GW1--07702_Well Construction - GW1_20231122

WELL.CONSTRUCTION RECORD FOr imarnal Uqc ONLy:.
TI4s•fcrio cart ba.uscil fir single or trullitic Ivc11$.
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1.'4Ve1l•COutOtetot Yirortugiou: . .
• 1.IAVATERZONLS . ' I . . .
Stefan Smith PROM., • 10 ' Deolttri-ON
%Remit-Actor 1.`:4111t0, rt. rt.
l't. - fr.. I • ,357 6A
AS.•".OUTER CASING(fdr Mutt kigitlife'llsi OR LINER11140-Etabler -.. .
NC Weil Co rdratior Ccrtillaitian NuTrIvr
FROM 10 DIAMETER' • IRDCKNESS MATERIAL
SAEDACCO 0 (Lt.. .6 . ft. 2 1. Oa. SCR-40 ' PVC -
CamputyNate,• ''-I6';INNER CASING OR TUR ING. MiliCiniat ettleil-loit".."•,:•';'._ - .
FROM To • DIAMETER. THICKNESS• MATERIAL _
2..Well tonStruCtiriti Perrnit 4: . ft, - Ft. :.'IA.
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LW oft op/likable tse4 pestrefrilix.Cotaity.qtariO,.Variaorr,Irtfattc4 00 ' . 1 .
ft.• - ft, i- 1. in.
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3:Well.10se.(theelt well tise): •
• -a 7:.-SCREIEN • _
Water Supply.Well: • • - ift4031- - TO • IRANIETER SLOTSIZE TRICKNILSS- ' MATER!A I,
6 It. 16 ft. 2 • iii .010 SCH-4 0 PVC
0 AgrleulMral ElMtinicipaliptiblie:.
f. - . ••
OGetithennat(Heatingtooli ng'Supply) CIReskliiitial•Water•SupPlY(single) ft. in..I• • , , •-
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El InduStri.'11/Commercial ORcsidentiA Water,Supply(slEItid) •••`.48i GROUT:.... • __ . ,. _, . ...,_ , „„. , _ _ ,,..• ,_ • .
1711031 10. MATERIAL- -EMPLACEMENT IDETIIG D&AAIOUINT
El Irrigation .. . . • " 0 ft. 3 ft... Portland Pour . •
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No ti.Water Supply Well: • .... . . .. . •
ft. • 0, .
lEMonitoring 1:1RONI.vCIY • • _ 0 . , .
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In*,Itto%I/CAI; „ . . . . . .
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Minting'Recharge . ClOroutidnater Rcincdiatiou • ...-19iSAND/GRAVELPACKlilaitibli6ttottr, . = -.-- .. :---.. - • .-.-.- -•-•.•, ,
pti •....-...- - Reoy CSali- Hae' -.mom To aATearA. -1•t110.41ENT OrTtfn
CArfcr.Stotagead nitYrt:
• 5 ' It.' 16 ft. gaud 1. • #2 . • .
. El Aquitcr TC5t. EIStoOrtce thilitage . . ,
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-• R. rt. .
l:18Verintenful TeelmOlogy CISitbsidencestioutnil' •
,0' .- - -40."DRILLING'LOGIattmVidditibnal 9deiti if itOniscarvt
1:1 O.N3" Eltniv.I.((Closed Limp) :111acer •• • FROM- - TO DESCRIPTION(zkr.hartIncvi,mal:nich ts.'M'graitt fiie,de.)
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EiGeolliennal(EleatineJCoolind Retutn) ' 13011ter(explain under42 1 RettiathS) 0 :ft. 4 ft, .Silt!.sand
. 4 It. 16 ft. Sand
4.Date Well(s)conipleted:'-10-26'23 Well IIDNRI-Mwl 0 • .'ft. ft. -
54 Well L
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. . '•: A;.,....1.. ,?_-_-•••!: ',6)i?..-. TT)
; ocation: rr. ft, -
Greenville Utilities Commission • . ft.- 0,
: NOV 2 2 2023
FaFtrifyAthvncr Nam racradii,ItIM.(1tappiiFabl4 i
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801 Mumford Rd., Greenville, NC, 27834 ' ft. - N. •. - . .. -
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• 01061 Ai1dr(ns,City..arul Ty •
'It:REMIAtti:S' ' • -' - ' ". • • '
Pitt - '2 foot bentonite seal from 3 to 5' .
Costs). Pout ki-21tORCation No.(PIN) • . .
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5ii.:Latitude anifEeinglintle in degrces/rninutcsisccinds Oi.dccimal dcgecc.i: .,22:..cirtifitati„,„ •
O'Neil held,one laD104,irSidfleizirl) •
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35.632028 N 77.363108 W ,. 744:13519' ' 1 • 11/8/2023
" SiginfiLiofC :ifiadIVCII Catitraoar I .• Da..tc
6.IS are the'Well(s):.1EPentiluteut :or ElTentptiraty .
ity xigning thig Aim./irr_rep.y.certify 144.thg'vents).ma(;iern)LWaytrifeled knecondance
.410 15A.KM'024'.pipo or 1,5A Mai('02C.0200 Well coniertorttoir Srorkirtals eta rItaz a
7.1s this.a reivairtb an OittittglydIt. •DIAN- or - No rcipRoft/o".r imini ltnkflren prorfard iriille wli(Avner.
If th(s!kn repiTikhfill oyi fiiiiiDD ici.11 C6715711(Cliciti htfcirmarion did 6plahr rh.onanne op/is I -
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rep&roofer P2tranarktistritan or on Me bail:eddy fnrnt. :23: i'te.diagrantor:udditionut wen.ttetans:
You May use the back of this page foIntWide.additienal well Site details:or Well
il.Nnutherof welts constructed: 1 constntction details. You.may.y isLth•athicli additional Pages if necessary.
For titailseige Irdtyilr41 at noolictirer supply tills ovix tutu rhosoor?eftistruittort,ywit ma r
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. sytomit one fintn.. SUBMITTAL iNSTUCTIONS I
- (ft.): •24a. For Alt Wills:: Submit this form wilhhi 30 days'of cOmpletieu'of-Well
0.Total Well depth helot%laud stirfacei 16 . .
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For"mold,*irellr'llo all depths Irdifferrint(escanpfe,3€,200'mm1.20100) construction to the following; r. - •
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10.Static water leici below top,of casing': . (ft) Division of Water ReSourceS,Information pineessing Unit, . .
if water fere!is above eatfog.ase"+" 1617.Mail Staiiec tdriter,Italelpjt,NC 27649-1617
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II,Borehole diameter:8.2 5" (i11.) 24h;Frir fileetktlYells ONLY.: In addition to•sentling the form to the address-in
24Saboie.also submit a,copy of(his forth within 30 days of completion of Well
12.Well construction method:RSA construction to the following' •
(i.e.eiter,rc4my,cal?le,"airect tiush.etc.) . i
• • • - PiVisIO it of Water Resources,padOgrotend fojection Contrid Program,
FOR%ATER SUPPLY WELLS ONLY: . 1636 kill ServiceI'Center.Raleigh.NC 276994436
13+•Viid(ft0 24e,For Water Supply tit[ejection'Welts:.
Flirt Nriiiitud of test: • -
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Also submit one Copy of this form within 30 days of c onipletion of-
13h.Diittfeetion type: Amount: well ceirStruction to the county health department of the county where constructed.
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Form GW-1. NonhCorollna Department of Etnir0amcnt and Natural ReD3DiCCS-Divii leo of Wale R• nrcm itctiscil August 2013
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