GW1--06400_Well Construction - GW1_20231009

WELL CONSTRUCTION RECORD• For Internal its°ONLY:. •
341is fond can be,used fa siiigh or multiple wells'
I.W LCautraetutlnforntation: '
:1.I:.WATER7.0NES. - 1 '
John Eisenman FROM 10 nEscuiPt1ON
• tt'dl Contractor Nam* ft. ft. f '
9939 ft. ff. f
NC Well CuntiactorCcnificalion Nwlluer :1S:OitTER CASING'tfoiuhiinit r rscnsi-'OR LiNER7ltaii`tkabk) .
FRO11 , TO ' PI.ANIETER THICKNESS ' 'MATERIAL
SAEDACCO . . tl.. f4' 1a
conateuq-Non • . . ' •' . 26 INNER CASING'011iT4181NG'keeilteF;dnf ctoscil-lonnl;'. .--
FROM ,'TO DUMMETER THICKNESS MATERIAL
2.Weil Construction Perri*O: 0 'ft. 25 it;• 2 _ • -iiL SCH-40 PVC
lilt tr11 npJilir bl.weir prier itt fir,.Comm:Stec,lrariatsr,Net0.69,csr_) •f • ft, _ ' to
•
. - • 3.Welt Use{.heel well tise)t -,17 SCREEN
���atcr sn)Ip1V Went — -a FROM' •1 TO DIAMETER SLOT SIM TIHICKNi is I MAtlinrAI,•
' 13Agrk,ultutal edMtinicipa)/'fttblic•• 25 fur 40 II. 2 i .010 SCH-40 PVC
l Ceotllertnal(HeatinglCooliog'Supply) .®Residentia4Water.Suppl}•(single) ft f�' in, I
DuidnsfriaVtu Contercial. ©Residential Water-Suppiy(shared') .'Ill.,„GROUT:..
FROti. ' •TO. FIATERUL EMPIACENIESThtEIROD&AMOUNT
Dluipation• . - . . . . . 0 ft. 20 . ft.- Portland Pour
Nast-Witter Supply Well - .
lIMuntoring • •EiRecotcry O. R. _
Injection Welt: it, . Att. • I:
DArprifer ltcodarg¢ -- • CiGioutidstalcr Rcittcdiation _t9:SAN D/GRAVEL PACx7;rairliucyntsr' _- - -.=---_---. ,-- --
FROM •TO' • '•TATtrttrAI. �lP1.ACr�III T ML"ti101i
1]Agaifcr.Slgragc arid Rcco c ' G1Salinit<13ai.•, • 23 ft.- 40 .ft. Sand' . #2 n
LIAgnifcr'reit t75toinin;itcrtyriina c• 1'
It.. • ft.
ElEzpatintcnial Technology AStlbsidcncc'Control ' '
2OI GRILLE GLOG"{aiiuhadditiorniI sbeels'if nccess,in•)
. OGeodtenral(CIoseiiLoop) DTrdcer FROM, TO - PRSCRIPTIONhobr.haMaeti:uinMreYtrpn.ra;nAm.dcl
tlGeodtennat(IIeatinuCaollne Return) OOther(esplain under#21-Retuadis) 0 .h. 40 it, clay/sand
ft: 'ft: '' .
.4.Date Well(s).Cauipleledc'9-21-23 Well IIWMW-27.
•ft. ft. I r '_ -'
•
5 ;Well Lticathru: .ft.. ft. f,;r' t: r 2.,., r
Ingersoll Rand - . . .._ • . - fl.- ' ft' ' . - OCT Sr _i.Y 0L3
FacitilyR3wocrNnme •- Facility i) Cfaltcabt ppe), R. ft. .-
501 Sanford Ave., Mocksville, NC, 27028• - _ • ft.- rt. itr;..,F,-,,..,.�„, ;•._,.....t•.+;;: ,•,'T:1
P 'si:ad...'C Zi - ' D J( OGhVd A it_andp ',2t:REMARKS . . -
Davie 'Bentonite -seal 20-23' '
County Parcel ld_utifG,lion No;(PIN)
Slit i ittitudcandLongitude in degve &Jminutcs/seeonds or decimal degrees: 22:Certifteationr l'
{iIneu nett.one lnl lottgts sofnelead)
N t,V b� -- -` 9/29/2023
Sigmwts'af .•..?r�: ,tu,.�- _ .- ' ._._ Bate .-..
�t !
6:Is(are)the tvell(s)t »Pcituatlent; or nTentltorai�' it,si obig ptix fault.• r t'4;YL; i(u ti.. :. i., .`tee ti„.ii.krl kr..•intr.&
1iidi 15r1,Y'CAC 02C.,!1.:-.., ,if i.;,.iZLN::;:-C,02tk7 I%WI Co,ua-tail n Sraalards and rlurr a '
7.Is thi_v a iieprtir:to au etu itin);wclli L]Yes or pNo 's p rofrhis ieconllrro it ea joinirkd to:ihe soilsirli on•,ier.
if rhls:ita r'palr,fillfill.rir haroud,is•eil oona;1cllari lormarlo;,owls pialn the m rare of the .
rsrpair(order 0?1.rrnmdCs'.serrian arNI the hruk of this form.. 23.She diiigram:or additional tscli dettiits
You.may use the,back of this page Co provide"additional well Site: ortsell
8.Number ofWells eottstrueted: 1 coustntction details. You um tls&ailactiadditional pages if necessary.
For a,mlrlpkinjeerh�norowilstarersuppl teens•O,t•LY111(isrhrsrrmeco,rsrriwtiorr,you stir 1
sabmit Ole jomu. - - SIIBMITTALINSTITCTIONS- '
•
9.Total Welt depth betoic hold surface i 40 • Ay24ta. Fur Ali Wills:: Submit this font within 30 days-.of-cilniplciion`of well
For nwlrlplcicslls'Nsr ail igthiiftifiterwwlotraa,pis'-3@200'and:2€1O.9)- - . constmctionto the following: -
10:Static water.level below top ofeasingi' • (ft.) Di.>,'tsiun of Water Resources,Inforniatian Frottessing Unit,•
1/Cater knells irbore eating.Mt!••+`• • 1617 MLtii.Scn'ice Center,Rulciglt,NC 27699=I617•
•11,Borehole diameter:8.25" :(ia:) 24b:For iriiecrlon Weill ONLY4�- hi addition to-sending the form to the address in
lid-above,also sulnitit a•copy of this fonit within 30 days-•of.completion of well
12.Wcil'eonsinictlou method:USA construction ColliefolloWingi• 1 '
(Le.augcc rs>faty,cnbte_:direct push etc} lfll islait of Water Resources,Underground itilecllon Control.Program,
FOR WATER SUPPLY WELLS ONLY: - 1636 Mail Service Center,Raleigh,NC 27699-1636
13;r,Yield m) Method of test: 2.4e.Fur Water Sappy&Iniectton Meth:
T Also submit one copy of this:faun,Within 30:days of completion.of
13h.Disinfection type Amount: well construction to the county I
alth department of the,county where-
:
constructed.
FontGW-t NonhCarolinaDcpaninenr.ofErwitunineaandNaturalResources-DivisionofWaterft utttxs Revised.August:to 13
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