GW1--06433_Well Construction - GW1_20231009

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WELL.CONS. TRUCTION RECORD For intengd tiseBNLy:-. • •
,}Tliis fent]can.he•useil fot Single of nmltip)c wells. - -
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1.Well•COntrartor Inforrnation: • - ' ..
'..I.1:-.11rATERZ()NES:.
John Eisenman FROM :.TO DESCRIPTION
1Voll Coiilmcior NAM- ft; ft. f 'I
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4439 "•
NC Well Contractor certiftgation Nunber . •15-:.-0117T.BCASEVG'tfllint:Pen•sia-irettif OR LINLitittitti-tkithk)...., :•.
. FROM' ' ', 10 - RIASIETRIt! imeterstss 'MATERIAL
SAEDACCO • • ..(L. .. et.' !:. in..
CoMmuq-Namr- • .16ANNER CASING ORTUBINGtketalinhaaleloiedaoilar;.; -.,. . _., •
- ' FROM! TO IHASIETER THICKNESS MATERIAL •. .. .
2.WCIA toHitIllethin Ppluit 4; 0 'ft! 30 ft. 2- ; ' In. . SCH-40 PVC •
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Lit'i 4,1141knble trillpennfri(i.e.County; '14..m.trariartre.lifec#4 oc.).
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3.'WelOsO(CIteekivditi .17 SCRE.114
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• Water Supply Well:--- - FROM , TO IMASIETER SLOT SIZE THICKNESS I MATTAIIAL
• - . ..['Agricultural OhltinidipaliFulli
30 it, 45 -'ff. 2 ill - .010 • sCH-40 ' PVC
• e,. t. - fu. . .,
EIGeethennal(Heating/Cooling.Supply)' LaResklential-Water-Supply(single) !in
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18'GROUT', -. • -
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• 0 InduSttialiCommercial ElRcsideutiai"Water-Supply(sieued)
...ET;01 -"10-. - MATERIAL ENIPLACERKITSIETROD&AMOIRIT
• .. . Clkrigation' . . . . . • - • Q •ft. 25 ft. Portland,' Pour
• • .• . Nod-W:0Fr Supply Well: ; . ..
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liaMonitothig- • -Elltfpcoyety ".: - ' — ' ._ • - • •• .. .
Injection Well: • tt. ' rt.. • _ - ; .
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°Aquifer Recharge , . • .- ClOnputill. svalcr RCincdiation ',2skSAND/GluiVEll•PACK'priiiiiiiii-Abter--
MATHIA
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1:1AtptiferStinage•anci Reedy-O.-. . liti . . ,..
liSally Batt ROM ler. • -v ,10 F: L IPLEENT• IHACM strrtion
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-- •-•• - - • • • - . 28 ft.z 45 ft. Sand . #2
El Arinifer nit - OSIOtninntee built:in& . '
' _. -ft..
bEivetimental Teclittolov - 13SithSiitenceltentral
• 7 16:.,DRI1LLINGLCIGInItakh`aidditicinal Sheets it twee:441ft}
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- • 13Oetithenual(Closed Lapp) 1:1Tnicer. • Frior• To - DESCRIPTION foilar.hardneti.WIVrocklype:MvAn sW.,(KJ
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CiGeothennalOkating/Cooling.Retutn) ClOther(explain under.#2 1 Rentals) 0 . tt. 45• .-ft. clay(sand
•ft.• - . . ft. 'I" ; - •
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. 4:Vate.Will(s)Conipleteit: 972172 3 'Welt 10#mw-25 -ft. ft.
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511.Wdl lateationt . - .ft. ft, I ('''',.1--L ''-- ' if; 't--)
(-- g...„, v I, -I 4 '
Ingersoll Rand - - '. ! • • IL- IL f,i . •
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Facildravrerl,lanie • • . • Facili*ILV iitappjiF.010), . -- 445444 • -I. 0, r4,-
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501 Sanford Ave., Nocksyille, NC, 27028- . . - ft.' • • ft.
. . Ohyikal di4idii?ss:•titY,..0114 * '2L'RENIARKS- DCV;-.Zi'3 CIO t-
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Davie
• Bentonite seal 25-28' ; •
Couuly . . Itirrel hindiTialou No,(PIN)
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Sh,.!..ittitude and'Ltinetuile in degreesimittutest,sicn!nlsnr decimal dFgieest- .221 Certification:
• ticoiAl Balti,i,Vog IgIlloit is!infIle'lkad)
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. N• . VV - • „,,,..,: _----7---1-:_----_--.,.=------- 9/29/2023
• . . . SignatureV.trATTeirs;;<-"ti:L7.4, --"-:---- Bak
6.Is(are)thewelfts)t.56Pernianent or oTemporary
• Its.'kiiiig '....14(3giti_iiAKI:71, Tur4trife-trii IR.A:eorrhuicr
. - WIN/P.ATCAC 02C.1.4 ,. .'-1-,:7, 61,::,4;.(C.0200 Mil Colo-action Standards gold that d
7.Ls this a rejtair•tO an eic4iingAvell: ElY Ltv- or NNO .ropr.6fagy irrOrd?Ai:III-en p.roritkd iii Vie ilyll fiirii,r.
if rh(s:ko TOO,fill ctir&Om Veil emanolon iirformafionoid oplpin die now of the .
iipoir taidei702.1ienuirki siriian or im the back of(hisfornt. ' 23:Site dingrattivr additional.wellitetails
You may.uSe the bac1 of this page kiptovide additional well site 4itails.or Well
B.Nutuberof Wells.eonstructed: 1 : - - . construction details.-You may a193=eh additional pages if necessary.
For sitaildpre ittjettloikErrninfHpirer supply wells ONLY with rhe.sinrtqc4rtruktim,yoo eon . . -. . • •. . 1
suttiniro.,..!e farm - SIIBMITTAL INSTUCTIONS ,
O.TOO Weil depth belaWland stirfacei 44 - . (ft.) .2,1a..For All Welk:- Submit ibis font'within 30 ditys'-of Iconipleti§tfof well
For etruitripie ii:elisliar el deprh:i if clwirt temaipte,3@200'and.,2e,109) - -construction to tiratoltoning: -
10.-StaticVrater level below top of easing: -_(ft.) Division of-Water ResottrieS,Ittforniatio-n Fineessing Unit,'
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if wive Iii4.1 iv above easing.eise"+" • 1617 Mail.Serriee Center,Raleigh,NC 27099-10.17 '
f 11.Borehole diameter 8•25" -(in.) 24b.F4.1aintIon Weill ONLY: in addition to-sending the,ram-to the address in.
24a'abde,also submit&copy of this Rim within 30 days of.completion of Well
. 12.Well construction method:-58A Construction to theTtilloWing:.• 1 . .
(i.e. i.i.gth4131nr)'.cal*:ditc-t icsh.cr.c..) .
• • Rirbitiit of Water ilesOu Res,Underground injection Contrni PrOgrant,
FOR WATER SUPPLY WELLS ONLY:' ,1636 Mall Service tenter,Raleigh,NC 276994636
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• 2,1e.For Water Supply&Injectinn Melts: ,
13n,Yield Oil* Method:of test:
Also submit'out copy of tins'grin within 30:days of conVietionof .
13b.ilisinfeetinu,0-ite:: • Amount: _ :well.ConStnietion to the-county islaith department or the•colony where'
_- -. conittuctcd.
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Rim GW-1 Nunn Depaineent or Environment and Natural Itesoutees-Division ofWater R‘otras - Revised August 4013