GW1--05272_Well Construction - GW1_20230814

WELL.CONSTRUCTION RECORD �� Ratlt�crnstuseONLY:.
Tl(s-ferment.]be used Far-silt,le at rmiltipk was'
'i D.Well.Conti:tcturhtforntatian:- \
fJ:MATE R LONbS
Chris Ruffer FROM. " TO OFSCRWEION
Well Corer Blot Name • ft. ft,
4223 A • ft. ft:
•
NC Well Contractor Certification Nuither AS.OUTER CASING(forittillt-Cisallidts(OR LINERIttitti likable)+: .. .
FROM ' To I DIAMETER THICKNESS MATERIAL
S EDAcco rt. ft.
Company Natue- -t6.INNER CASING OR=TUBING igi'ailerms1 doiedaoi p} -' _ '
•
FROM TO . DIAMETER TTtICKNESS - MATERIAL
�..WWcli ConstrUctirin Pen it#: • 0 ft, 52 ft. 2 :bk.: SCH-40, PVC
Litt rt1l r}pilicatrla well pcnxih(cc:C'eiunrv,Starr,•V riata r,frj O'--cfc.) - - .
ft. ft. m.
3 Well Use(Check well use):. =t 7:SCREEN
Water Supply Well:• : FROM TO• DIAMETER •st.otSIM Tit ICI(NESS MATERrAI,
DAgticultumdl. . lihltinicipaUiaitbhc 52 ft: 67 ft. 2 in O10 SCH-90 PVC
•
CiGeothcat(Tieatrngtooling Supply} DRes'identiat�Witer Supply(stogie) R. Ft. in.
nn
©Dndustrialtotiuuercial ©RcsidentiaiWater:Supply-(sin ted) tut GsRT , .: - .
FROMOU TO. MATERIAL EMPLACEMENT MEiIIOD&AMOUr'T
0krigntion• . . . . 0 :ft. 45 ft, -Portland Cen@.nemie
N(rtt-Water Supply Well: . .
6dMc nittiring I:R DA-cry II, ft. __•_ ,
Injection Welt:. ft, ft. -,
I;1A_quifer Recharge. • OG6oundwalcrRcnicdialiiou. t9:SANtr;GItAVELL'ACK:tifal1lI1 bttr - .:- --- -
FROSt -to n+ATERCSL PAIPLACEMENT sr�-tnou
DAgtdfcr S(origc and Reeo�'cis' ❑Salittirir l3airicr 49 R. 68 ft. Gravel Pack #2
El Aquifer Test ❑Stornin tcrlraiitagc
ft.. tt.
DEcperimcutal Tcehuoto ' 'i75ithsidcncc.Catiinel
:In.DRILLING LOG(attach sddllioital sheets if-ncccssan•1'
OGeodtemrnl(Closed Limp) • CDTrecer • FROM TO • DESCRIPTION(cvbr.ttartlncn.palEntatypr:p•aunwe.dr.1
[7Cr,otlemtal(FTeacin2i'Cuoliue Return). DOtltei(e;plaitt under#21 Remains) •et. f t.
• ft- ft.
4.Date Well(s)COuglleted: 7719-23 'Well iDIWMW-8 . .ft. ft.
•
54;Well LAicattun: .ft. fL •
Pinehurst Plaza fL ft + =7- s c' 'L.i t Z::,
• Factlity,'OlvncrName • Facility IIl,4(icappliiable),. • ft. ft. t
1680 NC HWY- 5, Aberdeen, NC, 28315 ft. ft. . AUG 1 f- 2023
Pk-Skill Address.City,aitd Zip •' .::21:RENIARIC5. taA-,_.-r...- ;r't•")r .1,: '. i !.
Moore •Bentonite seal 45-49' '-_aa:1 , ;
County Parcel Id iitifterttton No,(PIN)
• SIi.I:;ititudeanil Longitcedeia degrees/minuteslseeendsordccimaklcgrccs: y2:eearification:
(iruetl(acid,rats:latan,,;is-si llicle d) •
W Chris Ruffer 7/23/2023 .
Sigtuturr•of Certified Well Ca ntracta r Dale
6.is(are)lire\\'CII(S): X1Pl'rllldltent or L]Teugiorittl' }h•signing tar faint;.1 lrerrby t.rrefy relit:hr 7re11(s)poa f14m!)ckmsrnircrrra 1!7 rsescorrtcnr-
ii.irh'154 NCeIC 02C,010?or I SA NCrtC NC.0200,Welt C'e,atrtrrrioir St ir'dards,ptd rlurr a •
7.Ls thLs a'ertrair to an exnntingji Well:. 9Yt. tir RiNo -rnpl of;ilkT rrtor,I burr Sr-u prol'nrltd rei lh•well frir ,ier,
If tbls:it n,'shire,fill ono alocIej ucll:• e+arui,uc lma iftPflATIMIt errul t.$i4r therhrrare oldie - •
repairraalerN21"remarks siwita a ar nut tine!nick of thin fornr. . _ .23.Site diagram or adtiitiotral well detatts:
You nta}',use the back of this page to pto‘ide"additional well site:details:or Well
8.Nenuherof Wells coristrueted: 1 construction details. You inac aLse attach additional pages if niceSsary.
Forrnahipk iglecrhnn'or rrrut-nt:trer ripply tic/Is ONLY with rhr.satr,e coarser arrfou,}scat Harr
s:riiuihnne.farm. - - SUBMITTAL INSTF.TCTIONS '
9.Total Welt depth below land stiti'ace: - 68 (ft.) 24a. For Alt Wells: Submit this fors within 30 days of completion of'well
Fornratiriplt tells-list all dt'prhs if different te.vamp16-30200'evRl 2 J IVO) -constntetion to the rationing-.
i().Static water level below top of easing: Bt.) Division of Water Revoutrces,Information Processing Unit,, -
if nearer letIel Is dove
Casing,usc."+" - 1017 Mail Center,Raleigh,NC 27699-I617
IL Borelmtc diameter.6" (in.) 24b.For t iJc tgon Wells ONLY: in addition to-sending the fomi to the address in:
24aabove also submit a-copy of this limit within 30 days of completion of will
12.Well canstrttction.ntetbod: Sonic •cotrsiniction to-the folloteine'-
Ile.auger,rotary,cable.direct push.ctc:) -
-. - DIs9sioit of Water Resources,Underground frijetedion Control Progtani,
FOR WATER SUPPLY WELLS ONLY: 1636 Malt Service Center,Raleigh,NC 27699-1636
13a,'b idd WO -- �lcdrod of te9t: - 24e,For Water Supply,eft injection:Wens:
Also submit One'copy of this form Within 10,days of conipletioit of
13h.Disinfection type: Amount:- .wcil'constmction to the caunty health department of the county whale•
• constructed.
Form GW-1 Non1i Carolina Dcpanmcnt.of Envirotttnetn and Natural Resources-Diviiloo of Water RWILCOM Revised August 1013