GW1--07708_Well Construction - GW1_20231122

WELL CONSTRUCTION.RECORD Farrnternal-1.40 ONLY
This form can be•used foi.single or multiple wells. '
' • 1 ' ' . •
I.WOLIcinintetue IiiI0Tniatiort: . . . .
,- -.-, -
---11AVATERZONES - • • '. • •
Stefan Smith . FROM_ TO DESCRIPTION •
Well Contractor Name, ft. rt.
It.
3576A
IS OUTER CASING`ifite-ithill klaithiellsi OR LINERlicantificalakf. ... *
NC Well Conimelor CenitieutionNumircr
FROM. • TO ' . , DIAMETER' ' TRIMNESS MATERIAL .
0 .IL. 6 A, 2 i 1-;a. SCR-40 PVC
SARDACC9 •
ComlimiTNarue, 'tal NER.CASING ORTIMING entliersintrddell-loit" •:,•'.' .,.. ... I
FROM' TO DIAMETER. , TMCKNESS MATERIAL.
2.-Ni;e11-CoriStructiort Perri:lit fh R. R.
Uri 4ill app4rafgeisilf pehrd.ta(ix.County;S159,Variaraw,frjalk41.Or-7
. ' .fl. I- .•
i .
3.W.cit.lise(ehetic well rise): -.-17:SCREEN
_ • .
- - mom TO •DIAMETER , siorsur. 'Tnictorss i war...mat, '
Water SuPply Well:•
• • 6 It. 16 -it. 2 i#,., .010 SCH:-40 PVC
. ' °Agricultural, 1:1-tiiinieipal/INblie-
. .k. '.0.
EICreothetrnat(HeiningICooi i lig'Stipply) DResidential-Water 8-upirly(single) - . _ .
- ..
ClindusttiallCommercial °Residential Water,Supply(sIttred) 2:061:°Trr'-0-.
i MATERIAL i EMPLACEMENT MRIMOD&AMOUNT
0 Irrigation' . . 0 , ft. 3 ft. Portland ' Pour . .
Neu-Water Supply Well:" ... . ,. .,... . ..
. . . , ,ft., - ft.
• NiManiloring
Injection Welt: - - . . rt.' rt.; .
_.
. El AititifcrIlecharge CiGuaundwalcr Reinediation 49.::SAND/GILWELTACRiiialnslictInter -- - - - - - -
. . '-FROM ' .TO. MATRDIA I.• EMPLACEMENT METI1011
IlAiinifer:$Ithugc and Reeciitty °Salinity.Barrier 5 R.• 16 . IL Sandi,. -2 • •.
. CIA-nniferTcst °Stan:Mater pnliMige . . . . . .
It. (t,
ItIVAserinicatal TeChnotogy EISubSid.coce,Costrol • •
* •
*,,10.1TRILLINGLOGRillaelfidditibrial sheiliiirtteee4atil • . * '
. . -0*o. timmial Oised Loop) - • .1:In:leer . , " - - ' MOM- TO' ' ' DESCRIPTION roger.harducu.sttnaack.onc.-oxitt tatc.(lea
CIGeothenttaIfIleatiniieoollniRetuntl ClOther(explain under.112 1-Retuarks) 0 .ft. 4 ft, Silt1 sand .
. ' 4 • ft. 16 IL Sand:
. 4:Dati Wie11(s).,c0 Mr!de& 10-25- 3 Well Mit RI'MP 3 ' : - '
ft: • ft. . sr-,- :. -,i- ' '•. *i. '1;',---,..-•_
'-', ,t,, s, ..'-'.•*'"c A . ',,,,,li-I)
. . .Sa,Wall Locatitint .
..ft. ft, . •---,r....,
Greenville.Utilities Commission . . . . ft. ke-v 2 2 z(123
. _. ... . . . •
FiciliWOnrONturie • Facpity 1DP Of applienble), .
ft. IL• , . ,. I ri i0i7'!:-..:.;-'n '-1,.,7. ..-.7.,,•,1,-;=- ''
801 Mumford Rd., Greenville, NC, 27834 • ft. • rt, . .. .. - - • /...,,,,.,..,, 0 ,g
,:.•:.3
. P 10-106 AlcIM. ssrCity..*arni Zip - .,2 4-R1:NIA/His . ' . _ . . .
, . .
Pitt •2 foot bentonite seal from 3 to 5'
• -
„ •
County • . Parcel hinthr=ilap No;(PIN)
. . - •
" 511,,I.,ittitude-Ond lingititile in degreci/mitiotcSfseetinits nriccitnol(hp-cc*: 22,cft6ti„,:,
plea field,one 1311I04,is'sultlekal) - . ' . .
- - . • . •
•
35.632191 N 77.362471 ' , 11/8/2023
Sigma.' of Cc did'Well Contmetar:: Dale
. - . •-- i ,
6.Is(pre)thewell(s):.X1Pentronent or. °Temporary
tly 4ning this/aim.:1 hereby codify:41)a!du!well(s 0 Pau Ostire)eunyinfeted irt.acconlancr
. . . Iiith I.1 NOW Q2C.9/0k9 or ixt NOW 62 e,p209 RW1 Couirrucrlon Stark:lapis and Mar a
7.Is this.t repair M On ekistitaglic14 °Ito; or pNO r•iiiT.9fdily ierOnl hi&broil tooridc41 i,iiiiir welifiloirr.
If thtS:It.0 rgprir.fill(.10 kosoirm well 011137111Clidlilujormarlim dmil esplolu the nature of the . ! :.
ripair war,r•P21:reinorksseilien or 611 the.htial.Of hilLs form. 23.Site diagrlint Or atillitioual well details:
. . You may use the bitch of this',hie M.titovide.additional well She details or Will
8:Nutuberof Welts construeted: 1 • - - . . -consnuetion details, You May aLsO,allacttlidditimpl page- s if necessary,-
For muilripk Jrdershinir'ow-wirer supply ireqs ONLY frith the.sainq canstrui.tion,youswo .
sutnult lifJC km. . SIIRMITTAI,laSTITC.Tiolitk 1 , . •
i, •
9.Total well depth het&land stirfoce: 16 - (ft.)* 244 Par Alt Wills:- Sublitit this'form within 30 days of contplefien of well _
For UrulzIple wellslisr all dem*if illff ereq(maniple-MIRY asui.201419) consIttiction to the following: ;',
. • I . . . .
10:StatieWater'del held*top easing . . (ft.) DivislOo of Water ReStiti reek,Information Processing unit,
lf welly Wel is above casfui,,,isle"+" •1617 Alail.Sei-rice:ftentcr,Italei0,.Ne 27699-1617
IL Rnrclude diameter:8•23" (-(L) . 24h.Far forearm WelP50NLY: jilt addition tosending lite form to the address in
24a-abeve. also submit n..cepy of this fortis within 30•dm's of completion of Well
12;Weliconstmetion method:HSA consiniCtion tO,the folloWine!• I
tie.auser,*rotuty.cal?le;rlirca pint'.cte.I
- . . PlyiSion of Water itesou rocs,Iindergmund Injection Control Pro.gram,
FOR WATER SUPPliN wEL0 ONLY-; 1636 Mail ScrviceCerner,Raleigh,NC 27699.1636
24c.For watei•Sunplv&Iniretion Welts:
T 3o,Vield( pm) Method of test:
Also submit one"ciapy of this form within;t0-days of cOmpletion of
13b.Disinfection type Amount: . wcil:consinietian to the county health department of the connty where.
. constructed,
Form GW-I. Nonit Catalina Department of Environment nut Natural Resources-Lent ion oi Water Rptatrtm kevised_August NIA
. 1