GW1--03343_Well Construction - GW1_20230512

I
WELL CONSTRUCTION RECORD For hxcrital Use ONLY:
This form can be used far single or multiple%+•ells
I.Well Contactor Information:
14.%VATERZONFS I
Rich Lemire FROM I TO DWRIMON,
Well Commctor Nance ft. ft,
2593A ft. ft.
NC Well ConirictorCertilication Nua-ber aS::OUTER EASING Ifnr:nrnhl ravei0 a'eFls'OR L1l�f R tifa"itic3bki`,_
FROM I TO DrA3;KTER I TBtC{N►:55 I NiATERTAL
SAEDACCO Inc 0 ft- 55 ft. 6" lrr, I SCH-40 I PVC
Caugt:mr Name 46.INNER:CASING OR ".T7iBING eet6errnal cWiiilaod
FRONT TO DEA3tETER TBICKNF.SS MATERLIL
2,LYe1l Construction Pct•mit ar: N/A 0 R, 58 f1, 2" nL SCH-40 PVC
I irrall n1.y11irahle v:-Upenrtils 0-r.Crnrnre.Sime,Yr:rirarre,lryel?t�rr,:! tt. ff.
3.Welt I)sc(clicelcwell age)., :17:1SGRCEN
Water Supply Well: FRONT 'to DtAXFF.THR SLOTSvs: I 1111CltIt-15s I MATERIAL
tiftricultund UNIunicilml/Pubtic 58 ft, 68 fl, 2° in. .010 SCH-40 I PVC
©Geothemull(fleatintg,'Cooling Supply) DResidential NVatcr Supply(single) ff. ft.
Oludustrilt'Coumtercial DResidcntial Rater Supply'(slutred) =�8:cRou 1•;::.
FRONT TO MATERUI. I E VPt.ACENIENT ME71109&ANIOUNT
❑hn"atlan 0 fL 53 fL PORTLAND TREMMIE
Non-YPater Supply Welt:
®h/pnitoring ❑Rcco%•en'
Injection Well: ft. ft.
❑Aquifcr Rocharge ❑Grotindtratcr Rcutcdiation A SAND1C.%tVEL PACK(if"i tlicyble).,
VHONI TO %1xmit At. FMPIAC:EHk\T NIET11011
❑Aquifcr Storage and Recovery ❑Salinity Harder 56 ft. 68 h. SAND #2
❑Aquifcr Test ❑Stomm•ater Drainage
❑Experimental Technology ❑Slthsida-mc Control
"20 DRiCLi'G GOG"(a11ac6:iidditiouatehitil3if ircccssnril
❑Qviltenral(Closed Luupi ❑Trdcer FROM TO DISC'R1PTI0\(rnbr,F�nlncr+•>,dtnKklr 'nvtattcl
❑Geotliennal(Iica(inerCooliug Return) 11011ter(explain under 421 Retua&,) 0 it. 16 fL RED SILTY CLAY
16 ft, 60 fL GREEN SAPROLITE
4.Date Welt(s)Completed: 2-16-2023 Wcll ID#MW-41B 60 ft. 68 fL ROCK
5a.Well Location: ft. ft.
Corning Glass Works N/A fL f4 a v
Facility,+OnncrNnn>4 Facility117k(ifappliablcl ��`��^''•'-"-
3900 Electronics Drive, RALEIGH, NC, 27604 ft, f1 M AY 1 v
Ph}sical,addtcsK City.and Zip ,.2l REMARKS'. .
WAKE N/A BENTONITE FROM 53 TO 561 G +c ) 1 ;P .^C 1r'a^•'
('aanq' Rune]lrknlificuliiau No.(PINT
511.Latitude anti longitude in dt.grecslminutei/scconds or dccirnal dcgrces: 22.Certification:
(iftrcll fold,ptlLL lab1ung k im iciest)
35.830756 -78.603564 + �
K ��' � i/ljwt...c. 2/19/2023
SigwtureafCcni ie'i16'antractar Date
6.1s(are)the Nvell(N): MPernianent or ❑Tcmlmi-ary
Ih srgnhig tlrir fi,nrr,I irrrcbr t•rrrifs•rbcr the vrllrxy ssvx(tarn?cur!rrnra•red itr rr.rUrrlmcr
n•irii 154 NG1C 02C.0109 or I SA NC;tC 02C.0200 Well Consrr'h'rim Srrrrytards and rhar a
7.Is this a repair to an existing well: OYes or XN1Y e ry�r of dint rt'+'"iY!h,as FK�rr r�nrrir.4 rl rn rl:.•m Il nnuer.
1f rdris is o n•Ikilr,fill iNl;kimnw loot!r<rru'Irurtlrro itrjoirnrrrhm nor!ewplobt rho numn•r,/olio
repair raider AU remarkssetiimt or rm the brxkC ol'thir farm. 23.Site diagram or additiaoat well details:
You may use the back of Utis page to provide additional%►•ell site details or well
S.number of wells constructed: 1 Construction details. You may also attacit additional pabvs if n:cessan'.
For nralrlplr huaY rh>n#1 orut-ijarer stipl,Ir iveili ONLY i0r1i tin•some coirsrruerion,yQtr ear;
saOrairnne jorra. SUBMITTAL fNSTITCTIONS
9.Total well depth betow land surface: 68 24a. For All Wells: Subndl this faun within 30 days of completion of%well
For itrnlriplr u•rlis lisr rrNdrprbs•it dir;i-rety iuul 2@ AV) construction to llic follot%ing:
I(l.Stxtic water level bclu%%lop of casing: 28.72 MI) Uivhiun of Water Resources,Information Processing Unit,
Ifivivvr level!,riLove rawer.asc•"+" 1617 51ai1 Set-vice Center,Raleigh,NC 27699-1617
11.Borehole diameter.6. (fa) tab.Fnr Injt•clion}Veils ONLY: In addition to sending Iha foml to ilia address in
24a above. also submit a copy of this fonu within 30 days of completion of well
12.Well coastroction nlethod:AIR construction to the follo%vine:
(i.e.anger.rang•,cable direct puslr etc.I
Division of Water Resources,Undergromtd Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh,NC 27699-1636
13a.Yield kwpm) Nlednd of test: 21c.For Water Supply&Injection Wells:
Also submit one.copy of this form within 3o days ofcomplation of
136.Uisiufiction hoc:•v Amount:_
well constnlction to the cmmly 1tealth department of cite county mvicre
-- --- constructed.
Form GW-1 Nash CarOlilta WpanatcnE of Eta-imuma and N:anntl Itewurces-Divi;iott of Wnicr Rerotrces Revised August_Vtl3