GW1--07710_Well Construction - GW1_20231122

WELL CONSTRUCTION RECORD I i
Fur Imam'tJsc ONLY::
This limn can ba'uscd for single or multiple wills' '
11.4Wcll.Conttacwr IittorritatIon: •
14...(AThI ZONES I' -
Stefan Smith FROM: TO bFscitt TUON '
Well Coiticagor N nte•
ft. ft,
3576A It. ft.
NCWc19CoNraciorCcnificationNutrttrr tts:"OUITER CASING(ru'vinolikiiseiQRells)'ORLINERtif luilleablcl; .
FROM "i TO DIAMETER THICKNESS MATERIAL
SAEDACCO 0 ,fL 130 -ft. 2 I i.to. SCH-40 • PVC
Conp.uil=Namc I6:-1NNER.CASING'O_R;TUBING.(,eothcrmatctuiad-loon
FROM. TO DIAMETER THICKNESS I1ATERiAL
2:Wcll Construction Fcrniit>r; ft, ft. m
Lis(en appbruble well pen17i (ir,-County.:Stu:r.,Yariarne,ftye tiGF etc.). --
0.. ft. I �.
3.'Wc11ljsc.(chccicwchtise)i . 47:SCREEN " . '
�vatei Supply Well: - F1tO51' TO • oFAMF.TF,R Sr.orSt7 THICKNESS MATERIAL
°Agricultu al; OMiinieitml/pub)ic" 30 •ft- 40 ft. 2 ?� 010 scH-40 PVC •
®GeatIwnnat(Heating/Cooling Supply) ®Residential Wrater.S,upply'(single) - ft' I't. in.
t llttduslrial/Conuttercial DRtsidential Water.Su FROM tJ[IT' . .-
. pply,(s!>lted) PROM 'TO-. '. MATEtHAL EIIPLAC'ESIBNTMSfiiODSA,11ot1NT'
. Ellrrinatian' . . . . 0 ft.. 26 ft.' Portland Tremie _
- Non�Water Supply Well: ft. .. ft, ' . , _ _. . . . _ ... ,
6d len toting - , I:Recovery •• • " -
injection Welt: n. ft. ' , I
ElAQttifcr'Rccliargc. . f;IG[OundR'ttcrReinediaiiou t9:sANDIGItAVt 'PAC1 ifaigdia'gDtcy" _ • - -- - --
- . :"PROSE -In - MATERIAL t.EstriACI Vi:-NT Amnion
17Annifcr.Storagc antl.Rccd erg'. •ElSalinity Harrier 28 ft. 40 ft. sand #2
El Aquifer Test ElStoinn{;itec Drtinag° it.. ft: •
DEzpetinicntal To hnotogy • i 17Snbsitienee,Cur4mt: -
I(I:IiRILLThfLOG(,attachadditiotialsheNiifnecessan•}' - -
. . . OG.otltermal(Closed Loop) LlTrdcer • FROM- TO - DESCRIPTION rwb.h,sHct.�l.main,ctatytx„rka:�rn;.(te1
• IJGeothennal'(ReaiinelCaoliuigRetwu) clodter(explaiuunder:#21•.Retnarks) -0 .it. 4 ft. Silt:sand
4 - ft. •40 ft. Sand:
4.Date Weli(s).Cauipleted 10-26-23 •Welt i WRI-Mw03d
"ft. ft. i' .4 4 :•;)
$a;Well I itcutittn: i� i,.as a .'_
rL ft. N Q V 2 '}
Greenville.Utilities Commission_ ft.. . 'ft, a 2023 .
Facility,,dr oorNnioe Fachiy WO Cfappli nble). -- -. - - - ---_ -- - - - . - _ - - -
. R: ft. inrc;.:..<^.n i---1,^ -.I t�i'
801 Mumford Rd., Greenville, NC, 27834, ft. . ft.. - - `"'"'"'•-'v,.:.' •
Physidal'Addiaiss.Cit3•.and Zip '•• %21:REMARK$'•.. .
Pitt ' '2 foot bentonite seal from-26 to 28' '
County . Parcel Id:rgiti ntiunNo;(PIN)
Sii..Latin]:delimit l,ingif rile in itcgrecss/mitutcslseeonds cir-decititol degrees: 22,Certification:
(If pelt told,on:ia1,04 i!i sallittrrd) ,
- .
35.632191 I✓ 77.362471 11/8/2023
Sigm` ofCeYGcd Well Cantrrctor • Daic
6.Is(are)the:aell(s)t X1Pennancot or DTempO'rary cipiing thin farm;.1 lierehy certify!timi the trellte•1 Ixty I rre ion i,iCtedd kiteeoril inGr
krill,15,tNC..LCO2C,0100or LTA NOG 02C.,t)a170 Well Ctn:O wring,Statttfuidsmtd:lama
7.E this.a mirth-fa an eiistiag`i'ell: F3Yer• or EINb aiymofthis ivctialha t.wit provided i%i ttir an II(nrrier.
If this.I n!Oak,fill elyr&sores well rontmrctiori brforinarloa said eaplabt the aware of the I
repairrutrlcrb7.J-remarkssectien or tin the btu*.efthis fornc 23i Site.dwgrani or additional u'etl det:tits:
You ma},use the back of this page to proi`ide":idditionat.well site,details:or*ell
8.Numb erofWelts cottsfrueted: 1 ' coustmetion details. You may alkt attach addiiiotail pages if necessary_
Fortnnlrlple ltoerilon ta-ar,rt-u user supply wells ONLY with 11041Wt1rcoiratrurliwr,On coo
sabrnirann form. . SIlBft ITTAL iNSTUCTIfONS i'' '
i
• 9.Total Well depth below hind stttiaces , 40 . (ft.) 2411: For Aft Wefts: Submit this form within 311 days of ccimpteiioa of well
For Antrlalp1eicitlslist all depthsifdiffernu(cxmip(r-30,200'emit.2@WO) constntctionto the fottonin . '
� li
10.Stark water lepel below fop of easing . , Of,) Hivisiun of Water ReioUrces,1nfcnniutipn Fipcessbig Unit,
lfuaiei level brabove casing,asc"-f" 1617 hfait.Serrici Center,Raleigh,NC 27699-16t7
8.25" t
11;Borehole diamcth:r. (in,) 24b:Fnr,ilej�titlrr Wct�ONLY: iin addition to sending.tlie form to the address in
24a above_also submit a-copy of this limit within 30•days'of.completion of well.
12.Wellconstretctimt method:BSA constriction to the foflot 1iig 1
(i.c.auger,ictaiy,cable,direct push.ecc4 ( ;
Division of Water Res ources,,,Undcrground IDjecden Control.Prograut,
FOR WATER SUPPLY WELLS ONLY:' - 1636 Mail SerilcejCenter.Raleigh:.NC-27699-1636
13a,1((cld Wm) Method of test: .24e.For Water Supply.&Injcettari Wefts:
• Also submit one copy of this form Within 30.daysof completion.of
13h.Disinfection type: Amount: well.consiniction.to the county'he sltfr depaitinent'of the county wheie
•
constructed.
Farm GW-1 Noah CarolinaDcpanmcnt.ofEnvironmentandNJaturalRceources-Dfvisl000fWoicrRmotrc s Revised August 20I3
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