GW1--00473_Well Construction - GW1_20240116

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F
*ELL CONSTRUCI1ON RECORD •
Fig tricnel Vso ONLY:
This Conn ccut t .usct1 for singlo or ntultipk twits'
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1.tVC11COuttuetor htfOrtuation:
-WATER ZONES'. . ...-- ••" ,; .• • . •. . , .
. . . Rich.Lemire . . PROM TO ' ' 'DESCRIPTION i '. . . . •
Welk Contiactorliarnd R.• ft.. I 1 - • , . . • .
ft •ft. . • • .
2593A • • - . I i . . .•
,
NC Well Cantruckr,CcrtifiratiotiNtuthir . . -2.18.1013TER:CASING-ftist-cautlkiscdtitellsl'ORL1NER(Ilifif tkable).• • .. '
• ER0S1 -70 --... DIAMETER I-. i' MUTENESS- MATERIAL• . • 'tAftracCo • . • • . ft. •
0'1
,1* ' . . . .tiOnio - 763NNER'CASING ORTILIIIIINtafteotheriful ctosis1-todo)":•,.:,'' . . -
• FROM . • TO• ,..DIAMETER., , THICKNESS . MATERIAL '
2.WelkitonStruetion Permit 0 . ,: . :. . • . . . 0 • "ft: 20 ' It.' 2" - 'En: SCH-4 0 PVC • - . .
14st itil apigicage tmeRiicitiffil fie.County.Silt%Alationee..ligecric4 elc•l'. •
:ft;• - ft.- In'.' - . .
• •.., . ,.
. 3,Wr'.11 Usc(chechwell u-Sciy .17:SINUSIEN!• . - • • • . .•, - •
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Water Supply Welk , - - FRONT. . 70 • -DIAMETER ISLOTSIa. 71fICKNISS.
• . .. . .
.- •. . 20 ft. .'30 'ft. .2" .-IE.• 1..010 SCH74 0 . PVC
DAgieultu cal • I:Municipal/Public • •
.
• ft. . . ft. ' in. '
EiGeothcitnal(lieatingot Ooling SupPly) • EIResidentiat Water Supply(sin ) - .GROUT ' - - • - ' - •
• ChindustdaliCoutniercial
• 12Resift°631 Wal(41S°091Y(shir"1) • PROST. TO - - •.NIATERLSE,-•. - EMPIACENIES T NIETTIOD&AMOUNT
. ,. DIrtidation -, .
. - • . -,,•: • . .- 0 • It, •14 .ft. PORTLAN0 .' TRF-MMIE .. • • .
Mitt-W:10e SOIA11,7%lit.' • • • .
. • . . . .
•- . "ft. • - ft.: • - I ,'
1119.114onitoting. . .. , .1:IRecoyciy :•. _ .. - . . • .
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Injection-Well: ' • ,' - ' . , .• -ft,• . ft. . - - . I,.•• . . " •
• ., :
EIMpii4r:Itecharge : - 13Glotindirater RcirediatiOn- . ',10218AND/GR K AVEL.I.AC (if ititidiaittfc'
. . ...
'PROM'- ' ' -TO• •" MAMMAL',• - "- ' 'RAIPIA CEMENT Aim Non
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El AhniferStorngo and Rceovety ' : 1.--1Saljnity Eitiniti . . 18 • R. 30 ft.. SAND 1" •, • #2-
. . • _
1:1AiltiitcT,Tcit- • ' . EISICAluiVatct 11:Ituiptioc' - '
-ft.. • . .
. ......1. '
oi•peritucritll Tiiirictiom, • • IjSubSidence.Conbot
.' 20.-‘'DRIILLIINGLOGliittieh kddltiotint Ace&if lecessani ' •- . , .
ElOontltenual-(Cloied Loop) . ItTr.teer. . . . :FROM- TO - DESCRIPTION(cobr.hmrdnek4.-suRNIick OR.:trtifi simile.) ,
1:1Ceetlmtinai(Fleating(Coolius•Retunt) ::rlether(espiaitt under#2.I Renton:6) ..0 !ft. .14... . ft.;. ORANGE SILTY/CLAY - -• .
-
, • - 14 •ft: 30 . -ft. -PWR • 'I'
4.pate WCE(9)cninPlaed: . . . .
12-22-2023 Midi Ep#M47-1. - . ' • .' . -..(1.- ,' . - -...,..•,,,,,,...,--.1,,,,.7.-r,!..0.'7r' , ' •
ic•- '• 1, '1".••': r L.,L....-' •kil r-
Sit.'No,1...,..c.ff„„-: . . . . ff. . h.-- - ' •
. . . . • 1
• •
.'ft
PRESTIGE FABRICATORS . . . .
. - ft.' - • 1' • JAIN .i• 6 2024 • ..
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6cimyicit,,,,,,:kiii,.. . . - : .Facility!pi!.(itOpplieble) .--1.1,-. . . -- It
2206.
liktorAlgi,lirt-PFC,c,.-14.1W2f4-3 1./01 .
2206.Dumont pt.,•ASHEBOR0, ,NC, 27203 . • . , '.R. I
. - •: Plijrikai*ics,-C4-Aild:±1P.' '..1L RERIANKS., - • ' • ' -- •-* ' . • ' • ' ..-- • . ' • •
' •
-RANDOLPH . • • . • , , ..BENTONITE FROM 14 TO 18' 1 '
. • . . . . .
" Cant) ' • . , •PatrA4 ItktilInCtIlinn Na IP11Ni
,
• • '' • . .
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• Sh...I.:.ittilitdc"ind-LtingitutleintIegtveihninutei/Seennds or dechnal degrees: ..22.Ccitifteatinur. '.' ' It •
(tt'oell field,onetaeloetts-sidneteno - • ' - ' ' '' * - • - ' - 1
•"--- , - ,- erev‘vP.,...,
W . ' .'t. . 01° V 12/23/2023 .
. • - . N • . .
. - • - •- . • . . ' ' Signittioo'fbrti _';v7c11 e.--..6-ii,1,.- "i:--'-- . Dale
.... . . . .
Is ihtre)the well(S):_kPermanent. .or .nTeniporitry
• -Ity,iigniog dr1r.fonrr„..1 Irere4.cerly thiil 14.1414 was 1ppe.re)Evagruckyl fit OVIV.11/021Ce ' '
. , . . with15.ANCAC 02C;0100 or.15A NCAC 02C,0200 Well Conitrileilon Sroikiartis and Om a
7.Is this: a repafrto aikeiisfing well , Da, or 'liftNis , • -coly of NI nyCSIT,isis:N471ivoyirk.ii ro Jrni.ririi fnikr.
Iftpis'Is o repalrdiil oar kuriiiii well commtcreco:(*masker oral wit*the norare of the . - ,., -. . . , '{,'•,,,-
• - repair tind0-1121 irmarkvIrciiiiu or rat elm bda'redrit ham - " . •-;23.Site dow,raut or adthtioualwell detags; . .
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. • • 'You.may use the back of this page to provide additional Wil)site details or.welt .
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• 8.Nutnberof wells obstructed: 1 • • • • - - - - • ' eonsttuetiondelaits. You ma also attach Additional pages if neeessary.
For Iiialfiplc lnierloil 01-no.0-.10ter iiippli IrMsOALY"nirti the sarri:e consiruetteir,yet!eau . .
solyeirone ,
form. SUBNIETPAL INSTfiCTIONS,
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9.Total well-depth Odom-I-md stirfacet 30 • • • - • (ft.) 14a;Far AU Welk:. Submit this form 1,,ithiii-30•days of totupletion of Welt
Fernuildp1e1411slist ail hreprld if dOi;rott(enfolpre-3@200'and 2.0 WO) . tonStroCtionto theibIlowing: - • i
' 10.Static water level below tap of casing:25• • (ft..) 'Divisiiin of Water Resources,Information Processing Unit,
• ' lfltwiei level is diove e0,104,..;ase."+" /6171%fali Service Center;Raleigh;NC 278801817
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tl.Burchote•dianietcr:0!25 7 1 4" • •(in..) 24b.Fnr•iniection Wellv ONLY: InA addition to sending•the.brut to the.address in
.24a above.also submit a copy of this bona within 30 days of.cowpletion.Of well
. - .12.Well einuttaction'tnethan:AuPER/A-IR. . . . . onsinietion to the following:. t ,
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(i.c.-ougdr:f13131y.Cubic.Odd pitsh.dtc.).. - . i ,
- • . . .. 1/171S1011 of Water Resources;Underground Inject •ion Contwil Program,
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FOR WATER SUPPLY WELLS ONLY: - ' • 1636 Mail Service Ceder,Raleigh,NC 2769.1434
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• . lie.toi-Water'Snliniv&Injection Welts:
12a.Veld(gPtn) Method'of teSt:
- -'- Also'stinniiiiOtte Om el this form Within 30,days oicomPletion of •
Disinfee 1311; tion type _. . Amount: -
-well eoustruction to the county health rictrirtmint of the.cimnty.where
; n. . - • .
constructed. •
. FehuGW,1 . Nonh Carotin:1 Uk.IMITIleill of Erwipannrpl and Moral Resources-Divillon of Water tte0.17/S .Revised August ID 13
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