GW1--00029_Well Construction - GW1_20231218

WELL CONSTRUCTION,RECORD FOT itental Usc DNLY:. ,
, . • .
This form can bc-useti la single Of IIIII111117.1 icellS'
. . I
1.Wkiii•CORITilittOT litforEliOKII . . . . . . ..
•41:WATER ZONES . • .
John Eisenman THOM - 'TO , DESCRIPTION '
Well Cotiraci-or Nano:, • ft. ft' I -
R. • it;
9439-A
r,it&ttrrER.CASING'MiiittinitINTOR LiNERAtfiitItAblell, .....
NC Well ContinciorCurtificutionTTunter
FRO31 . TO - - DIAMETER, • THICKNESS 5IATERIAL
SAEDACCO . (4 • ft.' I °IL .
Compaiq-Noinc. , . t OR C1NNER CASING TUBINGAgritherinal eluted4oiipp.','.- ... •.
-FROM TO DIAMETER THICKNESS' ' MATERIAL
j..WCIt-Co p ittrUC tint;•Oertnit 4: , • 0 .R. 30 it 2- '2I1L SCH-4 0 . PVC
Err ell frpplicalifelsOl perpift .fiam'Coiony,:prat!,Variance,44-04 eIr..)• • :
ft • i . ift.. . ... .. . . . ,
3,'Wel1,Use-(0,4k WO!Osel: -17:.-SeltEEN • . i .-• . •
•
. . sum to 'DIAMETER ' SLOT SliE THICIOIESS 1 MATERIAL
Water Supply Well:• . 30 ft.. 50 R. 2 •ill; .010. SCH-40 PVC
• OttgriCultarai ' . . . COintidipal/Ptib.ha,-, . .._. •
. . . . .. ,
' It ft. '• ,
ElGebtliemtal(lleatingiCooliniStipply). °Residential.Water Supply(single) . • . ini . • - .
DIndustrial1Colunteminl pliesidential WrdASupply(shared) ' s/,'""'.ii.,.;,
• MATERIAL U EMPLACEMENT METHOD&AMOUNT • .
. El Irripritiori• . • . 0 -.ft. 23 ft.- Por timid Pour
•Nou-Wiitcr Supply W . . . .en: • • ... _. . .. .. . .. ,. .• • . .._. .. . ._ . .. ,fltiMonitoth).4 . - It'll:eel:new . _
Injection Welt: ft, • . ft.
•-.,- , , . .
0 Aintifer11:eclitirge Otioundwater RinCtliatioti. . -,192SAND/GRAVEL•PACK.4aMilleabter ._.
,,w1101,1 TO I 51 ATRRIAL - • •EMPIACIAIENT METHOD
ElAtittifei-o.'tOr9g—e owl Itc6iy•ety. 17SalinitY Raiticre •
28. ' R. 50 . ft. Sand i, *2'. .-
El Atinitci'reit . OSIOntiWatce Ittriiiiing,c' . . -i, • . • -
. ft.. f.t.' i' '• •
bEtpctintenial To:lioofoft • , ID$nbSittencc touirel . .
•40,4)RILLINGEOG•hitiaeh Oditlitiiiiil'iihieN it tatsnivl• -
--' . • 13•Geirthenital(Closed Loop) OTracer - Rost- TO • •• DESCRIPTION(rotor.hiniancn,UilVIIICh OM ttrtill WC.dc.1 •
ClGoothe noar(tleatimt+Co'ditto Return) Diller(explain under.intlietualks) 0 .ft. 50 ft, clay ;
• ft. ft. . I, ,. .
.4.Date Well(s):Completed: 11-17723 -Well m#PZ-6. .
J. • • ft. —,
- k..:,.: ;•.:-.",,.--. ---,
. . 1 • . . - k..l :'*e '(.:— "•.,,. .7....,..
54:Well Litelitlollt .ft. it; 1! -.,z ie i'-••• i
Former Clay Mine.Site . • rt. ft. ,. DL C 1 8 7• .. I: ' • •c.0'17-3
.
Ficilityiciwixriiutte - Faailit UM fitappiicablei.. — .
f.t. ft,.. ;•
. , . inf,:'4773alir'n 1'-
1751 Colon Rd Sanford, NC, 27330 ,
• It. • rt.. • 1', - - • DVV-''`, ."''..g UP 1 '
... a-
., iillir*fil-174/055,Citi-.4141-.11/: ,2t.-RERIARKS - '7 ' .- . -. - .•
' .
Lee
• • Bentonite seal from 23F28
'
. .-
Gustily . Parcel Id..z.11tirtition N .(PI )
• .
..lo,....1.41iittide'Uttil-1ikitiiiic in tkgrccsintintol6iseerind rir tfeeitnal ilegricir I'....
72.Certifications i, •' •
(11-.1%01 rgid,01111 klitioli iS'Slaflilignt) • .
. s,
•N .W - :-.. ...------1: ----- ------ 12/9/2023
' Sidtrourepf.u:m.FW,11:0.i...a..n.cti,,./ -- Date
6i Is(#g)theAV 11(N).1- IPIPerillkii1Mt .or LiTemporary Sy sianbii.thirfoliK5Pkit("Pdr;:if..ii,..SC.,"A'7,144a,,,-.4,Z.,*,:lc::,coat.iincie4 In.=emir:nee.
.with/5.4 i\rCA.0 02C..kiv-l -- C::4,;..•iliii7.0200 Well Consiiiirtioir itandcwili'and Mar a
7.Is thu.a rejtidiln 40g*hitingvc111. ElYMr" or No - 14tpf rhlr iecririrl bnillren inin'ided ni 414e%Irii(ntuier,
If this ka repak fill OOP linoigi trOlo.noriitcilatiWarounilon 117;i1 tiy?.aln the.orarare of ate l' ' '• •
repair ruder#21'remark?seciion oe on the bible dna for,,,.. - . .23.4ite.4liagrantor additional well details: .-. .
You may use the bach-of this page to;inovide.additional well Site.iitaiW or*ill
8.Number of Wells constructed: 1 cottsnuction details, .You may alsit.allatitidditionol pages if tiecesSaty.
For ntairiele infecrioner oon-mner s.upply we(p,ONLY iritit rlie.Sffirie construe:kr,yon.ckm
• sainnit one j9rra.. St11314IITTAL INSTUCtIONS
•
- 0.-Total welt depth hetoiv.land stirficei . 50 . _ (fa, 244. For All Wells: Submit this'flinit within 30 days of ceouptctiOti of well
For mold&iireiltlist oll depths if dfipnay(e.ronipte•-3@20IF anil.2@l00) constatetlon to the folioning; 1:
Id.Static Witter leir.1 below top of casing: (D.) Division of WateeDeitntrceS,inforniation Viticessing Unit,
limiter level is?above ecisfax iue'"+" • TOTTATuti ST/Tine i tr)iIfir,Raleigh,NC 27699-1617
. I. .
11,unratite diameter:67 . . . ••(in.) 24b.For bileellprt Weliq ONLY,: in-addition to-sending.the form to the address in
. 24a abbve,also submit a-.copy of this faint within 30-dmis of completion of Well..
12.WelIconstrttetion method:Air Rotary • constioetion to-the following- ;
{Le.adger,ham'„cal?le,direct illSti,CIC.:} . •
Division of Water Resources,Underground Injection ContrOf PrOgrant,
FOR WATER_SUPPIX WELL8.0NLY:' ' - 1636 Malt Senice!Center,Raleigh,NC 27699436
24c,For'Water'Supplv.&InjectiIon.Wells:.
13a,ViFhligPtio. Method of test: •
• Also spbolit'one'CO*. of this Ifiinii Within'30 cddyS of coMpletiott.of
13b.4 Disinte•etiou,typet. Amount: well-constr consituctcd.untiOn.to Me county belth dcpailment of the county where
•
•
Farm GW-L Nonh Comlina D,.-partmentof Environment and Natural itc:9311ICCS Division of Water Riqinrom Revised August 10'3
. 1