HomeMy WebLinkAboutGW1--05800_Well Construction - GW1_20230901 y
WELL CONSTRUCTION RECORD Pin[mental use ONLY:
'This form can bc•uscil for single or tualti}ik nclls•
1.Wd1.Contractorinformation:
:I:I:,WATER.ZONES'
Scott Hunt, Jr FROM TO ORSCttmPrla)N
Will 9 ft. 14 ft. white silty sand
4561-A - • rt. fL
NC Well CannectorCall-1,catian Number • AS.OUTER CASING ifortnuili;Ogedkcfs)OR LINER(irs'j 1 bIc)•
.FROM TO DEAMETER THICKNESS MATERIAL
SASDACCO• IL IL la.
Company Nana 36:1NNERCASiNG'OR•77JR NG{=eoikerritalelnsed-Hoop),•
. FROM TO - DIAMETER. TiICKNESS - MATERIAL '
2.Wdl Construction grit is • 0 'Ii. 4 ' ft: 2 ; ; 'in. SCH.40 • PVC " " •
list nil o p livable wrlllicnerits.(i c.Counry,'Shire,VVariamrcc.Ilea aad'eh:p
3.war Usc oho, u5e): I7:SCREEN
•
Water Supply Well• -. I FROM • TO -. DIAMETER &LOEW):: TnrCKN} 5 MATRIIIAI.
El IA Ohfe-.-•
icipal/lhtbhc 4 if. 14 ft. r 2 • •'l't.'. .010 SCH-40 PVC
DGeother}ml(lleatiogatooting Supply) ®Residential Water Supply(single) . 2 2 .in,
l l udustaai/Conunacial . , • DResidentia[Water Supply(sinned) ta:GRo[FI
mom TO MATERIAL ENIPLICEMi STlttEIIIODBAMOUNT
. Ofniiation ' ' . • -o'- ft. 3., • ft:- Portland Poured
Not Water Supply Well:"
R. ft.
iMonitoring . l7Rccovety .
Injection Welt: - . ft. ft." - 1.
l7AnuifcrRccharrre: flGiwundtratcrRemcdiation 9 SAND/GRAVELPACK(iftntltlicabte)=, .
'FROM TO - MATERIAL II EMPLACEMENT MEtilOn
. oAernifcrStorage and Rceoycty ElSalinity Barrie' 3.5 ft. 14 ' ft. Sandi' #2,
l7AgttifcrTcst 175tornntatcrl3rtinagc ft
-• Elt:xpsdtncadalTcchnotogy IJSrtbsidcnccControl'
2tt:-DRILLI GTOG Iutlack additionalsiontiif ttcceasaml
O Geolltermal(Closed Loop) OTracer FROM TO DESCRIr11ON(msr.hanlnedoutvoiek/vttr. siaOm.(Ia
❑Ceotltenual(Ileating/Caolingiletum), ❑Oilier(explain ruttier#21Retnalls) 0 f4 3 ft concrete fill
• 3 fL 9 . ft. silty sand ,
4.Date, n'e[[(s)Ctintpleted: 7-11-23, Wellm#Mtl-03. • 9 ft,. 14 ft. silty white sand •
3a,Well Location: n. V'iaa 1, ir
•
MCAS Camp.Le j eune- ft. ft, - i,•
Fact7it)•rlthvttcrNamc ' • Fac0il)•IDk'6foppiicable) ' . 'i LU2
_ft, ft. I,
• 4400 Douglass Rd. , Jacksonville, NC, .28540. • B. r
Inforlir c',..,cn ,v:;.t rig Lra
Physical Address.City,andZip 2L REMARKS' lfi.'v1: Uairi
Onslow • Bentonite seal from 3-3.1'
County Parcel kb:,tiiri:anonNo.(PIN) 1. .
fib.Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
22 Cc tifccatioD:
(twcll(*Wow aon is stcic ) •
• N . 'c rc 7/16/2023
• SignnttircofCcitilludWcllCoo dor:, Date
6.is(tlre)1he.w II(9): IPermaneat Oi ,I7lemporary signing thin arm,I hereby errri that-the weld, wars were constructed hr.rweordance
H3 5 t> f 3'err* 1'1
. •u'/th IM NCAC OTC A100 or IM NGIC 02C.0200 Well Cnnstrenetiar'S(andarfs and tlxri'a
7.Is this a repair to an existing well: E3Yes or EINo .coliy of rhlr record lids brrya pmride+d t ire lira owner,
Ifrhis:Is o repair.fill oar*snow well corutrue,ioia Isrfoimarion and explain tie nari re of rife -
repnir remlerA2l re,n arks xeciiun or art the bail•of this fore 23.Site diigram•or additional well details:
You may use the back of this page to'proeide additional Well site deta[ls,or well
S.Numberof wells constructed: 1 construction details. You may also altae[naddilianal pages if necessary.
Fos'miry*frifeeilcil or arr+t-nrirer supp* feel Is ONLY whh rhr.saote eorrstrirction,ruin can - 1•
submuit.vneform. ;SITBMITTALINSTtTCTIONS'
9.Total well depth betoF:land latrine: 14 - (tb) 24a. Ear'Atl Wells: Submit this form within 30 days of completion of well
For mairlple we/If lis►ail s?epshsifdifjereni(cs<mrp(c-3@200'rind 2@I00) constitution Millie foliatsiagg:
10.Static water level below top of easing 5• •.- (ft.) Division of Water Rolt`ourees,Information Purer:sling Unit,
if crater level is above rttalrag;'use"+" 1617 Mail Service Ccntcr,Raleigh,NC 2769'9-1617
•Et Borehole diamctcr:6"- (In.) 24b.Fur Infection Wells ONLY: din addition to.seeding the form to the address in
24a above.also submit a copy of this font:within 30 days'of completion of well
12.Well construction method: sonic- cotstinction to the following:• 1
(Lc:aatgcr.rtaat},cable,direct push etc:) DivIslon of Water Resources,Underground Injection ControlProgratfl,
FOR WATER SUPPLY WELLS ONLY:' 1636 Mail Service'Caster,Raleigh,NC 27644-1636
13a,Yield(gj►m) Method of test: 24c.For Water Supply&Injection Wells:
Also submit one copy of this foram within 30 days of completion of
13b.Disinfection type: Amount: well construction to the county health department rtment of the county where
•
- constructed. .
Farm GW-I North Carolina Department of Emhart reran and Natural Resources—Division of WaterRmotnes Revised August 2013