GW1--05702_Well Construction - GW1_20230905

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• WELL.CONSTRUCITON.RECORD Fer!menial Use PNLY:..
form can be:uscil fir tingle or multipk wills: •
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-1.Weil.Contrattor Information: • . .
i-14:..WATERZONES - -. •• 1 '. • ..-• • .
John Eisenman _ ;Most. 1 TO OnSeitiPt1ON
Well Co or Minic ft; ft. I I
ft: ft. I I
9439-A
',13::OUTER:CASINGIferiiintilliiiiiittiells).'OR LINEKOtnifantatiki, ,
NC-Weil Contractor Ccnification•Nindier .
FROM: ' TO -• • DIAMETER THICKNESS • MATERIAL
SAEDAcco ' . .1.4 .
Conipanytimoc• , • . ..26:,.INNER.CASINGORJUISINGlacoilieirindekikildininiv-',-.,..- •.- • .
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FROM -TO - - I DIAMETER THICKNESS MATERIAL
• 2:WeRCOnitructi F on ern* : -
0 R. 31 • ft.' 2 I! ' In. Sas-4 0 - PVC
.Lid ad ArlitIcabfe irelfpciFaks l'iii.CON,:.7mic,Variance,frialtil,0174
•' • . • If. . ;; -i•,-, .
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3..Wellifse(Check yet1 ttsel; • -47:-SCREIEN " . _ .
- Water Smiply Well: Foos: TO *DIAMETER ' SLOT Sin; TIIIC-KNESS• 'MATERIAL .
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. 31 ft,- 41 11;- 2 . 1ft •.010 SCH-40 PVC
• ElAgricultural piAtiniciNtliptibhc• _ - in
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• . I3GeOthermal(Heating/Cooling.Simply) EIResideitliat\Voter Sup*(single) .ii• Jt
ElIndustrialfr Commercial EiResidential Water;Suppb.(shared) •tom'. . •11-0. . ' MATERIAL EMPLA-CO'.-.I6i-T-METII'''OD.I Ali.IORNE v..'
CI kripation• . . . . . . 'It. ft. . - ,
Non-Water Supply Well: •• .. . . -., ... . _ . .., , . .... , . .. . . . .. .
• ft. • ft,
lat;donitOri.P8. . I:Recovery • • •. _.... \. . . .
Injection Well: . .it.:' 'ft,. •
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1:MittolfCr:ReOiarge ClUtputidwatct Ileincdiallon ,29i.S.411111C11AVEL'PACK•61411011r.abtcr
... • - ... . - : .. -PROM• •TO ' MATERIAL EMPLACEMENT mE-rnou • .
ElAiiitifct.§10.age.ancl RecrAfejy PSolinity Boiriet -
. 2 9 ft. 41 ft. . Sand #2' '
EMOustfcr Test ElStainiwuterpnitonge . .
' ft. ' ft.
ClEtperinteololTOiltuo.tou IDSobsictettec:Coadmi . " . .
-:;111;DRILLINGIOGIaltkhiddliibutil shciti if ncecistir0 . - -
Licteridtemmi.(Posed Loop) C1Tnicer . FROM- • To DEKRIPTION( r.liitrancii,p..iMlick 0 tx:min*AN tkl
0Gmthennal(ReatineireotingRetum) 1:10ther(ekplint under.421.Retuatlis1 ° .ft. 41 ft, clay/sand
f!-• ft.
4.:Dafe Viiii00.031111Iieleit: 7-27-13 .W.dt IDfimiq-1 • -. , • •
-ft. • ft.
, .
So:Well Lneatlunt .ft. ft:: • 1
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Cumberland County Commercial Site . " It.. • _rt., is— —, - . ,
FacHily•Ownerlitulle Fic11M.Itik(1eappiinb1c).
3900 Ramsey St., Fayetteville, NC, 28311 . ft. ft.. . SEP 0 .5 2023
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. pioidid•Add055city_iiha2ip-, 321,REmAitics. . .. -• '
bentonite seal from 26-29' Infc.i-maZicn Prtv... '..
Cumberland , un
. . GWCiAT.-.Cita
county- Parcel Ickidittiliou No.(PIN) .
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511...3...:14titUdehtlitlainkitMlein degoorittniiittle$,*(Mdsertteelincil&gre .cs:
Orison fickl,kiiig laIllat is•sntfleictei • . ..- . 22: creation .
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N W .„...4,....<___,-;-":11.... ------ .-"----- 8/2/2 023
• . - ' .Sigannre-5-..2.-::ix.1...%.1•4val.:1-7,11 ,,!:-!---- ''---- f7ate. .
6.Is(ore).the.Well(s); OPentianent or •XTemparaty'
hy Yigniiii;dritjahe:04.1k4.Kift,v.,..cf.i...4:1Ma,r',117t7: earl;ftireigyi ht./ay:my/mice
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lath'15.1 NC4C 02C-'1. ,...4,• -17 ;TC.4,.:,.art.:f0200 Well Coitsemen'e;a grarularsis and fikff a
7.1s this a rejmir to an eiistinglyillt ClYes- tir ENO triiiy.of OW!'emirs!;mi.Ircen iwirirkd r'.-Y 31r weld viviier.
4f slils:Isn repok.iill eo kin;IOJ Teelloownfellonliviyrounlon soul t;sploln the ousrare of the
ripair wider#2.1:1-ivnarkisiviiara di--iln Ilk back-of this:form '13:Sitediagramor additiona1iVe'11 details:
You mm'.use the back of this page ttf.provide.additional mil Site.details.or Well .
8.Nuatherof wells eonstructed: 1 construction details, You inaY also attadi additional pa' ges if ticeesSoty.
For frituIrdple lojeerlOn or-01Wilmiter supply iveip ONLY 111fil 010.SITtriq ceirstruidion,you eon
submit one form SUBIIIITTAL iNSTUCTiONS I
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• 9.Total wai depth below land surface: 41. . . (ft.) 1.1a. Far All Willie' ,Submit 114 forth iyithiti 30 days of completion of well
For milthric ii:ctfr list riff deptlir(fdiki•roi/(maniple-5'0100'awl.20 lll9) comtnittion to the folioning: ': -
10.Static water level bell)*top.oreasingt . . . (64 ,DivEsitig of Wnter Re'StairceS,InitermatiOn•Prueessing Unit,
//why leiel Is Aim:ensing,..isle"+" 1617•Mail.Serviee Center.Raleigh,NC 27699-1617
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IL Borehole diameter:8..25" (in-) 24b:For ileellon Weill ONLY: hi addition to•seading the form to the address in
24aabde,also submit a•copy Of this faun within 30-days'of.completion of well
12..WeRconstructiOn method: SSA COnSlille11011 to-the follociatie!. 1,
(.c.eifsrotaty,cable,'direct tinsii.etc.) i .
.Divbion of Water Resource's,Undergound Injection ContrO1PrOgram,
FOR WATER SUPPLY WELLS ONLY: , ' 1636 Mail Service Center,Raleigh,NC 27699-1636
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' 24e,For Water Supply.&InicetionIWells:
13*Yield'(giim) , Method of teit: _
• ,AlsO subniit'one'cony of this form within 30.days of cOnipletiott.of
, 13b.Dlslnfeetiuii ,tniet Amount: well,gonStruction to the county tc41th department of the Courtly wime•
• consttocted.
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Farm(1W-I Walk Corohna 11.cpanmentof Bacironnria and Natural Resources-DolritIon of%Vote Rmources Revised Aitust 2013
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