GW1-2023-02193_Well Construction - GW1_20230306

WELL CONSTRUCTION RECORD For trlcriolUscONLY:.
'Ellis Corm sun be Uwa for single of mulliplc 1SCBs
1.�tu'�lt.Cautractnrr Pllfortnttiau:
`4z.R'A.TERZONFS .
John Eisenman MOM. in I DFSCRIPTION
W 1 Cara MOT N:IM4
4439-A ft. ft.
NC Well CardmciorCcnificalionNitwb r AS.'OUTF.R'Ci4SiNG 2f W'dalU-e&r'94e0A OR LiNER(if, tleabk)
FROM 1 TO - nr METER TAIM-NESS MATERIAL
SAEDACCO Inc 0 ft. 6 f1. 2" 1a. SCH-40 PVC
(:oasP;ut1 Naps L&INNER CASiN_G OR'TU]BING i ea/t7lfttl tl l't9411 IOri l"'
FROM TO DUMETER THICE:.WF.SS MATERM-L
2.Well Consttuctiria t'elulit#: R, fr.
Lfsi 4111 rAplinible wellprnrritsOx,.Cnunty,SIUM.bi-IriafWe'frye:6crt f}. rt. i><
3.Wet Use(c4ccl:N1ctl n5c): I7:SCRLlN
WVaterSDplikyWell. FROM TO RLt\IE{Tt:R Sr.OTS17): T11ICKN1S5 I MATRRrdt,
Uiizr(cnitttral tJiWi(inicipl6Tublic 6 ft. 16 R. 2^ in .010 9CH-40 PVC
©Geotltem�t(Fleatiiig/CoolingSuppl`) ©ResndeittiabWater Supply(single)
h. fL In,
12ltldustri*Couintercial OResidential Water Suppb-(slurred) A&GROiIT•. _
FROM 70. MATERIAL I EXPLACEM ENT METHOD&AMOUNT
❑hri Ileon 0 ft. 3 ff. Portland pour
Nan=WatcrSu tip l}'WPM ft. ft.
5d14lanitorin1q 1311=oycry
IRjeclion Well: ft. ft.
❑Aquifer Rcc.hargc laGmtindrt wlcrRaiacdiaiian t9iSANDIf;RtYE&CACKIif'u'rilicrDtcl:`
"f+R1DM TO NIATMAL .VA VI ACCAIF.NT SIM100
17A,quifcr:Storagc altd Recovery ❑Salinity Aarricr 5 R. 16 ft. Sand #2
❑ArptiierTest, ❑5toflnn ttcrbriinage
R. it.
I7Experimcn1al Technology Mulisidcrlcc Condral
Ia.DRILLING LOG7alWh iddlfronid sheets if iu 6mryl
❑Geulltenual i CQustd Loop} ❑Trat er FROM To MCItIPTIOv rtnbr.>;rntnca srilur,Mq h u,' Jon wc,dot
❑Gcothennal Meating Caohue Return) ❑Odrer(esplaiu rutder.:421 Retuad s) 1 0 fL 16 fi. Silt/sand/clay
fC fL 1...
4.Date WVeU.(s)Cnugdeted:'2-9-23 Well iD#P14W-5R
5a:Well l:ricrrtinn: rl. rc, MAR 0 `L
Former Planters Chemical Company
FacJliiy,10ivrcrNnme Facility tI)k 6 a ip nblc),
610 Commerce St., Fayetteville, NC, 28305
Physi^,atl riidress City:sndZip' -2l.REhrARKS .
Cumberland Replacement well; bentonite seal from 3-5'
G'oriull }'orcC]1[N_mliflC idDu No.(PIN)
5b.,Liltitudc anil I-ringittliic in dcgl'res/mintutes/seconds or decimal degrees: 22.CcrtifccaHoa:
(if��ell lKld,t�rr l;rU1uug J c xrdticJ�rd)
]` W 2/24/2023
of—,""L!
G.Is(Ake)the a'c11(ti): Xperinanent or ❑Tentporatl' � rgnh,g rlrir foi,r r:JtE1%ih t� fl y j nis t�c�j run_xJrircJeri 8r,meevnlmcr
Ivirh/S+t,1rGtC OeC.�;i��-J.�+; r(;�e.;�:'t',n;O(7 ni'iJ G7lrSrrYlfrlNr SrarXJQ!{Jd elJl(l JrJnr«
7.Ia th6 a rc[taii•fu au&istinw wcW ]i1Ves fir ❑NIb lYi(ir.nf LJtJv r�frir,l hf1S frern prryPirled Hi Jlre aul/mv,ier,
((thus Jr a mplii,fill enrr krrrnra Ji`rfd cr rasnu�Jfnri h(rpraJrrlon mJAr_tfrfnhl rbr+JpxJ,re of the
reprfr rtrrrfrr to?1"rcmards srrris,n aran the hra:C of rhls farm. 23:Site diagram or.additional.well defaib4
You nay use dia bac6 of this page to Tiovida'addilional well site details,or well
8.Number of hells constructed: 1 coustnt.etion del iiis. You 1u#als6 affacli additiorid p u8es if inxess fly.
For titahiple Jirfeerlvn ur ami-itwer sulJJrly wells.ONLV irJdi fiesrrrrrr emrsteucffar,pear nia
srJ(rJnirunc form. SUBME f IL INS`I•UCTiONR„
9.Total hell depth helot`land surface;: 16 (ft.) 24a..For All Wells: Siibntil this form wilhiti 30 dj3,s-of cdtuplclion or is-ell
For nmlrl plc lvrdfr l(;M afl depths frdlfferou texarnple-3 t 21V'aml n 10i) ' eon51ructipn to the folloning:
10.Static'
rater levet below rot)of cashtgs ((1,) Ui�avian of WVptcr Rcsnurces,Inforntutiun Ptuicssing Uuit,
tVlj rev level Is uLare cusfrrr,use'"f^ 1617 NbU Set-vice Center..Raleigh,NC 27699-1617
11,llarchotc diameter.8.25^- (Ind 24b:F�[Fititetiort WW'eW ONLY: In addition to sending ilk font to ilia address in
24aal6e. also submit a.copy"of this forril within 10 dm}s'of completion of iu:11.
12.Wcll construction ntcthod: HSA Constructioir louse`'followitm-
(i.c.augcc roust)`,cable:divot pisslc cud}
Iliviyiou of Water Resourcca,Underground ittjectlen ControlProgr-aut,
FOR WATER SUPPLY WELLS ONLY 1636 AM[Service Center.Raleigh,NC 276"-1636
13a,Vicld(glint) .11411041 of test: 24,�-For Water Supply&fniectlim.WVells:.
Also.submit ow-crapy of this'farni within 30 Aay 0f colupleti0n.af
136.Ulzinfr etiuo ape: Amount: wvclb construction to the county health department of the eainty whCre
constntctcd, I I
Fonil G1V-1 Nonli C;,Iall m Ucpanmanl.of Eaviromucta and NautM Rcmurce9-Divs Ion of Mlatcr ft-"-otro-- kv-1srd August l013