GW1--07714_Well Construction - GW1_20231122

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WELL CONSTRUCTION RECORD 'Fr Itacmal Ilse ONLY:
Thr.fain coil be used for-single or multiple wills• '
1.Welittanteattot•Inforination: - • • 1
i.t4MATEEtzoNE&... - • •1 •. • . - . . . .
Stefan Smith. FROM TX) DESCRIPTION ,
%Wli COIttliMpr,ttaRtC, • R. ft. , .
'•
ft. ff. 1 1 •
3576A .
-15AUTER CASINGIroil&tilt kiiialliellsi ORLINER:Matti-tieablo' ....
NC Weil Contractor certification Nturb'er .
FROM . , TO DIAMETER THICKNESS' '_ MATERIAL .
SAEDACCO 0 (4 6 , :it.• 2 t' I in. SCR-40 ' - PVC
•
Compala-Nome • • ' ',WANNER CASING UThtNG cro-Sed4oilin : -..-. .....
FROM' TO . ' DIAMETER ., THICKNESS MATERIAL
2.Well Conitalctifin Permit 4: . ft, ft.• I :ill'
Lin oil app'11 cable will pennir (i.e.Cooing l'IroO,Variance.flectif4 cfc-,1'
tt, : -ft. 1 , in,
., . . 1 •
3.Well.lise(Opel:-well use) , -,[7:SCREEN , , • • .
• • •
FROM TO to-Amy:rim ' sr.OT stn. THICKNESS I MATERIA I,
Water Supply Well:•
ulattai rAltin 6 ft 16 rt. 2 il, .010 SCH-4 0 PVC
riAgricicipaVP:ublic..
C3Ge011termat aleating/Coolimi Supply). EiResieleatial•Water Supply(single) ' .fl* .. ' 'It
C3 industrialConunercitil CiResidential WatenStipPlY(sinned) --
FROM 'TO: MATERIAL i IENT METHOD&ANIOUNT
. El laieation• . . . - - o ...ft. 3 ft. . Portland Tremie
Non-Water Supply Welt:- , . ,. .
'. . - -• •- , • •
• ft, . ft. :
It/Monitoring. DRecovery • ! . -
laicetion Welt: n, . •ft.
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ClAquifcritcCharge 17.16iountisialcillc,incdiMon . .19'.-SANDR-atAVELPACKtillinp1160tur',r.1-----'-----,...- -,--.--------,;-.-----. , .-7 -
:'1,120A1 • • MATERIAL . ',EMPLACEMENT Iftcrtion - -
' -
• 1:1AitifcrSitOragc and Racavety 1:3aliiiity Harriet': •5 . R. '16 ft: Sand' #2
, . .., .„
CI Aquifer Test CISIcarnstiter Prniongc .
' . :.
• &Experimental TeChnotom., EISubSittence'Contra
;30.01111..LING,LOGftittaelt addition]iheitk if iteceSsarvl - .
ingend*nind(closed Loop) 1:1. Tuteer FROM -• To - DESCRIPTION(4.41:1r,bardricti.milVnick((Is,.mill fsn,dr.) • -
. .
1:1Gootlicimal(Heating/tooling:Return) ' Otither(explain nutier.#2 l Rematks) A) . . --1t, 4 ft. Silt)sand
• - 4 ' ft. 16 ft. Sandi
4.Date Viiell(s)Completed! 10-23-23 •Well ugt RI-mw0 9,
'ft. . ft.. PT.--..:f•—'7...7„,-:-,1,, 17.7
5a,Well Location: .rt.. ft. . .. ....,-...,, ',..—71 V '1;',J,,•.• .
•
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Greenville.Utilities Commission ft, . NOV 2 2 2023
FaCility*terNamo FaCility IliN iitapplicable)
801 Mamford Rd., Greenville, NC, 27834 -ft:- ft. ,
..
._ ElWC5.1:SiDG'
Pipit AildOss.cit3'--a0 PO .-21.,REIstAiiKS- • :' •
. . .. . .
Pitt 2 foot bentonite seal from 3-5'
!.
County Nice]klantitIcation No,(PIN)
51i,Latitilde and-Lai:grin*in tk-givcsiminutCsisectindS tn'rdstimul degrees: -'2-certificatim,,,
(i1001 fictil,one lat104,is•su.itiicni)
. .
. --• ,. ,
35.631246 N 77.363238 W , ....,..* • ' 11/8/2023
Siam. of Ce died Well Contraater'„ Dale
. .
6.Is(in.)the welt(s):'XiPennattent or 0Temporary
Ay.signing ild.Y farny..1 limb".cedify'#)to Ihr.1.14411 kill( terq comonere4 in•Avyartlance
-WIN 15.4 N.CAC 02C.0190 or 111NC;r1C 02e.92an It'd!coschrarricut Standards and;bora
7.1s this a impair l . . .o an*idol;well: !Diem or ®Ni) oiky ofthn irefird 104 been avoided r,OM spelt oirner,
(10115".1sn IfikYffr.fill an kirogi well conmedoo Infonnatim cod explphi rhi.!/Ware of the
repair tader 02.1'rincrki-sedan or on the bad:of this form.. - 23.Pe diagrum.or additional welt,detaiLi:
You may use the back of this page lintosiclo'additional well site.details'or.Well
S.Nutuberof Wells outtstrueted: 1 • . •eonsnuetion details. You May ASO.attach additional pages if necessniy.
. For sitairlik.irefectiOnnr oon-water mpidy wet!,ONLY illth'the.same coostrudhor,you ear# • ' '- --l'
mho*Li*firm. SUBMITTAL,INSTUCTIONS
0.Thal Welt depth hc(o land surfacei 16 (ft.) 241..Far All Wells: Submit this farm ssithiti 30 days of centmleticnt of well
For orairipleells-liArnil depaks ifel( ron-lesompte-3@200'm1112.0700) constMetion to the folkaSing: ' '
10.StatieSrater leVel below to pof easing: 00 DisisiOn uf Water ReSounceS,Infitrraatiatt PrOcessing Unit,
- lf unter'leket Is above dosing,ale'"4 ,-" 1617 Mail Sertice t.S.ater.Raleigh,N .27699-1617
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!I,Borehole diameter:8-.25" (in,) 24b.For Inicelloti Wells ONLY:: In addition tosending The form to the address in-
24arali6e,also submit a copy of Ibis form within 40 days'of completion of knelt
12.Well'qmstruction method:RSA consuuction to-Die folimiine! i
(Lc.par,ci-,law.cat•le...:direct posit ctc:)
. Division Of Water Resources,Underground Injection: Control PrOgrant,
FOR WATER SUPPLY WELLS ONLY; 1636 Mail Service'6uter,Raleigh,NC 27699-1636
13a7 Yield(gm)„ ., Method f test: 24e.For Water Stninlv&Inkettlnal Wells:
ri o
Also submit one copy of this formwithin 30 days ofcompletionnpletion of
13h.Disinf .ection type: - Amount: well-cotiStroction to the county health deportment of die county where'
- . constructed. 1
Fenn GW-t NonItCanallna Fkpariment of EGVirOILIIKIII and Natural Resources-Division of Water Rourcm Revised August 2013.
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