GW1--05845_Well Construction - GW1_20230912

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WELL toNsTRucTiciisi'RECORD- FoFfintemial Ule ONI.:17:-
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This form can ba utcd CO singlc in inuiiipla mells.f,' I
-1.'Weliciltlira' iiill7.1filf0Fillillinill' . . . . I
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1.1.-WATER 201)1LS: "•, , ',.-':-1, I: - r.' .-
Robert Miller „ , .. -FROM. .II) DESCRIPTION
W,cII tpnle4c14.Kupc ' 'ft. ft:. F
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_ft. . I : •
2675 ft .
NC Well ConitactoeCertilleatioo 1,,,Itother ',I 5.OUTER CASING(for eau hi-Dined iielhn tit OR LINER op Iirab
. k FROM'. TO DIAMETER THICKNESS .- '...11ATERIAl.
SAEDACCO 0 . 41,', 23' ft. 4" ', .1o. SCR 40 PVC
Colman),Name: ' ' 16.INNER CASING OR TUBING oporothermal cleseill-lonp)._ .- _'-,‘'-• '
FROM -TO -DUMETER ...„ THICKNESS NIATERIAL
2.:11`..01:Ciistevetion•Permit#:- _ • • . :ft.' -It ; -0.
1,4 fedi pliiiil penults(6.,Conity,`5140r,..1foriguce;IlectiCapc.)
3 y0;1*(eliC'elcMtll use): 17.SCREEN
Water Supply Well:,: ;FROM_. , TO• 'DIAMETER ' -SLOT SI74. 'THICKNESS I MATERIAL .
23' .fl., 43' ft.' 4 " • --ii;1 ;*.620 SCII 40 PVC'
tlAgiieititural 1:1Nlii4icius11/Ptiblic• .
-ft: ',Iti,' .i
CfGeotitennai'(tieittingICOoting-S0pPly). 011i:side:Mai Wntergitp•piy.,(Shigie) n... 1
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OholtistiriaItCommenial • DResideritiatWatcf Sipply'Isha In:GROUT ted)• -
MATERIAL, I-EMPLACEMENT NIMROD S.ANIOUNT
0 Irtieatetin 0 '.fflt:,,, 19' ft. Port land I pour
Non-Water Supply NYell: .
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ettvfonitoring CIRccoyety
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Injection Well: • ft: It.. .
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1:IAqiiifet Recharge - POtetandmiter 11eitiediatiOn- 190.SANINGItA'VELPACK Of applicable).
.. -:FROM- - 10'.. -'. MATERIAL", . 4:31PEACEMENT Airrnon
pAtioiti:F.SIOr.ii0ittiltliteai4'.- 08:11init'y Battier• 21 ft 43' IL Silica sand 6/20
0 Aipiiiti3q' t. 0 SIbtrinr.iter Botitiage-
.... . . It.. ft.. - 1
OE.‘-perirneptal'.f&hoolpg. El Subsidcace 6110'111 . _. .. ,_.. .• . - • • .
0:DRILLING LOG(attach addltional sheet.;if accessory) - . • ',
Clfrepilteptiallgio4ettLoop). .
ClTracer , FROM, - -TO DESCRIPTION(Mar.hardlom.wa:nptit!I pr.grain 4.tr.4461 .
EIGeotitenttal.itleatimiCooling Retool?' mOther(explain under b2 I•Retnads) 0- •tr. 20' ' It. Brown silt - .-- • - -
- i 20' ft.. • 43' ft. Rock" 1
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4.Date Welgs)Completed: 7-25-2023 Veil IDIDW-5
ft. ft: • 1 '
, FS!t •-;VEE)
r.s r•
si,AVII.1.4ciatio0: .ft.. -ft. t 100;;"a,....r
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.ft.' ft.. SEP 1 2 Zi
Facility-031)par Name:. .
taciliii'.lDg(i(appliFablc), .
• ft:: ---ft. "- • . '
1420 Concord.Parkway South..,. Concord, N.C.,,. 28027
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DWQ/SOta •
Pham#-Ir's citY•04PP I '7u.RESIARKS • '- - . . .
ed.4.0,7-1,.._4 2' bentonite seal from 19! to 21'
Campy Nrcel Wixtirtioollo,(11N). .1 .
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Sb Latitude and Longitude in Alegevesfttimitri!Seednds'fir.deOinial ilegieni:
22.C'ertifi' cotiopt.
Of olio fickit;ow:14164 ifi•suilleizto
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•W ,,,,,,,_,,,,. 7d4..:, .7./23/2023.
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Sigroom:0 I.,...',::cri:e:0,yerE.17,:Ett:S71:1..4..otek•-•'--- -.Date
6.Is(are)the well(s);.111Penituietit On.OTetitporary: .. -. -
#.?3ignin M g ir fon)i,:i l ierrb y eertil,-thig.thg lielif.$)i5-ra(enrol cuivin!ciett in ekrOnfrilir
wi:ft,r.s/i,Aoic 02c OI4 pr'iSit NC:tc 02C,02 00 Weld Conloiroilitin Sralvtariti mut tar 6.
' 7:Is this,a repiiitiiiite4stingitilli.... EiVes•-.or. 'EN°. ' .4/Told&ri-:pdrif idaY b.e01pIZZI'lifeilliiri,.1M.1.11q1olt?1cr,
i)..iPi;ItitigjialrifOimrinoirti wdkahuiruciluta iitiorritiiiiins tirul-itivni;1 the ilaryrt..of the '' - :; . ' : •"..-'-••-•-'• ---•"-';.;'•'''' i
repair taiker,921 irm4rk.stiviiin eir on'At biid:of 114:Arlit. :23.Site diagram or additional well details:
Iroui-MaY'ruse;th6.back-Of t14 iiige;toiweeitii additional well-SIM-(letaits of well
$ NSMiber of itelk-eoristriteted: 1 . . cnositucliall details You May also titiackidditional pagesifiktesSary."
For ini101,e if ijetiltil'cieflivi.;:iiorer$upply.ir#11,04.1,1,fir.irlilly,•some.iOsstr...iiiliOn,Oli<op' - - .-- : -. - --_• -• .. •-,--,--,-•.
i'zilmiii•emiliii70.; . - " ' '' SUBMITTAL INS,11..TCTONS-, 1
0..Total-.well depth.kithi hod surfaivi u-'' (ft) •24a.,Par'All 8Vells:•-.Subtidilki.'fdriit•Within:-30'd.if%*';:of reedoPIctrep or well
'oritilitilple elf r list ail(4.17.05:11difli70 ii..irortiptc,3 ,209''a 1 til 201419) - tot41*Cii0i1'to litC foltanirit• ' ' "
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10 Static water loYel.beloty top ofrca.singt•21' . - (f!) . Rhisititi of Water 1C6iourceii Information Pitiirsiink Unit.
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If liOr ki,,,1 b iViltai.:aie"4" '1617 Mail Sciiice Centel.7'RalelgNC 27699:--1617,-
II':Borehole diameter:8" :00 2.1b For infection ell ONLY In addition to sending the form totheaildits in
24a ibore.i also suliittit'a,cops of this font within 30'dayi:Of•eotopletiet.,:of well
12.Welt conMnietioit method .Air eoinlnictiottIo the follow 1oe: t' 1 ' - -- •• ' " •-• - -''" '- .
tie.autti;rOM.O.:,0111e:&reel push.cid:). ' • I 1
biViSidir o.f Wateikesourees,f."OtliegrOood tiicaliiii.'cthiti01Pivii4k
FOR WATER SUPRLY:WELLS ONLY: - ' 1636 Sall StirrieECeitter..ROleigh,SC 27699=1616
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Fitt'.Water 8sitipli•&Injection NVelicv •
i 4ii.-iiiiiifiLipiiiii '11ctliod•tiittst:
- . • 'Also;iiihnlit.opi.tOpY.-.of Hilt fotiii lsilliiii-.30'tla .i'Or eiitoOletiotiOf
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Disinfeet1oO typet A CH'cO.nstruciibii to the ctointy:Iteithh deli:Unocal'of Ille,eonniy'irkte.
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:eonstiticted.
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.t'pottdiv-1- North Carolina Dsmart inent ofindromnermattO Nmaralftesoutees.=;1ivii ion of WmerResotro3 ".fteVised Aitgost 3013
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