GW1--03345_Well Construction - GW1_20230512

WELL CONSTRUCTION RECORD For h4crtnd Use ONLY:
This faun can be used Car singly or multiple%•ails
1.Well Contractor information:
14."AYATER ZONES
John Eisenman FROM TO 11MCR(P,irON,
%'CllComm otNanry ft. A.
2675
NC�VdICanlr.IdorCcnifieationNuni+cr 21i:`OUTERCASfNGfrnriinuh(abseil"isr{131ORtl".Rftfa"iticubkl': =
FROM TO Oti,SMTER TnICKNiS5 1nAG.t*L
SAEDACCO Inc 0 ft. 130 fL 1 6" in. SCH-40 PVC
Campur)'Name MANNFR:CASiNG ORTLrtiING reolk, 'at clued-(uujrj'.
FROM TO DIVNIETER THICKNESS MATERIAL
2.Well C9n5trlaction Ircrntit#: N/A 0 ft. 138 ft. 2" ut. SCH-40 PVC
I isr rift applirvsf,f-tt li permits(i.e..Count}•.Slam,trirfatire,I!erfiert rh:1 ft. ft, is
3.Well Use(check well IL5C): 17_�SCREEN
Water Supply Well: FROM To DIANCTk:R I s1.OTSrrr. I TlurhN_,S I MATERIAL
Mgdcultutal CIMtlnicipaMblic 138 ft. 148 A, 2" in. 010 SCH-40 PVC
OGeo(llennal Meldllg;Coolitig Supply) 011csidential Water Supply(single) h. fL in,
OludustriallCootatcrcial ❑Rtesidential Water Supply(skired) yB CROIFT. . :
FROM TO NIATERUL I EMPLACEMENT\IMIOD C AMOUNT
❑1m atlon 0 ft, 132 ft. Portland Tremie
Nou-Water Supply Welt: ft, ft.
Mkionitoring ❑RccovM
Injection Weil: ft. f1.
C.IAquiferRecharge E10roundvShtcrRcwcdi:ltion 19cSANDIGRAVEL-PAC:K(if ii)licnblel
FROM Tn 11ATF RW I. RMPIAG'F'AIf.\T SIFTlIOn
❑Aqutfcr Storage an-4 Recovery ❑Salinity'Barrier 148 ft. 136 A, Sand #2
❑AquifcrTcst ❑StortnivatcrDrtinigc ft. rt.
❑ExTcrinicnial Technology ❑,9nbsidcncc Comrol
1UDRICLiNGI:OGfunaeti.nett(itioiinlslicNsifnceasnr•1'-.=` -
❑G:rothenrvll(Closed Loop) ❑Tracer FROM TO 11MCR MON'(col r.hardnt".w,illiwkh pe,pmi.iwe.Nt1
❑Grothennalffleatine+COOHM!RCtnm) ❑OtlterteXplaiu under#21Retuaths) 0 rL 50 ft. silt/sand/clay
50 ft, 150 (L weathered rock
4.DateWell(s)Cottlpleled: 2-27-23 Well ID#MN-41D
rt. rL
5a.VYell Location:
Corning Glass Works N/A ft. ft. ,%'%,.
FacilityX)wncrNante Facility 1DR(1fappli able) ft. ft,
3900 Electronics Drive, Raleigh, NC, 27604 ft. ft, 1L1�L�
P6ysienl•lddrvss City.and Zip 1 Irv'
an
Wake Nag Bentonite seal from 132-1361
freely' Panel lLLu1 re;fflun Na.(PIN)
Sit.Nititudcand longitude in ditirccsfminutcs/scwntls or decimal degrees: 22.Certification:
(If:scll frclJ,urea:I:n-7wry.ir:suflickul)
35.830758 N -78.603564 VV 3/2/2023
Sign�mte of.........^.�,:�.i%re: -- date •.
G.is(m)the eell(s)r EPenuanent or ❑Teniltoran ,
ih'edgning llri.r fhnu,f irrrrhr certifyd,cl Menx$rr1 Isvr(wrn•I cum'fnrt•fe'd ire ucae+rrlrmne
It-411 154 Noic 02C.0107 or 154 NCAC 02C.02M)R i•if Cun511-anim srarmlargis gold rNI a
7.1s this a repair to an existing well: ❑Ye+ or Mo rafn n�diir rrr'ordh,rs'L'rrn pnn ir!+gl rnrh.•aril nunrr.
lf+his it o rrlxrlr,fill axe,knnnvf n•rUrnrrylnig'thrn infnrnu+rirm and e.rplahl rhr•rl,rrnrr of rfrr
rrpcir rnnfer a�21 rcnurri r srrrlcrr or rue fhe br.:k r�Cfhis•form. 23.Site(113granl or additional well details:
You may use the bawl:of Ilnis page to provide additional well site details or well
S.Number of wells constructed: 1 construction details. You tray also attach additional pages if necessaR'.
For,uarlrlple r,(jevrhrn or afa•I-narev supply rrrifs ONLY)OM rfrr senor carrs(rurrimr.yoar ran
sae n1ireviefarm. SUBMiTTAL INST TCTIONS
9.Total well depth below land surface: 150 l j.) 24:L For All Wells: Subudl this fonn within 30 days of completion of is-ell
Far nrldriple welds lie all deprl+s irdifti•rrro(exvelg,lc-d eIXV veal l@ ffv?) construction to tits follot5ing:
M.Static eater level below lap of easing: 29.27 (ft.) Di),uiun of Water Resuurcc.5,Information Processing Unit.
if reenter level Is shave[Y15lrt;.else^+•• 1617 Mail Service Centcr,Raleigh,NC 27699-1617
I1.Borehole diamcten 6" (in.) tab.For Gditi.;tlon Welts ONLY: 'bt addifion to sending the form to the address in
24a above. also submit a copy of This folm within 3U days of completion of well
12,Rrell construction method:Air Rotary construction to cite following:
(i.e.anger.rotary,cable direct push etc.i
Division of Water Resources,Undel• 011INd Injection Control Progrial,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service iCcnler.Raleigh,NC 27699.1636
13;t,Yield(j-arm} Method of test:
2Ie.For Water Supph-.1c Injection Wells:Also submit one cop), of this fo,rlii within Sa days ofcompletion of
I3h.Disinfection h-pe: Amount- well construction to the county llcallh deparlinent of the county•where
constructed.
Foruu Gl1'-1 North Carolina fkpannbent of Encirolmrcur and Natural Resources-Division of 1Valer Resources Revised August_R111