well construction Pel•mit#: N/A 0 R, 40 0. 2 h- SCH 40 PVC
iijr 4111
ft. R. in.
3,WO (chcckwell use): 17_Sf'ttI EN
Water t Tll MAMETFIt SLAT St7F TITICIGNESS- l NIATRRIAI.
iti ater Supply%Vellh
❑AgrIL•tllhlctl miunieipalrl1lblic 40 it. 50 ft. 2 .010 SCH 40 ' PVC
0Grothetmal(Headkel'Guolir Supply) ORtmidential Water Supply(single) fl: ft: in
OlndustriallContpicicial ©Rrsidcntiat Watcl'Supph'(shavA) 118.GROUT 70 li.tTERLIL LN[PL(CENIEVTNIETt1OD S.INIOUNT
❑hii gat ion 35 ft. 0 fL Portland Pour
Non-Water SuplIky Well:•
®klanitttrin'- ❑Racovcry
Injection Well ft. rL
❑Agriifct Recharge 06mutid>5nlcr Rcmcdiaiiur t4.5wNn1(:wt ti EL hAGK I€r a t il;embtel
'F'RilN1" TO 31pTFRNI. E\1PI..A(�f_\IF:\T\1}TN(1n
17Ag1iifcrSi4iagc;tii RcCn�'sn ❑5ahnit}'13amGr 50 R. 38 rt. SAND #2
❑AtluWi Tcst ❑5tPrnm-ltce D1•,yt, .- 7t. ft.
❑Eqrt:iirncntalTcchnotogy ❑Subsi&n:cCnimml
20.DRILLING LOG lattach additional sheds if rwessawil
❑GioFlls ntaal(Closed I ot7p) ❑TrtCt[ :FROM. TU IDCSGttfPT1QN fivb,han9ric.+.�lii'nK4 tr air �t,ttt.l
❑Guar.ennal iHeaI-1nE oliiig Mum) 00ilter OxVlain under 92.1-Rettaiks) 1 o ft. so (L Sandy Clay
-3/15/22 ft.. fL
4.Date Welt(S)Conlpleled: Well I]D# MW-34A ft: fL
Sa:Will Utcatuln:
Corning Incorporated N/A ft ft, II'
Facilill�iOwNrNa3w. Facilh )D4(ifgppliiblc) J`UN-9A Za2'-
R. f6
3900 Electronics Drive Raleigh, NC
Pltt'si al •ddivss City_atnl Zij� ""
21.RENIARKS `
Wake County 1715781482 Bentonite seal from 38-35ft
t'minly' W.1r>:0 la.n irc.�liun Na.fPiN)
Sb.1.46todc and Longitu&in,degreesfmihtitrAiscennds 61•-dceimaI dcgmcs: 22.[:crtificadnii:
35.832589
(iT'�icl1 Ixld,urrC I:titlau;�iz srrilicknl) .
-78.604500 �'` _
N � X_ "' — _. 3/20/2022
^Date
6.IS(arc: the well(s): ar ❑Tcinporat�'. s�
r s-igni��;�Ji7ir iui,r.- •. ,aPu,i�.��..•':+x�.::.,,Was 1::0'.,-7-vv��lructox?ilr.rrasarr.4nr�e•
lriol'15A JVf':1C:(i*C.`; +'� -r•::(ram Jt:.l7 W?nnl Cvssrrr+rtion Srwl fev.ds aml r)w a
7.LS:thts a repair to an existingwelti tO es or ONO) rbVrliis roreordtarn'{r of r wid rl rn;ilm•,wll rnewer,
if bia is r7 fepa&, vi"Jr tnoirvi�erfl ccTustnnriori brjaamriou aryl ex,Iohi rbe iiavire of r1le
repair remler 9)1 rRARPr..S SCi'J7LHJ or rm the i vvl-qf.rhi.1'furor. 23.Site diagram or additional well,details: -
you niay�-itse the back of this Nge to proti'hit.additionat tvell site elails or Ti-ell
8.Nuinbcr of�t'ells eonlbttucted: 1 _-- -_ ___ conslmetirirl detains. S''ou7ltav also attaeh additiotiat pages if mcessan•.
f yr ar1ii'ri14'e wJeC04m ar a(4-avdier siqppfy wells.ONLY l6di dul srcr7iArrinatructiuJr,.;ra Jl ixir,
.ratjpuiironr jor•J. - suBmimL wsirt[ST70NS':
9.'ToW welldepth homy land mirfacei 50 (ft,) 24a. For All.Wells, Submit this umi within.36 days'of cainpletiou of well
Fc-r tnJlirlph,Irl'iir lisr aff dep-dn ifdiffeeenr(exwppfe-Je@299'iuul 2@/&?'y constilictipri to tlic 1501101ing:
11).Static water level below lop of casin(;: - (jy,j Division of Water Rrsaurce.5,Information Pruc+-'ssing Unit,
If Iviv t 1eVei Zi r;lluee aystN ,use'"+" - 160 Mail Service Center,Rile ghNC 2760-1617-
11.IinTebote diaMetci:8 (in.) tab.EnK LpfgeifUt ^IIv ONLY; In addition to sending Ow four to IN.-address in
21a above. also submit a copy trf this form Mthin W dity's of eanmpletion or wall
11,%Veil.lLVRSflTtctiorl method; HSA construction to the fotlowing_
(i.c-augger._iDlaty,cable diTern Fish,cfc..1
'Division of Water Resources,Underground injection Control Ptunratn,
FOR WATER SUPPLY WELLS ONLY: 1636 Alain Service Center.Raleigh,NC 276!0)-1636
[3:t Vicki(gpnrj 24c_Far iW':ttcr Supply&injection Wells:
Method of test:
Also submit idle ec>pp of this faun a','ithiu 30 days of eonlpletion of
13b.Disinfection tvpe: Amount: well constniction to ttae conmy Itcallh depannl::ni of the cminly tehcre
ca�n4in14tt d.
Fonn OW-1 Norih Carolina and Sl:r,aW Rcaiurces-Uiaiiior.of Watcr B non-u Revised aWLW.K?l3
I