GW1--00030_Well Construction - GW1_20231218

r
' WELL.CONSTRUCTION•RECORD D Far itdcrnnl Use ONLY:. I '
its•form eon be used fat single of inuliip3e weds• •
1.Wcil:CoutratctneIuforntaiion:, . _ _ .,
• l4TL'RZONES. '• •l-W •
John Eisenman r'14051- To DFSCRIPTION .
WeitCurnmc oriv7me• - ft. ft.. i , .
4439-A ft. fG I ` .
NCWcl9 CanuasiorCcrtificttioaNun ct 'iS:OUTER.CASING'ff.9i*iiiiiltl=eii�stl=tiettSl OR LiNER(ttatiitleablet'- .
FRONT ' ' TO DTAMETElt THICKNESS NMATT.RTAL
SAEDACCO . ft.. it.- 1 .1,1a.
C011013l•flcanar. 26:4NNER.CASiNG'OR-TUBING(f eaiLcrinal etuseiMoiliti--'
' FROM O DtAi !TER. TrnCKNESS MATERIAL
2.Welt Constllaetion Permit-#; 0 ft, 50 ft. 2 SCH-40 PVC
Lai Fell appll wMfe Felt primitpte,C'narnty.:Sale,Variance,1rja11c4 etc.). • •
. .
3:WdD Ije(chccicwelt itsc).i q7:SCREt N •
+.. 2. .FRO51 TO ' .DIAMETE.R St,OTSIZE ' THICKNESS SIATEDIAL
Witter 5uPplt Well:
ClAgnicultittal. • DIGSiinicipalf.Pttb)ic. 50 ft: 70 • ft. 2 iri:' 010, SCH-90• PVC
DGeothemtal(HeatingICooliug•Supply) DRes'idcntiat•.\V itci Silppl,;,�(single) d, It.• . in . • . .
E ludustnaliCon1ntercial. ®Residential Water Supp1':.(slatted) 'tti.GROUT.-_
.FROM ,,TO.
te _ MATERIAL- 1 ENTPLACEM ENTMErnOD&AMOUNT'
DlrTir tion- . . 0 'ft. 44 , ft. -Portland Tremie ,
N nVar Supply yel: . - . . .
. - . .. .. - - . , . ..
IldM4nitorin4- - C]Itcegm'tly ft. rt..
Iujecll •
on Wcil: ft, ft: • -
. CIARinferRecharge GI3mundimierReittediatien -,192SAND,'CRiVELPACKYIrrayrpucnbtet'"- ---.:--" . . : --.. - .
. . - 'FROM '• -it) - MA'rpItrAI, -EMPLACEMENT METHOD i
I7AA)iitfcr-Storage'alxl)Rcoii;i3' I S9linity flairicr 98 ft.- 70 ft. sand ;. #2
. CIAilnifcrTcst• • EISlgtniil;mtcrDratiiagc ;
ft.. ft, i
. • DE:ipe imcntal Tcamolog .. , DSI bsidcucet'entnil
• eodiemyll
:'•20:DRILLiNG'LOG(altacliiadditiooalsbtt'ciIneccssarvm
DG (CIoseid Loop)- DTrdcer • roost to DEStinlFTION[Mar.haraneti,umtnatli ntx:eratio im tic,1
•
OGeotliennal(tleating Coolina Return) O011ter(expinin under.#21 Remarks) 0 ' .rt.. 75 ft, clay 1
4.Date SYel[(s)Cotnplcledt 11-17-23 . Well IDi1PZ-7 .. . . • ft, ft. `'
I
I ; s. �,.,
. So.Well Lucathin: .ft.- • f4 .7_. r ' `... i.--
• Former Clay. Mine Site . • ft.. ".ft,• 0 .1: 1 8 fn1
Factiity,'OwperN[nuc Facpib-IDklfapplieeblc).. ft I. �yt��
1751 Colon Rd.-, Sanford, NC, -27330 ' fA ft. 110„,`''';•-
Pl(vsicalAddress_City.andZJp x21:,REMARKS'. ' • • •
Lee - Bentonite seal from 44-48'
County beret idciatiticailon No;(nlN) . i
tiIis I:iitutu deUnit Longftirilrt in clegtt /minutes/ coeds cii•dechi tf ctcgi'eei:• ,, I'
. or wen tight;one IaI1ougis•srdlickrd) tcrtiticn6on:'
. N W �_� _�_ 12/4/2023
. .Sig'mtureo.:.L.:i,.. .ti:J..i,,WE;i`---- Date •
6.Is(tire)the:,,i'ell(s)t xlPertuaiient pr DTemporar If1 rlr a.-" „m„•• fni,a.• Ye.", i, iti 7.1:1-70' i -..-y.F ej.vJr Yfnicied,.rnY'Otrfmrrr
rivrh'ISrt NCrtC 02e.'x l n aZei,:.r;.IC,02o011'rll Censrrn.rioar Srararlards aid lima a
7.Lb•thLs a rejlistr'to an czisiing-wclli DYt.r .Or 2aNu 'ctrry`'J.ofth,G recmrlIiig ken r nn'iafed raiKaesnfimr,icr,
If this:df a rrpelr,fill our Iiwii a ivdJl edlamrctimi di reallon imd i:rj,leht the maim of the I • .
refrrrir mivlcr p2f:rmrariFs..siviian or Iva Thu brut r f this fornc. -23:Site diagram or additional es ll tletallr: •
You may use the back of this pine tol:providc'atdditional %'ell Site detaaiis:or well
8.Number of Wells eottstrncted: 1 consttuctiou details. You nlay also,atlaeh additional pages if tmcessun:
Foraanftlplr hifecrlon nr rn+vl-nei'rer ri pply uvhhi ONLY ii Jilt theme??coarstrirrtum ye.t aura •
srakniftrinefomi. - SIII3ML i'ALiNSTUCTiONS .
9.Total R•ell depth below land stirfrice: 70 •. (ff,) Ill Far Att Wellwi Submit this latin withhr 30 days of ccsniptctioti of well
ForiFelziple4lisJist ell depths ffrtfftrr,ratnrrn.S'-1@200'and.t@sWD'i . cnnsinrcttonto the foltosingr: ' �!I• `
10.Static water lesel lteluw top of casing: • (DJ Division of•Wuter Rr vctui+CC9,InformatiunP,Ettcessing Unit,
.11weier Leval is above easha.g,•kw"+" -- 1617 Mitit.Sctl ice j cntcr,Raleigh,NC 27699-16 t7 • •
11,'Bor'ehole diameter:6' - (in.) a'ab.):nr 1TiJtratoji welt;ONLY: ;in addition to sending.ike form to the address in
24a alroe'e.also submit a-copy of tliis.tonil within 30•days'of completion of welt
12 Well construction Method:Air Rotary constnictlou to-the following!-
(Lc.auger i c5i y,cable..direct push,NO .. 1 I . .
DiviSlau of Water Resources,Undergr'onpd Itijeetion Cdntrol PrOgiu_itt,
FOR WATER SUPPLY WELLS ONLY': -1636 Mali Service iCentel,Raleigh,NC 27699=1G36
13:1.X(dd('jinn) Method of test: 2.te.For Watci Supply.&Inicctfon Welts:
Also submit•one dopy of this forum Within'30.daysofcompletion.of
13h.Disinfection,typem Anmount: - well,congtniction to the county Itedith deportment of the•cottitt.where
eonsimcted. i
I
Font GW-1 North Carolina Llepaim toanm ent.of Envicau and Natural Resources-Diviiboof Waterte=atttm Revised Attgust'20I3
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