GW1--03243_Well Construction - GW1_20230511

'WELL CONSTRu C'f IOIN RECORD Farb em!Use ONLY:
This farm can be used far single or rnultipk wells-
I • \ :
1.Welt.Contractor Information:
•
`•u:WATL'RZONIS. '. . I •
Brian Ewing FROM 'Kt DLSCIOPTION
\l I Corgragor N irae I ft. fL
ft. ft. I ,
4240-B
NC Well Contractor Certification Nu whey
IS.OUTER CASING(tor ridlti=cisrd titilsl'OR LINL'R-fitap ticablel'. .:. ..
FROM TO DIA T,,TF.R 'frllaiNESS MATERIAL
SAEDACCO Inc 0 ft. 46 ft. 2" is SCH-40 PVC
t'snrlp;utyN:ru4 ,ItiR'INNERCASINGOR.TD8tNG:iatstiheirnuichand-lone! --'-:-, +
FROM M TO . • DIAMETER TUICKNESS MATERIAL
2.11(dt Construct in Permit#: ft. .ft. .,im
Lift oil a licabfe xrltprnnJ' (Le.County.Stale,t%itriarre.b7iedeit ere.) ,
ft.• ft. in.
3.1tVrlt Use(check well use): .t7:selt4N . ..• . .
Watar Supply Well: Room . TO UtA rP.TER sr,nrSin TIllaCNrss s1ATr.RIAI,
•. El Agricultural Cllvftiliicipal,Poblia 46 •IL- 56 R� 2" in 010 SCH-40 PVC
i3Geo mat at(BeatingiCooli(lg Supply) .DResidential Water Supply(single) • ft• It. in,
©ludustriaUConmtercial DResidential\Vatec.Supply(shared) tt:GROUT'•.
FROM ' •TO. MATERT L I EMPLICESIENT31Ef110D&.010UNT •
Dkripitian ft. ft,
Non•AVater Supply Well: .
itMonitaring IDReetWer R* O..
y'
Injection Well: ft. •ft
°Aquifer Recharge O cironndwaler Rcnicdii'lion '14 SANDIt:RAVEL`PACIZ(if aitplh..1 e►"-• • — - - ' --
tiROs1 TO • si,rreRr 1, •Rs1P1.ACEMENT M THOu -
0Agllifcr.Sttiragc and Rceovely DSalinity Hairier 44 R. 56 f1. FILTER SAND # 2
D Aquifer Test OStotiliw itcr Drain age
• C]Ei perimenthl Technology i75tthsidcncc.Cardr>al
1,;211:DRtLIANG,LOG7aittiCk addillunatsheets'if ircccssan•i`
DGeothemiat(Closed Loop) .DTricer FROM TO • • DESCRIPTiON twaor,lrrnfiica,tri4'owli hrx.:sw;n:+rn,ttea
DGeotltenual(Fleatine+Cooling Room) DOther(explain under 421 Refunds) 0 .ft. 10 - ft. FILL SILT AND SAND
10 ft. 56 ft. WET SAND CLAN' L.
i / '+
4.Date Well(s)f'Anlpleted: 4-3-23 Well i NAD-PZ-1 t~ '
ft. ft.
So,Well Location: ft.- (t. MAY 1 1 2023
Paul Abril ft.- ft, ItitOTPAr;c rn• Ufa
Facility/Owner Nano Facility ON(i[appli able), R. ft. + Cite d�l[i
4216 Marshwood Lake Rd., Fayetteville, NC, 28306 R. ft. '
l'litsical Address.City.and Zip 21 REMARH$'
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Cumberland PIEZOMETER INSTALLED.' BENTONITE SEAL 42 TO
County Patent It iitittCidan No,(MN) 44'
s
56.I..ititude mil Longituile in degrees/minutes/seconds Or decimal degrees: 22.Certification:
(if well l-Ntd,one I ioug ls'OGniciiaa)
•
' li; W Bruin Enron 4/12/2023
Sigrutur'ofCcnificdWellCollimator. �g g Dale
6.iS(are)the•\1'C1A(+J): CPCr71131ICttt _of $ITCIri1101 1t. Hy signing Mir form.1 hereby rerti(r rher the rtell(x)wart way)conprircrerl in.mron'-kijcr
With JSA CAC OW,0100 or ZSA NCAC 02 C,0200 ll e1J Coustnrrrien Srarxlar+ts crud Doer a
7.Is this a repair to an costing well: l-JYes or No 4:47yof rlric e((rini 1.0y bervi r ukd re Me%mil turner,
If th(s ft a tsp.a)r,fill,--Oc kaoital ivCJ cnril-rifcritta iirfomlrrk.ti trod t:vpiahi the rivrare of die -
repair under On.remarks siuiaa co-cm'the beer)of this form23:Slte.dlagrant or additional well details:
You may use the,back of this page to provide additional well site detailsor.Well
R.Number of welts iotistrueted: 1 • • consituctiolt details, You May:1Lti attach additional pages if ticcessnry.-
For uuilydpke IAfeedp,i o nrNI-!eater a;ppnk•Jreldr ONLY i'Jdi the srtme carrstntrtiwr,y eu ma
szentit WMPrin. - SUDAiITTAL INSTIJCTiONS•
9.Total well depth beta*land stitiace: 56 (ft.) 24a. For Alt Wells: Sitbtnit this fonts within 30 daps of completion of well
Fornrahiple's'easlisrtelldepthsifellfti'renrrenrmpfe-Y@?,)0'trod2C1100) •cons(Inctionto the following: '
1(1.Stacie water level below top of casing: (11,) Diyissuu of Wlitar ReSourceli,tnformatirin Processing Unit,
If wtver level is irbove criabtg,ilii'"+" 1617 Afail.Scrvice Center,Ralei ,NC 27699-1617
I1.Borehole diameter,8.25" Om) 24k.For i)(jecliart Wells ONLY: hi addition to•sending the fonu to the address in
24a above, also submit a copy of this fonu within 30 days sof completion of full
I2,Nell catistruction method:AUGER •coilstrucilott totke following'
(i.c.3agcrr,rota,},cable,direct push etc.} •
Division of Water.Resourccs,Underground Injection Control.Pi'ogr`atu,
FOR WATER SUPPLY WELLS ONLY: 1636 Malt Service Center,Raleigh,NC 27699-1636
I3a,!fill(WO Method of test: 24e.For Water Suplilv..&Injection Was:.
Also submit onecopy of this form within 30 daysoIcoutpletioti of
13b.Disinfection type: Amount: well constnictian to the calmly health department or die coimty.w'heie
constwetcd.
Feria OW-I Nook Catalina Depaniaeru of Environment and Natural Resources-Dien lois of Water RrBolrcm Revised Auguste 2013