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GW1--04628_Well Construction - GW1_20230714
WELL CONSTRUCTION RECORD Far henna Usc ONLY: This fano can be used for single or tntdtipk wells i i 1.Well Contractor Information: `1.1.WATER ZONES' Rich Lemire FROM TO ' DKSCRIPTIOY Well Cor4radorKaifu: ft. ft. 1 2593A fit. rt. NC WellColrtmctarCcnifuationNuntier • •15.OIITER_CASING[for-atilti�easedwwetlshOR•LiNER(flaii Tlcabk)•. FROM TO , DIAMETRR THICKNESS MATERIAL SAEDACCO Inc ft. rt. is Comgi:no Name I6.'INNER CASING OR'TUBING(SeoIharmal cloud-loop)' ' FROM TO DLLIIETER. THICKNESS MMATEREIL 2.Well Construction Permit il: WI0700459 0 R. 8 ft, 4 'ne SCH-40 PVC /In all applirahle wellpenatils(ix.County.Stale,Variance.frjab't.FF car_l R. ft. in, • 3.Well Use(check well usc): ' 17.SCREEN Water Supply Well: • FROM TO istmit ThR st,(rSrrt: THICKNSS 1 MATFRIM. ❑Agiiculultal ❑Municipal/Pttblic 8 ft. 18 R. 4 ill. .010 SCH-40 PVC ®Geotltemlal(Heating/Cooling Supply) ®Residential Water Supply(single) R. ft. in; ©ludustriaUContmerciai ®Residential Water Supply(shared) i8;GROUT• -.- FROM TO MATERIAL I EMPLACEMENT MEr11OD&AMOUNT ❑Irrigation 0 ft, 4 " ft. PORTLAND POURED Non-Water Supply Well: ❑Monitoring CIRccovery R. It, Injection Well: R. ft. ❑Aquifer Recharge l°GroundwaterRemcdialion t9:SANIWGRAVEL,PACK(if upirlieabtc) - FROM TO DL1TtiRL1i, EMPLICEMENTMF.TIIOn 17Aquifer Storage and Recovery 17Salinity Harriet 6 ft. 18 R. SAND ; #2 ❑Aquifer Tcst ❑StomnvaterDrrinage •It. R. ❑l xirCrimcnlal Technology ❑Snhsidcncc Control -10.DRILLING'LOGiatlacli additional sheets if neccssan•) OGeothemsal(Closed Loop) ❑Tracer FROM TO DFSCRWP11U hnbr.h:Inkier,soWnrckh11t.grain n,e,alga ❑Geotliennal(Heating+Cooling Return) ®Other(explain under lk2l Retuaika) 0 ft. 12 ft. DARK CLAY/SILT 12 ft. 18 , It. BLUISHSAND/SILT 4.Date Well(s)Completed: 6-2=2023 Well iD('IW-1 fit. It, SSti,Well Location: ft rt. WEST PHARMACEUTICAL ft. ft.. f 3...,:.I .• i''.1=y...'1,v,4 tit' 4,...L,, FacfityADwocrName Facility ID8(ifapplicable) R. ft, t (]7 2525 Rouse Rd. , KINSTON, NC,. 28504 it. II. JUG t i 2023 Physical Address.City.and Zip '21.REMARKS' LENOIR BENTONITE FROM 4 TO 6'. tii+veer'+ "� ' J County Pared identification No,(PIN) 5b.I atitude and Longitude in dcgrce&/minuteslscconds or decimal degrees: 22.Certification:quell field,one lat0ori5 is gnllleterd) ' := r _ ;�. N �V =ry /..�c� 6/4/2023 Signature afCc rti Wcll Connnctar Date 6.Is(are)the wells): ElPennanent or. .DTemporat}' tar signing Air Juno,1 herchv certify dial Mr well(s)writ(orrel corartrneted Err accordance with 15A tVCAC 02C.0100 or 154 NCAC 02C.0200 Well Construction Standards mud 1lxir a 7.Is this a repair to an existing well: fYcs or ElNo copy of Muir record hos been provided to the bell owner. If this is a rcprlr,fill out k.nthm well construction IRfnrvmixkor end explain the wrote of the re rrircinder8121 rrmarkrsectian or cm the hark of this forme 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well S.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary. For multiple i.tJectIon or non-water supply welts ONLY with the same construction,you eau submit one form. SiiIINIITTAL INSTi7CTIONS 9.Total Weil depth below land surface:. 18 (fit.) 24a. For All Wellu:: Submit this'farm within 30 days of completion of well For multiple wells list nil depths ifdiP-ercnt(example-tn:(Jt1'and 20)100) constnietipn to the following: 10.Static Water level below top of casing: 4.5 (It,) Division of Water Resources,Information Processing Unit, If Writer level is above cast ta,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 I1.Borehole diameter 10 5/8^ (in.) 24b.For infection Weill ONLY: in addition to sending the form to the address in 24a above. also submit a copy of this fops within 30 days of completion of well 12.Well construction method:AUGERS eonsftijctloo to the following: (i.e.auger.rotary,cable direct push.etc.) Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center,Raleigh,NC 27699-1636 13a Yield(arm) Method of test: 24e.For Water Supply&Injection:Wells: Also submit one copy of this form within 30 days of completion of 13h.Disinfection type Amount: well construction to the county health'department of the county where constructed. Form OW-1. North Carolina Department ent of Env ironnktoand Natural Resources—Division of WaterRraoirces Revised August2013