GW1--00034_Well Construction - GW1_20231218

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WELL CONSTRUCTION RECORD Far[mental tfsc ONLY: i;
This faun can bc•uscll for killdeer milli*wcfs' . j
. 1.%M1'e11,Cantratttor 1uforntatiou:
f J::WittER.ZAN F S . . .
Scott Hunt, Jr EMITS] 'TO DESCRIPTION •
Writ Contractor Kane, 26 ft: ft gravel one that had water '
9561-A ft, fG ( . , .
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NCWcICalrtraciorCenificationNlrmtter t5S'OUTERCA5111G"(ror-iiittir6sedwccUsl''ORLINER'(Ifa9 fleubt& ..
FROM ' " TO 'D1A61F.TRR TRICKNEsS MATERIAL
SAEDACCO 0 .ft. 20 tt. 2 I In. SCH-40 • PVC • '
Cdavarrtiaua:• +I61NNERCASING'ORTUBING:Iieithecinnl'ctakil400pl:•^" -
FROM ,TO . - , DiASiETER TIiJCtu'NESS r MATERIAL
2:Wctt Constr'uetiett t'ertuit 4: R, ft,• I' ''in:
44ir it app'liraMe ue(I peimit .(i-C-Cmiii v.:Staac,.lr'iariaarce,'Iryadkiq ea) • 'rt., ft. in.
3,•Wsll Use(cI�CClt welt use); • :I'7:Sc:REEN
Water Supply WI: Fnusr. . TO RtAstFTP.R. STOT5r7Z T111chNtis - `iA.TI:utnl,
riAglfcultutal p4itticipaliPubhc 20 It. 45 h: . 2 in; .010 SCH-40 PVC
❑Geochennal'{13catingTCooliog Supply} E3Res'identiat Water Supply(single) p. - td. ' •.ins . • •
❑hldustrial!Conmtercial_ ®Residential\Valet-Supply'(slated') GROUS:..
T . - -_._, .... - . : - - " ., - .
FROhfit1i: TO. MATERIAL" • EMPLACEMENTMEiTIOD&.LMODINiT
• ❑Irrigation• . . - . . 0 ft.. 16 ft, Portland Tremie
Noti VaRr$upply��:ell: rt . . -
• 6BhRenilcsrdng i7ltctievcty __ •
Injection Well: rt. . ft:.
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17AgttifcrRecharge• Citroui dauicr"acnlediatiou-. =19.sANDICR,tvEL'•rACItir:'ajuilleintcr - -- -
"PUt)M TO I MATERIAL, -ESIPlACEHENT MICTII0U
AA goifcr:Strjragc and Rcco��ety i]Salinity.SitrricP' 18 R. 50 ft, sans #2
❑Aquifer'Alt ❑Stoat ivitcc Drry tage
'fti ' (6 1 .
CJ>;vlie[ntcntal7ctihnofvgt' 175idtsictcncc,Coiaatol :10 DRILLiNG'LOG(attitch%additionaiilihirlsif'ncccsciirrl' -
OGeothentwl(Closed Leap) DTracer FROM• TO " . DESCRIPTION(w1ar.trartlncn.varinrck*rx::r1iin.rac.dal
❑Geothenual(Heating/CoolingReturn} ❑Oah n er(esplaiuuder#21 Remarks) 0 :ft, 5 -ft, brick' and"red fill
5 IL 20 ft. , red silt compacted
. 4.Date Well(s)c iiipleted:-11-9-23 Wen m PZ-2
20 •tr. •50 • (t, red compacted clay silt pwr
. 5a,Wail 1.rrcation ..ft. ft. - ik,.7::^ '�='-
Former Clay Mine Site fl. I(, '^ $•' io —
FlietlRy,'17ai•arNatue Faciiity II)ll�`itapplicabte} R. p.4 1, �
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1751 Colon Rd. Sanford, NC, 27330 f1, ft,
" IniJ;,:TJFI::',:;:i: !:::::1-ft :i
PirysicnlatddicssCity:aiti411 2L REMARKS•. . - - `
Lee 'Bentonite seal from 16418' L ;'- y
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Calmly Parrcl Idaailif aiIou NO.(PIN)
Sl,Liatitade an d I,ongintile in dcgrc&5lminutcs/sccrinds ar'decimal ctcsrccs: 22_Cc cation: .
or welt hid,oars gadget titi•Srdf1fka4)
N W � l .r•. 11/26/2023
Sigost�F si .WellCaniactar Date
6.Is(.tee)the fleIl(¢): X1Ptun.tlllttr or 17TeutporttiT si:ining whir fanrr;.l hereby rera'ifi'11iallthc n•d)(s.J ilia{µen)cucultircrer3 fir i iioivlancr
u'iah 159 iYCAC 02C.01(1)or 15a1.NCrlc't12C;N2ft 'nil Cwrstirirrlwr Srw,&rrrls(yid$liu d
7.l a this a rej►air to art'Orbiting octal ®Yes- .lir No 't'oprofrids rctorr$?thy I raa provided ri+;itar.tell mriier,
if this:It a reli r)r,fill)Far.tram[a li'di ediru-ira ibi s hyrgrmar)vn mid o aplahr the aanaare of the
• tapnir rotifer p?1:remar.I.i sivian.orrsa she bask ofrii1sfornc. -23:Site.dillgt'am'or additional,we'lldetails:
You May;-use the back of this page to.providc additional teell site.details or Well
8.NutnberoBvelis Constructed: 1 consttuclion details, You may aIs&!attach dddilioual paages if necessary.
For dirndl*htJeciton nr urair-curer supply u'elfs ONLY ai'Ufi rho.srnrae coatstrurtiwr,)..au eta
542arirrine firm. SItBM1iITTAL iNSTIJCTiONS '
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9.Total'veil depth beloir-land stirfaci;: 45 . (ft.) •24a. Far All-Wcllsi Submit this fomi within 30 days of contptetioti of well
For irrarltlphi i:ills'lim idl depths lidwrrm lcounnple-3@2(1O anai.20 IOD) constriction to the fol[otting: I '•
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1U.Static h ater level below lop of easing' 19 ((y,) Division of Water Retiuureei,7nformatipn Pitieesshig Unit,
if waar'r Ind is abuse tiaairag.iase"+" 1617 hlai[.Srn ict C'eatcr,Raleigh,NC 276 99-16 17
11.1lorchote'dianrctert 6" (in.) '2lb.For Injection WSIigONLY in-addition to sendiiigthe foml to the address in
24a'aboce,also submit a-copy•of this fait'.'within 30days of completion of'tali
12.Well constriction method:Air Rotary construction to-the followitgr 11 , -
(i.e.aagccforay,cable clircci prssh.ctc:} Dlv_iwlon of Water Resources,llndeergr•oliud Injection Control Program, -
FOR WATER SUPPLY WELLS ONLY: 1636 Mull Service Center,Raleigh,NC 27699-1636
i3:1,Veld tiro) Method of test: 24e.For Water Stools. •r rnleet[oa Wells
• Also submit and copy of this:form}Within 30.days of completion.of
13b.bisinfretiuu type: Amount: well constriction to the catinty health department of tile-county where
constmcted.
Fanu GW-I N'.onitCarolina D.psalmsnr ofEntiroauncio and Natural Rcsourece-D.Mil000f WaIertt+Lre s Revised August10I3