GW1-2022-06737_Well Construction - GW1_20220628

WELL CONSTRICTION RECORD
For irtsnul!Ua;.ONLY:
This Wren can tki xiwd far sinric or nidltipk wells
1.Well Contr:actorInformation:
14.%VATER ZON►s
John Eisenman FROM I TO OF_q-1KIPrIoN
\fell Connector iranh ft, ft,
4439A
NC Rrcll Contrlclor Cerlificalit n Niurber 15.OUTER CASING(far mullkased wellcl OR LINER tit a 1 flca6"I
FROM TQ DU+IIF,TFIt THICK.E55 1ATERIAL
SAEDACCO Inc 0 ft. 1 150 (t. 6 ill. SCH 40 PVC
Con>fl;un Nome 16.INNER CASING OR TUBING' �c<lhet,nal iluM c1 lon}
FROM To D12"IETEIt mICKNESS L MATERIAL
2.Well.Construction Pel'mit#: N/A 0 ft, 155 ft, 2 SCH 40 PVC
Mir ail g.)jiron!cKr.Nlrr-im(is'(i-r. It7}kdw,ex.) rt, rt. in
3,Wr11.Gsc{chcckwcll usc); 17_S(Rt3E N
Water Supply Well: FROM 1 To Dra1rFTFR SLOTS171F. THICKNir-S5 I MATFRI41.
OAFticulturai Clbf►micipalePublic , 155 ft. ! 165 ft;. 2 in. .016 SCH 40 PVC
Gcothe,mial MeaVngCovlir„'Suppl}-) L�R e)csidential Water Supply(siniil (t' tI tf is
C7
0IndustriallConuticicial ©Rcsidcntial kWatcr Suppl+'(shared) I&ROUT To MATERIAL. I E1tPL+CE1ff_Nr 1f1"fiton c.+1[otrNr
❑Itripifion 149 ft. 0 (L Portland Tremmie
Non-Wester Supply Well:
Mmonit5Apg. . ❑Recovery
injecllon Well: L rL
❑Aquifer Rc'h iigc' 17Gronrldt+:iacT RCntcdiatioli i9.SANb1GRAVEL PACK lira 0icatite)
'i'R1111 Tt7 .11A'rF,RWI, F:11P AC"Vi_NT14'rn[Ill
❑AquMr.Storpgc aiid RCC"1vzTy ❑S3linit}-88mcr 165 ft. 152 f6 SAND #2
❑Aquifer Test ❑SOnTnivater Drainage
17Experimcatal Tcchnology. ❑Subsi Lie nce Can!rxi
20,DRILLING LOG(attach additional sheets if necessary)
❑Geothentud(Closed Loop) ❑Tracer _FROM TO I SCRiPTION(mbr,),artinc a,sal'nKkt. aili we.ctel
❑GLothemlal'(Heating+Cuolitlg Return) ❑Other(rxplam under 92l'Retnalls) o ft. 77 (1. Saprolite / PWR
77 ft.. 165 ft. Bedrock
4.Date Well(s)Ctirllprcled: 4-11-22 Well ID# MW-30D
(L t{.-:.-
5a:Well Location: ft, fti
Corning Incorporated N/A O. Ft. . 2022
Faclit}:ClnncrTlanic Eaclit?TDT IiCappli iblc} . 3 Uri:
. ft. ft, lflisGi;iiiw:2 �1 .PiC>C+9�';r:f"
3900 Electronics Drive - Raleigh, NC ft., it.
Pllnskal Addars.Cin•.and Zip 21.RCLM1LM1110S
Wake County 1715781482 149 - 152ft. Bentonite seal
Calln1v P;arvel ILL,3MrtC;liipn No,(PIN). I
6.14ludc and Lonkipulc in ticglrcclminutcslsccnnds nr decimal dcge ; 22.Certification:-
{itmull field,vial latloug b;Sidtieicw7
35.832589 -78.604500 �.� `J -='� — —' 4/20/2022
5ignamrc b 51 l.0 — Datc —tea
6.LS{arc).the tia'cll(s): MPennanent or ❑Temporan' "t. � ,t✓� ,fad � - a 1
1h aignu,�n,er(ur,r.. rf�.i, -. / r+:e:�yzyrn7nleteil iu ocrvrranrr
adti(15,1 Jvc.tG OdC-•';< r, 5:( eG 't:,Q3ali Neff Cvirathrtion Srkuxlcvds and Akira
7.Ls this a iviiair in an eiistin�ncll: MYes or ❑No. o-vy of rhit reel ril hers kern rimrided ra th.e mm11 Oieiier,
If rhrs is n.repjlr,fui w 41"(1474 Wed C(18i;11,71100/IIforrnav',li Anil explcthl the,mrare of rile
rrpairicndr la 821 reenur wseciian or-cvi fherl,rrl;of rhos furor. 23.Site diai;ram or addhional Well details:
You may-use the back of this pay:to provide additional well site details,or well
S.Number of w0ls etanstrueted' 1 construction delaits. -I''ou iirav also altach additional pages if Mxessar.v
Fur nu,rrliJ'e/.lCi'rl4Y/1 JP.df•Yhq'il7t'r A11',lY,(5'let'rrs.a,�'LY mlrii r6asrrme enrestruitiwr,yral c•ar,
aubnrir nor foriu. SUBMITTAL-iNSTLICTiONS
9.Total well.delit6'belois._land surface. 16-9 (fl;) 24m For All %Fells: Submit this form within 30 da}'s.af completion of Nell
For inarrlvle icrrlrh.ir aU rlelvin'ij di erew{Icwaipre-3 z:09'wi l 2@ eonslnictipn to dic follosiing:
IU.Static water level below top of casing' ({y,) DivLsion of Water Resources,Information Processing Unit,
1f u'aterlrvrl ti a'liol'e rdslirg,dx'"+" 1617 Mail Service(':enter,Ralcigh,,NC 2 7697-16 1 7
11.Borehole diameter.12/6 (in.) 24b.F_fir fit i M'"tW lc ONLY: In addition to sending 11w foml tothe addmss in
24a abate: also submit a copy of this forn within 10 days of completion of well
12.Well cotrstnactiou method: HSA/Air Co1lSimctimr to[lie f0110a611e_
(i.e.auger.ruiary.cable.direct gush c(cj
Division.of Water Resources,UndergroundInjection Control Progreso(,
FOR WATER SUPPLY WELLS ONLY; i636 Mu I Scn'ice Center.Raleigh;NC 27699-1636
13a,Yield(gwpm) Method of test: 24c-For Water Supply&Injection WON:
Also submit one copp of this fornrwithin 3(i days ofcollipletionof
13b.Disinfection n'pt r Amount; =11 conmrarripn to the county health department of the crnmh•where
cmivr tctcd.
Fonn OW-1 Nonh C=Iina(xpsnn;enr of Ent iromix ru and Minim]Rev.1urces—Division of 1Vaicr Rmo rces Revised August_Ht l:l