HomeMy WebLinkAboutGW1--00035_Well Construction - GW1_20231218 i
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• WELL.CONSTRUCTION RECORD Fur Internal UseDNLY: '
31iis Comeau be used for singled multiple wells' (
1.Well.ContrttetorInforntation: \ •
'14.1VATERZONFS..
Scott Hunt, Jr mum TO DILSCRIPTItIN
Well CatMr ctor Name 36 ft: ft. gravel zone that had water
4561-A ft. I ft
;IS:OUTFJt,CASrNG`trur multi=dived wctlsl'OR LiNER(Irat-Geablcl .. i
NG Well ContfaciorCcniftcatioaThurber FRoM ' TO DIAMETER.` 1111MOCESs • MATERIAL
SAEDACCO 0 ft, 25 • I ft: 2 :' To; SCH-40 . PVC
ContFortNotee• Id INNER CASING'OR TLIDING:I&'itilierm:il'rbdstd-loujtl '• ; •
FROM ,TO DIAMETER! TIIICKNESS MATERIAL
2.Welt Construction ltcrtitit#: ft. - It. I 'ill
. LitifillopplicObfe will petutkt(ix.Cowity..Str:e,.lnrimrre,irjeC tslrrc-..)` -
ft, ' rt. 'in.
3.,'Wel.l_ifse(cltepki•eU ase): r17:5L'i1FJ.N• .
-Water Supply Well: FROM 1 To DIAMETER, 'SOT WE TIIICNNUS$ i s1ATPRIAI,
DAgncnittlrai C114ftiilicipt1iPRhiic 25 ft. 45 It! 2 rod O10 SCH-40 PVC
EICteotltemal(Heating/Ccoling'Supply) DResideittiat-WaterSupply(single) fi• 1 '11; •in,'
71F C57R OUT:.T_0_..• -• ` '
Okduslni1f onnercial IRcsideutial V Suppl}(sha ed) ..
MATERIAL EMPLACEUENThiErrlOD CAMOUST
Dlnipotian• . . . . 0 'ft. 20 ft. Portland Tremie
Ncrn�Vi°atcr Supply Well:, , • .
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• 6dlvtunitcsritig Aitccm sr} • r1. r1. c - , — .
• Injection Well: ft. rt. ;
El/Wafer Recharge llGiotttidattterReineditition ,19:SAND1II1 VLLPACK1,1amilie;,bter, -- _ - .
;'FROM -In 1 1MATF,RFAI. -t IPL CLMENT 511:r11O11
fAituifcr-Stonigc and Rccotcry. DSRlinity Barrier 23 ft. 50 ft. 'sand • #2
El Aquifer Test, DStomin':(crfrtii41gc (t.. f6
08tpetfnlcntal T .hnotogy • • DSubsidelccc'Cordial I . - . -
%,20,t)RiLLE'tLOG(sits,ch•additional5herlsif ite son'l. -
DG:�nitcnuul(ClusedLoup) t7Tr.lcrr moat- ,. ILI - nFSCRIPTION(wtar.Sawse ,stalixrtyre.arnin :.cu
DGeotitemal t leatinuCooling Return) • DOtlter(e%plain uinler_#2I Remarks) 0 -fL. 5 ft, brick;'and-red fill
5 (t.. 20 ft. red silt compacted
4:Date Wef(s).Completed: 11-e-23 Well Intl PZ-1 .- -20 ft; 50 f4 red compacted clay silt
S4.Weil Lectinn: .fr. ft, t I `' ("'
. .,
Former Clay. Mine.Site ft. f( $,w -+
Factliity',�hvoar]lutue Facility pm tifapph lble) h. hiz
. �'E�-12 20?
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1751 Colon Rd. , Sanford, NC, 27330 ft 'ft. n1;'cr,-,:,; ,
Plg3r.�ulAddiess.Gity.andZill• z2t;,REM,1 D',' `�^' :r ,ItICS vi ,i. u•i f'
Lee •
Bentonite seal from 20 23'-23
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County . P Creel IdenliCcaI1on No,(PIN)
ib,Littitude1tndLtingitnilc111degrees/minutes/secondsar-ctccimal-dcgi'ccs: _IICc1•tifirntionl
(ituell held,one lab1aii i i kit1)
• 1 .
N W - '' .11/26/2023
Sigue t•eicclt. -,l.IIC'onlraetor : Date
6.Is(arc)the'well(s)t 3OPerninitent or I:Temporars ily.signing thin fatm;.1 irereby ertgrr Out the u•e'ls)war r(nets!)ronttrUcred br.occorrfrrice
Writ 154 NCAC 02C.0100 or 15.4 NGtC 02C,flail Adl Conirrtrrlat Standards crud Mar a
7.ls this arepairtuanexistin);went CYt. or [ONO etyirof Mk'ie'on!hashmru provided re.tire mg)tnt,irr,
1f rh{,r'I tt re#wlr.fill eFir fiRmLW Well ydrairm'Cr10U Ii irtnatlhn taut explain the tgrnrs oldie I, ,
repairwidetb'?1 retnarLs.;rertion nrtvi the-bock bfMiv form 23.Site dlagrtiui or addlriotrmi WO t dehiits:
You may use the:back of this pag .to prov'idenddiiionat well site details:ortiell
S.Ninnberof Wells constructed: 1 cOnstrtletioil details. You inn}itisialatthrchuidditionat pas if necessary.
For multiple bfecNon or ores-never supply wells ORLY with the Same Cirnstrriterion,you coo
rmbmitai a form. SUBMITTAL iNSTUCTTONS •
9 Total Well depth tieluir-land surface: 45 - - (ft.) -:III Fur All Wells: Subndt ids
. form within 30 days of cOmptciiou of well
For multiple Ict 1Jc list all depths(rdo rani(estapplo-3E200'andI@ 1149) construction in tine follot%ing: I:. '
HI.Static it•ater level below top of casing: 19 (B) Division of-IVnter ReM urcel,lnfclrnintipn Processing Unit,.
if Wert.knit it above caslog.t>k"+" 1G17 hIniI_Set1'ice Center,Raleigh,NC 27699-1617
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11.Borehole dirunctcl:6" - . (in.) 24b;For Injection Wells ONLY: in-addition to sending.the form to the address in
24aabove,also submit a-copy ofi this form within 30 days'of completion of well
12.Well construction method:Air Rotary _ consunctlon tothe folionirtg:
(i.e.ali cis rotary,cable;diseci push,etc..) i .
. Division of Water Resources;IIitciergound[tijecfion Control.Program,
FOR WATER SUPPLY WELLS ONLY 1636 Mall Service tenter,Raleigh,NC 21699-1636
Mctlroit of test:
• 24e.For Water Supply 4 Injection Welts:
f3a,Yield'(gam) Also submit oat•copy of this forin'Within 30 daysofcouipletioti of
well construction to the county Itcalth department Orate coiuuy where
13b.Disinfection type: Amount: constructed.
Feral GW-1 N-0nh Carolina Department of Eavllaiunenl-and Natural Resources-Division 4 Water R OLrt6 Revised August 2013