GW1--04588_Well Construction - GW1_20230714

WELL CONSTRUCTION RECORD For]lcenml lise ONLY:
This Conn can It used Cur single or rnultipk yells
I.Well Contractor Information: '
'I:I:A';,ATiIR.ZONFS-"
Rich Lemire FRQst TO DESCRIPTION
Well Cur4rictnr Name
ft. ft. 1 1
ft. rt. '
2593A
NC Well Contractor Certification Nuniict :I5.OUTER CASING tfnrtnutll-cased Wells)OR-LiNER ttfannllcabk)
FROM , TO DIAMETER THICKNESS. STATERiAL
SAEDACCO Inc fL fL is.
Canoruty[lame ld."INNER CASiNG.ORTLIDING.I4rikermal ctused4o0M.. .
FROM , TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit ar: W10700459 0 ft. 8 ft. 4 ill. SCH-40 PVC
List oft applicable knot penults(Le.Courts,S:trh,l ariarrrr,!erecting 1 etc.)
- . ft. fL in,
3.Well Use(cheek well use): I7 SCREEN
Water Supply Well: FROM TO DIANIF.TER SLOT SIZE TRICKSt'SS I MATERIAL
ElAgricultutal ClMunicipal/Pttbhic 8 ft. 18 D. 4 0. 010 SCH-40 PVC
OGeothemtal aleatin ICooling Supply) llRcsidential Water Supply(single) ft' rt '°'
© nibs!
industrial/Commercial ❑Residential Water Supply(shared) GROUT .. " . -
' TO � lLITER[,1,L EMPLICENILrVT 1tiEr1100&hM0[i\1'
❑Irri siLion 0 f.. 4 ' fL PORTLAND POURED
Non-Water Supply Well: rt. fL
DManitoring ❑Recovery
IuJecllon Well: ft, ft.
D Aquifer Recharge Dcroundwatcr Rcmcdiatian I9:SANDlGRAVt L I'ACK of applkJbtol°
•FROM TO MATl(RtAt, ESIPI.ACE{tENT%I Trf(ln
❑Agrtifcr Storage and Recovery ❑Salinity Barrier 6 ft. 18 ft. SAND #2
DAgrrifcrTest , DStormwatcrDinisagc
ft. rt.
❑t cperimental Technology DSnhsidcncc Control
-10rDRILLli1G'LOG-(attach addltioae;l.slieetsIf'necessan•1 •
❑GeotllelnaL(Closed Loop) ❑Tracer . FROST TO -DESCRIPTION(color.h:artteo.scnnKknlYt.rsnn s:i43.M,1
❑Gdiennal(Ifeating/Cuoling Return) ®O1lter(explain under#21 Remarks) 0 ft. 12 fL DARK CLAY/SILT
to
12 ft. 18 fL BLUISHSAND/SILT
4.Date Well(s)Courpleted: 5-31-2023 Wen m#IW-15
rt. ft. .
Sn.Well Location: ft. fL ^ r`� — s�. r^e
.,. —ro L--.p r�1 ° '`° r •
WEST PHARMACEUTICAL ft. It. y
Facility,OwnerNanue FaciiityID#(ifappiicable) ft. rt. }!,d 1 1�L 23
2525 Rouse. Rd. Exd., KINSTON, NC, 28504
Physical Address_City_and Zip <2L REMARKS E,>k' t. ; +.?
LENOIR BENTONITE FROM 4 TO 6'.
County Pan;c1 ltknttic.1non No,(PIN) .
Sb.Latitude and Longitude in dOgrees/minutes/seconds or decimal degrees: 22.Ccrtifreatian:
Orwell f`rcid,nrre lit{tleug Is Btrf1cieut)
___ oe _
N W —.F1tns.+.�r:r 6/4/2023
SignatureofCcrti WeilCoulmctor Date
6.Is(are)the well(s)t SlPinnanent air ❑Temporal,' • Ay signing thin foam,I kerrhy terrify that the vdl(.$)stir(nrre)cvn...waled Lit acaoirlmtcr
with 1M NCAC 02C,0100 or 1M NC4C 02C,020O Well Construction Siarxiards and that a
7.Is this a repair to an existing well: 121Yes or No ropy of dues rerar7l has her•a(uovidrd to the trot owner,
If this is o repair,fill twit kt:r:nvt well cmu-trucrloa lit/017147r10n and a tplaltr the norm of the
repair antler 021 remarks arctian ar rat the bad:of this farm. 23.Site diagram or additional well details:
You may use the back of this page to.provide additional well site details or Well '
8.Number of wells constructed: 1 - consimetion details. You may also attach additional pages if necessary.
For ratrlrtpk lrrfec-iron or tan-unrer supply was ONLY with the souk,canstrurtiotr,you Caa
salmis ant form. SUB[4 I1 TA L INSTUCTIONS
9.Total well depth below land surface: 18 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For tnnirlple'yells list ail depths ifdlfrirretnt(example-Joe 00'and 20,l00) construction to the folio isingg:
• 10.Static water level below top of casing: 4.5 (fL) Division of Water Resources,Information Processing Unit,
if titer level is above ceasing.site"+" 1617 Mail Sc1•ice Center,Raleigh,NC 27699-1617
11,Borehole diametss&-0 5/8° (in.) 24b.For Infection Wells ONLY: in addition to sending the form to the address in
24a above,also submit a copy of this faint within 30 days of completion of well
12.Well construction method:AUGERS construction to the following:
(i.e.auger.rotary,cable`direct push_etc.}
Division of Water Regan rod,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY 1636 Mail Service Center,Raleigh,NC 27699-1636
l3a Yield r(gpm) Method of test: 24e.For Water Supply&Injection Wells: ,
Also submit one copy of this fornt within 30 days of completion of
13b.Disinfection hype: Amount: well constnlctiun to the county health department of arc county where
constructed.
Font 0W-I Noah Carolina CSep ilnitnt of Emriratuucin and Natural Resources-Division of Water l�-airtxs Revised August 20I3