GW1-2022-09544_Well Construction - GW1_20221014

WELL CONSTRUMON RECORD
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1.Weil Contractor Inforuratlort:
14AV [EK7t)NES is
John Eisenman t FROM to nt'erlttMON
r Well Qvirictor talus:. ft. ft,fL
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4439 tG
NC%McllCoidI 1or€L-ri5=1iouNumber 2{:OttTERf Gi6'acmntftwxa ➢kiriklURt.tihMllfi"1 1
Fatilt TU nTAIMETER THICKNESS MAT"AL
SARDACCO Inc 0 h. 11 tL 2" f Ala SCH-40 PVC
01114mi)tv.-rtac 'ACL INtLtKASING ORTU8iNQa_,i40ieii53t'id9i ii i
$ MOM TO OtA1tETHR THIC f{tiE53 S7>TEnLAL
2.Nvvjl Construction Permit:: h. 14.
1Jst rift k"rjA---aivllpe=4 Ox.4ountc>S.xv.Kwiamv'fIZececa r!r_t -
3.Well VW(check wdl use): a7_`tic LrEEnr
Water Stipp k. Well: t EsRI}A1 TO` nTtiAl�7ift Sf07SF73: rIriCKYTaS;1 {1hTnnl,tL
t epicultutal IJhluniciprlll'ftUlic 11 tt• 21 2^ in. 010 SCH-40 PVC
Mothemul(ItleminuiCooling Supp�y) E Resift0ai%'later Supph,(tingle) ft. it. to
L IRdttstrial ColTuitari ia! 011csidzutiat)bracer Supply(shared)
FRONT TD St\TERT L U,%IPt qC`. IIENT3IVII[OD ,tllOtl\W
Non-W ale 0 h. 5 tl, Portland Pour
Non-Wtrlcr StFt}pC,�Well:
�A'lonilr?rinfi ❑Eiccm'cTy tt. tt,
injection Well;
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DAquiferft-hargc GGuaundwatcrReundiatton 14sAPi®JCcttllsL'I:PAC fify`i1GRe)777,j :n
Cnl/5T Til At:tlt:tYF41.. _1?�lpi..tCFq€.riTAlk1'nrlfl
O ttpFifcr Storapto and Rccocefy 135a1init'Ranier tt. Sand #2
ClAquiferTO CJStormwaterOniimge tt,g ft, 21 A,
G1HX'It;:ritocumi fthnolog,C OSnbsid.^ncc Colutai rr BRi I tNt;I.UQ's"{nt3ftf Ailita11111/tt5tltCC4tf RCCl4itlr'r
LlC"xatlirntctl(Closed Loop) 13Trli'et I moil I TO GtrsGUTEl19}xttonrhan7nrs�.la,nasssa "y wuiarf '
MG,viliemFtd(ilentho''Cuoltua Return) ❑4]tlic'r(vi lam under AIZ I Retuatl:s) See gho s log n. �
ft. fl.
4.Date Well(s)Completed: 9/13/22 Well ID#M-23
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Sa.Well Location:
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Honeywell tr FacitEty%tautscrNaltm Factlttl ttl„rifappitablc) to il.
636 John Riegel Rd., Riegelwood, NC, 28456 tT. n. Uf
Pln-seal Addrss.CJt+.and Zip
Columbus Bentonite seal from 5-9'
C-oa tib, Noel likru+r`tratiDn No.1ITN't
5h.Latitude and Longitude in dcgrcrl/mluutc ifsecoadt:as,decimal degrees: ,�CcrtifYrmtimu:
(if aelr iwJJ,uae hxL'it,rr_is srJrrti:nl►
N `v 9/19/2022
Date
6.Ls(am)the well(s): EPeroranent or t7Tem porat3
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u ir,Y l M NC AC 02C ., J . C re. ++ ttZiarr Wrdf ComOrrtrios Sr,sr;)miss wilt t!_Wo o
7.4 thix n repair to an existiug vvelt: Mrr� or KNo a.prcl'ifs r wror0jai,I4'C2r pmr rltiw4f rrr tryr'HYIt fia'Aw.
lf' %i fill.X116-moili wril revonleclion'11(ferowri4n wal t"ApT bt rho Ito wer of
rep.fr ururrr 021 revwr:hr t'eiWaP ar tvr thr..&wk of this form.. 23.Site dltr;rain or additional well details;
You nlay use the b ch of dds;(rage to piolide additiomil hell site delails or iseil
8.Numberof►tells constructed: 1 censuu:lion des!lids. You nov atso aliaLli adilitiotLri p it es if iwcL-,uary.
Far>1s tJtitVr li;i<v rt+»rtr aell-fewee tlrrgrfr motifs OVl v a'trfr(he SrfHt @ a<rnstt atrtigtr.Yt:rr Coo
a.brunt„»o f"r». SLtli11 TTAI:INSTEtiC'iTONS
+).Total well depth Mo%land sariale: 21 (ty,) 24a. For All Wells Submit this form within Rt days of contpiction of ivell
For,i,oWpfe welh lig r+lt foplt:s y G_rd11l"r) constrmeUon to dw foltottiug;
I
10.Static water level below top of casimt: try,) IlivNian of Water Rls urces,tnformathln Processing Unit,
if nw er trot is al+re cnsrr+,;,life"i" t617 Avail Service Center,Raleigh,NC 27699-160
11.Borehole diameter:8.25" (in) 24b,filr Intcea uF Weltc OMNI, in additsou to sending tlw fllmt to tlt*addrm in
2-a above. also submit a copy of tl is funu wilhin 30 days of completion of well
12,Well consuvedou tnrthod:HSA constmetion to tht fallowing-
Oct.au¢-r fa tsti.curare,duct posit ctc.l Division of Water Rcaaar ces,Undergound Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: t636 Alait Service 'enter.Raleigh,NC 27699-1636
13a,VIM 4jq►m) blcihud of sent. 14c.for Water S gaix die Ipj"thm.Wetly!
Also submit arse copy of this foiniltsilbin 30 days ofcomple'liouof
13h.DLAiufcctiau kylfc: __. Amount: _ ._...a..� .. .,
well consiructifin to the county heal'iit depavinetlt of the county n'herr
_ y constructer)
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Penn G%Y-1 Nonh C3foluva C*:pagtrtcra of i uVitmflwin wA Natural Rc:uses-Division of Wmet rt�otrt� flex ised r5trgtlYt'o 13
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