GW1--03339_Well Construction - GW1_20230512

WELL CONSTRUcrm RECORD For intcrnull Use ONLY:
This forte can bc used for single or multiple n•clis
1.Well Contractor information:
ILL ATERZONES
Rich Lemire FROM TO pFSCRtFr1O\
%101 Corartctor Nantc ft. ft,
2593A
NC lGell ConnuclorCetiifucation Number
1S:DUTE[t`CASi�iGfur.nlulilerseilweFlsl'ORGiNIERfIt'-"e Ileuhk
FROM To Dr-015TER T111CKNEaS MAURL
SAEDACCO Inc 0 fL 92 fL 6" In. SCH-40 PVC
Cainp:utlNam: 1&4N.UERa_i' N_G:Olt" SING iaihei tclu""4iSi` ,
FRO5r TO DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit R: NSA 0 ft. 95 R. 2^ tlL SCH-40 PVC
List ell nppilir uble well pawky fix.Cnmrtp.Slam,l arialwe,Ir ecd[O en:) -
3,Nell Use(chcelcwell use): 17sS4R!F N "
Water SuppiyWelt- FROM TO I ptnxF:rt:tt I starstrF. I Tltl('tiYrtiS I tt3rFRLtit.
ClAgricultui-al ❑MtlnicipaUhtblic 95 It. 105 fi. 2° in, .010 SCH-40 PVC
❑Gcothemtal(Heating Cooling Supply) ❑Residential Water Supply(single) ft. fL in,
❑lndustriaUContmtarcial ©Residential Water Supply(slxtred) FROM TO mATEkin I E"%rPLICEFIENT.NIMIOaSAMOUNT
❑Im atlon 0 fL 89 fL PORTLAND TREMMIE
Non-WaterSttpply Well: rut. tt
Mhlonitoring ❑Rccoveq•
injection Welt: ft. tL
❑AquifcrRecharge ❑GroutxmaicrRcotcdiatian 19"SANDr'GRAVEI"CACbUtti iltuhtel'
F:MMI.AC:I:HF.\T HETIIOI►
❑Agoifcr Storage aldRecovery ❑Salinin'6atrier FRpM 10
93 ft. 105 fl. SAND MAT6R1A1. #2
❑Ar)tlifcrT¢st ❑5tomnlniterDr,►inagc
❑E.yscrimcuial Technology ❑Subsidence Control
2a;-DRIG'L1NG'I:bGa'all�ch-adrlltiunal3hcef3itr►rccs`sui•t ._ _ _
❑Geothemral(ClusedLoup) ❑Tracer FROM To DESCRIPTIONrrnlar mrrrp,a#.1
❑Getttller al(HeatinglCuoling Return) ❑Oilier(explain under 92.1 Retuarks) 0 tL 16 tL RED SILTY CLAY
16 ft, 60 fL GREEN SAPERLITE
4.Date Welt(%)Completed: 2-20-2023 Well ID#MW-41C 60 n, 68 tL PWR _ _ ,
tla.Well Iation: rL Rocx `e.�t, -0�4� �Y
.rrc 6s It. 105
Corning Glass Works N/A fL fl Faci.R1Y, *rcrNanm Facilily1Dn(ifapplicablo) +'i'M--•"9 L—2023 3—
ft. tl.
3900 Electronics Drive, RALEIGH, NC, 27604 fi ft r !r
Physical Address.City.and Zip a2L'REM1IARICC'-,<
WARE N/A BENTONITE FROM 89 TO 931
Caat11). Parcel Idenlificallon No,(PIN)
Si►.I.1titudc and Ungitude in degivoilminutes/scConds ol•decimal Ilcge-CCS: 22.Certification.,
(ifuell 1'N:Id,one latlong I%gnnleicuf)
35.830758 N -78.603564 R' � � �,Qjj�t....r,, 2/20/2023
si,.mtur.:or enni =,Nuil Conmtctor Doc
Co.Ls(are)the wells): SlPennanent or ❑TemiRwar}
fn•avgnirig liar fi>nrr,1 irere•Lr rrrrifv rhru the vrlllrl mxtr jwrn•)rum'rnre•frd in rrrvrricnrr•
u-$ii 15A NG1C 02C,tllrk?or d iA NCetC 02C.{209 lVelf Construt riot Sraoictrllt wid th7r a
7.&this a repair to air existing well., 17YL-s or ENII rryrr gjthir rwnnilurs'la•tvr prtsrir4'rl m th.•tn•!I nnn,•r,
If llds It R igmir.fill ra9r krwm'Veil comIlui licto hrfor ite ion ood e rplobi the lair ee of rhr
rgrrirrerrcfrr8?l rexiardr.rrrlicr.or cut the hr,•r�(nfdiix fnrui. 23.Site diagram or additional well details:
You may use Ole back of this page to provide additional well site details or well
8.Nuntlter of wells constrlreted: 1 construction delaits. You may also attach additionwl pages if necessary.
For rnrdill e later dvll w teal-alum snptry nvells ONLY n 0i the some roustrurtiwr,yu:u e(to
saloilirmie fora. SUBMITTAL INSITI .TiONS
9.Total well depth below land surface. 105 (pt,j 24a. For All Wells: Subndl this fort within 30 days of completion of well
For mltlsiple we1A liar rllldepths ffdip,i rriv{exauapfe-.IQN117,clad NE"1t-0 constmction to 111c foltowin :
10.Static water level below tap of caxin-g: 29.41 (n l Division of Water Resources,Information Prncesxing Unit,
if nruer let is abaL a cvrsie;.!ram•"+" 1617 plait Service(.'enter,RAlcigh,NC 2 7699-1617
11.Borehole diameter 6° 010 24b.For Gehrdnn LWIN ONLY: In addition to sending file fomi to the address in
24a above.also submit a copy of this form within 3U days of completion of well
12.Well(rnstrnetion method:AIR construction to the following:
(i.e.auger.rararp,cnblc,direct push c[e:l i
Division of Water Resources,Underground injection Control hvgrant,
FOR WATER SUPPLY WELLS ONLY: 1636 Nfall Service Center.Raleigh,NC 276"4636
I
134L Yield(gptn) 4lediod of test.- 24L-For Water Supply&Injection Wells!
Also submit one copy of this form'within 30 days of completion of
I3b.Dixinfection trper Amount: _ well construction to the county health dcpanmem of the colmh•where
constructed.
Fanu G1V-1 .Minh Carohnil Depansitem of Enanowtteng and Natural Resources-mysion of laicr RL-sotrees Reviscd august_>irl:l