GW1--07711_Well Construction - GW1_20231122

WELL.CONST'RUC ION•RECORn
Far Gtcratal Usc.ONLY:.
714s frrnican,be•uscdfai.singieormultiple was' '
I.Well:Contr a for Information: 1
- -!14::YATERzONPS' • -. I
Stefan Smith FROM • .tr0 I DESCRIPTION
WA Corinrgot N;rnt4 ft. ft.-
3576A ft. fL. I
NCWellConttaclorQlenift�itioRNturllcr S.'OUTER CASiNG•(t'o"r'ataili �fcsitislORL1NER{iLi'pptit�ibic)""
EROM TO •DtVatr:TER - THICKNESS .MATEntAt.
SAEDACCO 0 ,fl, 6 :ft." 2 I hi. SCH-40 PVC
•
Companyt3atuc'• 46:1_N1NERCASING'OR- 1JBING.f1.eo herinaleti sed-loiij ',•:' -
FROM TO DIAMETER THICKNESS MATERIAL
2.Wct!Constnictirin t'crtinit#: ft, ft. .•
tiff tat opphrabfei e'lpcnwiIfin.County.Sru:c,Variance,/ ectici.•IG.). • -_._
ft.- ft, if ht.
3:Wcl(lisc(chc4lcWril use): 17:SCttF IN
Water Supply Well: FROM " TO UTAMFTER- sr.ntSIES, THIC7ININS I wlATlznr,tl,
CJAgrmuitural. ElMtinicipaliPublic. 6 ft: ]6 •It; 2 a�: 010 scH-40 PVC
®Geatilennat(HealingICooliag Supply} ClResidential•Water Supply(single) ft' • tt'' . I". , .
17luduslriaVConmoercial ®Residential WaterSupply(shared) giGROUT•.:
Oar TO. MATERIAL EMPLACEMENT MEiHOD A AMOUNT
I7ftriptitian' .- 0 'ft. 3 - ft. . Portland Pour
Nan-Water Su.plrly Weft: . - ".
ft, • a.
oMonitoring . i7Rccgecty ft. O.injection Well: -
CIAquiferRecharg-e • I]GrouiidaatcrRcnlcdi;itlon ;19:SAND/GRAVELPACK'fifaptiliciaittr- - - : - , lI
-.- _ , -- - I •
-
--MOH TO MATERIAL . 1PLtf,' NT MIT1iOU .
ID Atjutfcr"Sloragc and Rccor%cty OSalinity Barrier 5 " •ft.• 16 .fl. Sand : #2
. 17 knitter Tcst C IStormitiatcr firaenagi
ft. ft.
' Di:i petintcntul ToJinolo •. ASubsidcnce oostml •
:.2fl DRILLihG•LOG(.mein addilioea1 Stteet if ctece4arti•1'
oGeullrenrml(ClosedL•uop) !]Tracer • "Rion. • TO DEscRE TION(color.hardncli.e[+R,'nick0ax.^-rranwc�tie.)
•
EiGeotlteuual(HeatiiieICoolitig Retutnl Bother(explain under.#21 Retuarhs) o :f4 4 ft, Silt,,sand
4 ft. 16 ft.. Sand! ' •
4.Date Weit(s)•Completed: 10-24-23• 'Well i #R_I-MW07 r '"; )
$11:-Wd11 Lociltfan: .ft.- ft. 1; '
Greenville Utilities Commission f . ft,
: NOV 2 2 2023
a
Facilu•ocrNatoc FacilityID><(ifappiicable) - - • - .-- - -- -- �:
Ra I Ins;.. ._,^l . .", _." ,,�1- ',I
ity,'il
801 Mumford Rd., Greenville, NC, 27834 • ' rt. ft.• `° ''�`�``3J
Pltyiirol:Atfd_ress,Citg:.imd Zip <2t:HEM1t k u s` .,,,•,„ • •
Pitt '2 foot bentonite seal ifrom'3 to 5' '
•
County Porccr ki"_taityc;rdaa N .(PIN)
Sb,I-;itftudc and i iingifardcill dcgt &niinutcsJscconds ai•dccimai degites; _22.Ccitification:
(itnetl nerd,owininoirg h sctltiz lcii)
35.631372 N- 77.363346 iV :l' ., '{7'r""" 1, 11/8/2023
Simi-7 ofCe..rGcdW4,cl Coiivactor; Date
6.Is ,ere theweq s}: XlPcrmanent or fTcm ora
( ( p. Afgning Mis fetinr..1-Irereby eerti v that Mg ve rs.,i'17"1(NUM cor4tritcled I rAvonlonce
WIN I M NCAC 02C,;0190 or MA NCAC 02C;0200 Well Couslis,crfoir Srarrdrn fs and Art a
7.Is this a refiatii-fta an eiistin„`Yell: DVei or lNo 'cops"ofthir ireotll has been pmvidal indie ql li rnm.v
rk(s s a n_rlr fill car krrmvn uvellcorunac:lrrri br oroiptiortarul t�,t•.fah(rho nature ofthe i
7 lh 1. . ' p.
repair owlet 021:romans section audit the back of a:tic form -23:Site dhti.rumor.atitlitionnl well details:
You may_use tik back of•this page o provide"additional well site details:or>sell
S.North er'01 Wells constructed: 1 •construction details: You:nay illsiraitaettaidditional pages if necessary.
For ntnhlplg btfec lon ur rnui-miner supply wells ONLY Oh Am.sanreconatrucfioir,your<wo ;
"rttknriro»c form: - - SLi1tl1(ITTAL iNSTLICTiONS I'
i
9.Total Well depth below land surface: 16 !� (ft.)' 2da.:Fur All Wells: Submit this font within(30 days-of complctlod'of welt •
For nruhlple(colds list ail depa&ffelif'rrnr lcrentp14.3@200•and 2@100) construction to the folfowiug: • -
10.Static water.level below top of casino . . (ft,) Uh•iSiun of Water It ources,infirrmatiynPtricessing Unit,
1j wilier Ida is:dove easfan Om."-s" 1617 RL•tit.Se rice;Center,Raleigh.NC'27699-1G 17
II.Borehole diameter,8.25" (in.) .tab:For itifltlon Welty ONLY: Iir►addition to sending the form to the address in
24a above.also submit a copy of this forth within 30 days Vol.completion of dell
12..Wcll construction method;•RSA cotlstiuction todlte following:
(Le.auger,iotary,rabic;direct push.etc.) "
. .Re. Divlhlou of Wafersourefs,Underground In m jection Control.
FOR WATER SUPPLY WELLS ONLY: 1636 Mal(ServicejCenter,Raleigh,NC 27699-1636
13;h Y(cld(gjim) Method of test: 74e.ForWater.suppl &Iniectiori.Wells:
• Also submit one'copy of this form Within 30.daysofcompletiou.of
II3b.Disinfection iypt» Amount: well.constructions to the county health department of the county where
constructed. 1
1
Form GW-1 North Carolina DepaRmciu of Environment and Natural Resources-Division of Wafer Rr!-0curs Revised August 2013