GW1-2023-00362_Well Construction - GW1_20230103

WELL CONSTRUCTION RECORD
\ '� For ilusmal Use ONLY: {
'171iis form can be ussd for single or tnultipk asps'
1.Well.Contmetor hifonn"ation:
'"MAVATER ZONES-
To 0MCROMON
tVclEContrsnoiiZ�tlic ft. ft.
4478A fG ft.
NC.Wa Contractor r-cnif=tionNumber :18 OUTERCASING(fhrewtlI4dsrd',&ifl1ORLINER![fa ticabk)'
FROM TO DBll1rF,'rBR- TnICKVESS MATERIAL
SAEDACCO Inc 0 J.L. 1 28 fL 2" " ;a. I SCH-40 PVC-
Coa>P;uryNauw X-INNERCASING011.Tf1BING kiwilterm2iclosed-too :.-
FRoar To OIAAWCER THICKNESS MAURUL
2.Wc11 Constivetion_Pcrl[rtit 4: ft, ft, dd
J frt ufl opplicrtGfe vcr11 penWts fie.Caunry Suae,Yariarrce.T/�`erd err,.J
. . -
3.We11.W a(chcsle wdli.asej: K 7:SCRs CN
Water Supply Welft - — ----- FROM TO ormwirmER I srorsin i TnlCKNMS I arATaarar:
©e�grirtiltgtal .0muildipal tblic za R. 48 ft. 2" hiO10 SCH-40 PVC
17Geothennal(Heatin000ling supply) ❑Resideutiat Water Supply(single) % ft;. m,
MidustriallCotuntercial 1311csidentiaL Water Supply(slxined) 18:GRQIJr
FROAr - TO 1fATERrAL L�AIPLACENMT31RHIODBAAIOMT
❑lrti atio]l
Non--Water SupplyNVefl: tt._ tt,
IMMonttoring - 13ltccove '
IaJectlon�YeO:` _ rt.: tt. -
C7Act11rfefRCcharga; acrollmnalefRcincdialioa °t9:'SANDIGR,AVEL PACK fir IlicaDlxY,
`BROAr • TO AIATkRIAI, nhlnt.ACT,t1r:NTwwon
f3a4iinifcrSlorlge Ind Rc cbvsty C7Sa�linityl3atiact 26 R, A8 . ft. Filtered Sand #2
DAqw(crT6t ❑Slvmrnatct l}raiei tgc
l3)±xpCcimental Toclnw[o 17Stlbsida vies Control -zn DR1IMNG LOG(attack additiodid streets Checessan•)
❑Geodiennal(Closed Loop) ❑Tratter FROM, TO . DrseRarrtos mbr.Mardnc"wn'nlckr. e. n*4c1e.I
❑ ieolhetntat(FIeatinglCaoiiu Retum) ❑Other(explaut wider#21 Remaift) 1 0 f.. 58 ft, PWR/Sand
58 fL 60 It. Granite
4.Date Wett(g)Coulpleled: 11-15-22 t CHID#MWS=3,
ft, ft.
3a.We11 Ltrcathm: ft.
Vickers Village• h, ft.
Facilit}�Dlvopr7Jamc FacOhy IDl!(iFappWable) R. (t.
271 Jack Bennett Rd., Chapel Hill, NC,, 27517
rt. tt. Irfias: .a�n #'rt j Uric
plrysicai Add s Ciry._d Zip ;.21.RE&URKS
Chatham Bentonite .seal from 241'-26'
Coanly Partd WfillificalirnlNo,(PIN)
511.l:atitudr and iLungitudc in_ttcgl�et:s/minutealseciinds or decimal dc};I'ses: 22.Certilientigne i'
(INII ll field:one i,'ttliong is sufncknt) ��6
35..81805 N -79:07789. �Y ��� "� 12/4/2022
ofCcRl[rcd Wcn Cant=y i Date
6,is(are)We:well(s): 13Petnnauent or. MTemporaty..
- 1!}•xrgning ihls form•f Prerrbv aerrijythuu.thr ur�l{sJ tsns{wrnJ curssrnrcferl frr irerorrlmice
ar1th 15A MC 02C•0100 or ISA NCAC 02C,0200 Well Cwtstroerfan'Srarulards tvid Avere
7.Ia this a rrrpairto,an e",ng'well: ❑Yes• or EM) colrpojrhlr rrcoMlutsbeea pmrldidtnrfr urll on,rer,
If1his,li a repak.fltUark7Avr Ivell mw;i,ctror btforawrlar wul exptobr t/ae iwrure'ojrhe V r
relmir under d3J remaAsaretina or aui da lark of ifi6 forur 23.Site diagram o"r additional%vA details:
You.to}y use the back of[his page to provide additional ws ll site details ar u•_elt.
8.Number of~fells constructer➢: 1 constiuction details You a6y also aiiach addtonal pages if ttecessmy.
For marl#plr lroWrlwl orrummiurer.supply Ivells'ONLY ntlh rly-srineconswirertwr,you edn
ro8vuumleorm. . �CiBl11ITTAL(N&'li'CTC'!'fONS
9.Total well deptU betmt•laand Surface: 48 244L For Ail Well,: Subirdt this fdrm Within 3D days of completion of well
For maaltlple wells list alldeprhs IfdljJerew lextupple-MW onrl MM y conSlntction t0 the foltolNina: 1;
10.Static water level below top of casing: 00 Division of Water R6otir&4,1hilarmution Processing Unit,
If11wer lrged is irpovr c'uaiilx-esr"+" Ifil 7 Rf,2i1 Sm'ice Center,Rrlc*.NC 27609-1617
li,Borehole diameter,6" tab.Far fn inn'MMONLY: ;In addition to sending the fort to the addim in.,
246above.also submit a.copy of this,fort wilbin 30 days of cotilpletian of hell
12.Well construction method: Sonic coustiuctlouto the follotvit19'
(i.e.pager,roft q'•cablc6 divers paste c(c.) Dh Lvlou of Water Resout ccs,Under
ground Lljcetion Control Program,
FOR WATER SUPPLY WELLS ONLY: NI_Y: 1636 MO Senice Center,Raleigh, C-276"4636
13a.Yidd(Jgpm,) Amcthod of test: 24c.For Water:Sup&&&Ipjcctton Wctls:
Also-sitbmit one copy of this folnl 1 ithin 30 days Of Completion of
13b.Disinfection type: Amount: 1vcil corlstntction to the calmly health department of the counh•where
_ constaictcd.
FarmGW-L Nor*CamlimDeponrmofEmilul mulandNarurW Resources-Divi;lonofSVal&Reialues RcOsedA(gist2113