GW1--00485_Well Construction - GW1_20240116

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WELL CONSTRUCTION RECORD • Fin internal uscONLY; • '
This form canbcvsel for single&ondtipk wells '
1.We1l.Contractor luforinatiou:
=TJi WATERZONFS-• i •
John Eiseman - - FROM I TO DEMCRIPr1ON1 '
Welt COrACadorName ft. ft._ I . . . . .
4439-A ft. ft I ,
NCWellConlmetorCcttificatioiiNwtruer 1S.OUfER CASING ffnemutiteased'eellsliORLiNER(trait ticabkl,. •
-
. %Aver Tn ' • DIAMETER t i TMCIOWSS STATEATM,•
SAEDACCO 0 .fL, 30 f.- 6 k SCR-40 PVC
Company.Name. 16,'INNERCASiNG ORTOBING(geatberMal elused-bolt}.r'
-room TO - DIAMETER,- ' THICKNESS MATERIAL •
' - - - 2.Well Construetion'Pernik ii: . •' • . . 0 . "R: 40 '.. . f1:• 2 • `in. SCa-40 PVC
Mat al applicable well panaits,fLe.ComityiStut?,•Ilarieucr..Nectitea;rfr_l' .
3,WC11 ise(chccicwell pee): • • - 17:5(.'Rr.EN . .
�Vafer.SupplyWell: — - - IFSoar - TO 'IMAMSTT;R ALMA:WSW, TIIICICNM'S�S. 'MATERIAL •
• IJAgtisultittul- . .•01Slaiieipal/Poblic - . 40. ft. 50 •ft: 2 ib' O10 SCH-40, PVC
• ®Geothenrat eatin - . 11.
.(13 gtlCooling5upply} ®Resideotial�5tatcrSupply(single) • ft' • R. io.
• .©tuduslrialVConuitercral- . ©Residential Water'Supply(shared) :t8 CRO[1T
Pnom . '. To.. • .- 2-..MATERIAL,. • EMPLtCES]EVTSIErrtODSAmouNT
❑trTipation•.' - . . . ' 0 ' ft.-.31 ' 'ft. Portland. . pump'
Non-Water Su Tpl(}won::
.
. 8 Monitonn _. . - ..DRcccn'cry. R. •ft:
inJed(on Yell: n H. ,. .
. °Aquifer Recharge DGrounthrttcrRstucdiation" --19:'SANDJGRAVELIACKOJ,yatu btaa;; . _ _
• ;PROM- To' - - aR WRRI, • : •tOWI,ACT�v1►vrarr;TnOn
17Agnifcr.Storage and ltccavety E Salinity Hama 36 - R:: 50 ft. Sand I #2
IJAgli fcrTcst -QStommaterPra nags f, fi.: ;
• - 171 tpekmenlal Tcclinoiosg •' , I35ttbsidcnce Centel ... -.. .
2n1DRILLiNG'1:WG(attachndditionaIthcdi-ifnecessar\'1 -
EIGeotltenital(ClosedLoop) ' . . °Tracer.• .FROM • TO : DESCRIPTION(MN.:hardnec,:wisnl ktlnr rma.ve.W.I .
. 17Geotltenual(Heating/CaolingRetutn} DOdter(explain under'#21 Reurailk) 0 :IL 50 ft., sand/clay
. . :ft. • ft:- - I .
•
4• .Date.Welts)Completed..'12-5-23 - WdlID(#MW-3, • ft,• ft. cc ,
•
• 5a.Well Locations it.. to ". h •+ a , a.., �r
Murphy•USA - 'ft. ft. - JA(N 1 U
Facfdgr �ncrNiu e. - Facility'1Dk(ifapplicable . . _ . _-' _ . -
801 East Gannon:Ave., Zebulon, NC,-27597 . :ft.,. fl... �3 b�..r��' .. •.. 4
•
RYV3�y'G . . .
Plnsical rtddresi Cicy..ai tzfp '•21 REMARKS.• ' .
Wake Seritonite seal: 31-36'.
C nttt Parcel liltoilineattou No (111\1)
i' .
sb/.ailitNde and i on,ttutte in degrn:cilminutcstscconds or'ticcinutl•tlegreess . 22.Ccrtilicatinri: •
tit;SO uteby-mr.ia oni ssreiei4} i •
iidil .
�_ +.- ~- - - 12/18/2023
N W �� ,f, t ,r
Sigmtnreaf�.Y z; '1'V drr:t ' --'.- Date -•
. 6.Is(are)the.well(s)r..XiPcrnlanent .or fTetnporat} I6n./ ; -;A -mo o
ftj•}rgnag rhu.futri:. r ,t:�catf c.a errs r..e,rl cnrxrrurrrd bt-axrardnrrcx•
• Ira1M NCAC 02C : -7'1:,A7TCA�.GEC.0200 Weil Comm-W(rioir Sta tda,da and Mai a
•
7.Ls this aripairtoan.cxj tipl,•,wdl: - 17Yct. or ®No :cosiyaf Mk won!has bran pro-Fitted tal e,irllmwnrr,
Ifthls Tr n iepalr:fill rockrvlt.inveit comma-lad brfortnatlon and explain!he narnre ofNlc
rgmrr rirder._Tl&marss o ca n ur on the brrl of rims form. .23 Site diagrom or additional well tletaIs:
You may use the bac1 of this page to`proside.additional well site details or•%'sell
8.NR:nberof wells constructed: 1 - . - construction'details, You Dirty also art iefladditionat pages if necessary.
Formaltlpt.elcjccilonurnoa•ndreriupp{i•wells.ThLYirlrh'diiesomecottsmucllon,voncon I'
soravilt or foam. •. SUBMiTTAL INSTUCTIONS
• 9:Total Well depth below land surface. 50 - - . (ff.) 2-fa. Fir_All Wells;, Submit this fain,viithin 30-daps of'completion of.Well
FOr/ante!ple.4,ett'liar all depnci/fifeerrnt(cranptr,3@200'arul2@li'I0) Construction to the following-, • {'
10.Static water level below tap of rasing:' • - - {fL) Division of Water Resonsves;InformatianProcessincg Unit,
if enter level!s above casts;:toe"+" 1617 Mail Sery ice Ccnter.Raleigh,NC 2.7699-1617
If.Boreholediamctcr.12^/6° •(tn) 2�6.inr Infection ells ONLY: in1addition to sending the form to.the address in
24a above.also.submit a copy of this fonu within 30 days of completion of well
12.Well construction edethod:RSA/MUD' - eons[nletian to the following:'
(Lc:auger rotary,cnbl�dunes gash etc:}
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'Division of Water Resources;Underground Injection Control Progr'atil;
FORWATER SUPPLY WELLS ONLY: 1636 Suit Service Cenle r.Raleigh;NC27699.1636
.24c.-For-Water Supply&Injection Wells:
1- Yidd tom) Method of test: Also submit one copy-of this form witliin 30 daysoicouiplelion.of
II31t,Disinfection type _ ,amount: wontconstruction Cu the county health department of the.countg.whcrc
- constmcted.
Fano GW-1 North Carolina Dganmeni of Environment and Natural Resources-Division of Water Rew.r Revised Algust201i