GW1--00487_Well Construction - GW1_20240116

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WELL CONSTRUCTION'RECORD • Par ttal Vac ONLY:.
This Vann*tic'usodi far'sirlid oi tradtipk walls
1.WC,11COntraetOr hipannitien:
-c:til-,.MiATERZONES
John.Eisenman „ . ' . „ ft$01.1 -10 'DRSCRIPTION I - - I • -
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Wan Contractor.Naree • ft.. It.„ I . . . .
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:ft IL. . ; -
. 4430-A: r • . .. . I. . .
r'AS:OUoinithile-adseWit140R-LINER firatiotierahlel• •• - -'
NC Well Contractor Certification Naibhcr TER CASING tt •
• most •TO '' ' DIASIETERI I THICKNIESS- - NIATERIAL:
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. ' .10.. ' ft..• . - 'lc:- ' • . •
• .SAEDACCO
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Congiani Nam. • . 16.1NNEXCASING'OR TOEING(wothennal elased-Idiap), „: - -
•FROSI TO' DIANIETERII . TUICKNESS MATERIAL •.
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' - 2,Wen t0110114#1111PRITIII7 11: . . . • .. . . . . . 0 -ft; 10- it: 2 ' .1ht.. -SCH-40 •PVC - •
„El an-Griiiicobk wen perantr,a.g. 'intety,,,State,.Vadattee.friErfian.ete.) . .
. .114- ;'- . ft.-' ' • ' ' ' •
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3,IW;111yse(th celcir-di a 5.c);. .- .El:SCREEN . - :. . . • . .
-• Water Supply Well: • • Fo)iki. . -TO - •PIAMETIIR ',SLOT Sin THICKNESS. MATERIAL• -
- , . ' 10 'ft. 20' II.-- 2 - in,• i'-4 .:10 -SCH-40 - PVC
Ingtkultntal . . ,ilMunidipal/Public - - .
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OCtenthetmal(Heating doling Supply). • CIResidential Water Supply(sin . .gle) . . hi 1- -
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• • - - - - : ' • ' "- • •- - . •,-..:-- '. - . .-- -:- '- - - • -lIndustrial/Comniereial i ClResiclential Wilier Supply.altol 1861101.1T
id/ -
1/120S1-• '•. .76 • ' •• '•It.IA'TERPAL,• - ENIPLA. CMS IL'S 7,1110MOD'AMOUNT
1:1frripation-. •'- . . . - . - , . 0 - *ft. 5 * ft.. ,Port.lanc -. Pour . : _. .. • • - .
NOn-WitterSutipb..Well: . ., • - ' . ft, . . , • -.
knitting , ,,• . . , .0Recovery- ••, • . ' " -
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Injection Well .
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d/54110.0113-CCbare0 • ClaioutittnaletRentcdialion • -1192SA.NO/G1tAVEL-PACKtif aaalicabley:: - - .- -. . .
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‘tfonmr,--',to' - • •- •iitAniauti.1- .' - - '-tistil,,tmosT mirttion
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. . ilAttniferStotageliirl Restive:1y - 1.3Salinity lintrici, 8 It.. 20 ft. Sand 1. • #2 - -
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pAquifer Test . - Mionoivater 13ta- tea& ft
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liEverinicnial Technology - liSabsidenee.coutrol- . . .. .i. . . ...
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• • •••20DRILLING•LOG faltakti additional slicitalf accessary} - .• . • .
13Otothetinalloicil Loop) 1:1Tr4eer. • -FROM .- TO . DESCRIPTION nobrannhodi molthilek 0 at:mill riiie.-de.1' .
CIGeothennal(Ileatinetaoline Return) .-ElOther(ffplain.iinder#21 Retinnhi) ..0 It.- 20 ft,, sand/c1 '
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ft' ' - r.:‘J'''--.17A N.7‘;":17:ri2710/21L--41"-".-
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4.Date Well(s)ctintpleteti:•11-'28-23 WaliDiiMW-4 I
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Sa.Well Loeatiool rt.
Murphy-USA . . • ft; ft; i
Faailyklivoorilarao. . - -- - - - - -- - - -
'racillY11)#-(if'4431klibk) -ft. - ' it, • • - , lrifZ:;rp.r......7giz.r1 i .-t-c. 2 I ji;N •
801 East Gannon.Ave.,.ZebulOn., NC,'27597 . . . . Ah . • rt.- . - .. .... . illiv kia.-;k..:.C4 . •
. • • . , Pk,-tiial Aitc!i:cs:city.And Zip'
11.REfilAHRS-, ', " -: • " .,; ' ' ' . . , . . . ,
Wake . , . • . . . • Bentonite seal: 581. . •• ;. •
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- Corialy . • rarc011tkidific.alionNo,(lintqi '
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Ir....3;Olitiideititi Ltioglutdein degcciiininuticiiseerinds rir•dceitimil degrees: . 22.erttifitation:'• " '. .
- titutill field.ointataoirg ts*fiufficiehn * •
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N • W. . -:i.: ----- ---
.e.„,...,.4.1.57°7.,
, . • Sigoatura,aS.,>,-1 .!iv..Ini,T;Lapii:- -. Dale
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. . . 6.Is(ire)the well():.10Permanent ,or pTeniporaty •• •'.,... ; ....•_les.ticis-r., ;011.-...1,:r.....7....----pce,..-1. •• .. ..
-tty 1.141ettg hip johte:-...-"cr'I 7:VW!.!s..a.a",:',..,:i.•it:tj..)ivla k_ii0F)iy,IILSIIIILlea 01 aprortern,,re
• ititit 1M PletiC 02CY..-1:7,1-MtiC ii-117.OPP Well Canstrfletion Si'atadartis and ilmt a
7:Isilas a repair to anevistipg wet!: Elft.ts -or 111INo. teriy of ifsk word:?las f*s-np ra y i de 41 tally 6/1owner,
If 01,5*b a ie,tialr;Jill 4-4.4throilii well coaniircrtan Warm-Juan and rAplain the nature of the r •
repizir tinder#21 irnuirks-3raidno.r on the barkof illik farm. • . 23.Site.diagrant or additional well details;
You may use the ha&of this page to.;•prOvitte.additiothil well-site details or well
• - 8.Ntiotheiof Wells constricted: 1 - •• •
-. . - 000StntetiOildetai&. You May alto allaCiradditiOnal pages if i=esSaty.
For ninfitple Injecilan wool-ietiter ritppli-'weih ONLY irldi ihe same eadsirmetion,pa,coo . . . . . . •. .. .. ;'
sapid,'one lafm. SUB .SUBMITTAL INSTUCITONS, 1 •
. . 9.Total well depth below land 20 . - . - '. • 010 24a,-For All Wells: •Submit tinsform.veithiu.30-days of'completion.of well
For maid*ivelislisr all geprhs If drffiTela(e.iample-3@200'and.2@l00) - eonstnietion to thefollowing:
10.Static water level below top of casing:• (ft.) Division of Water Desoureo;Information Proeessing Unit,
If water kite/is above eastag;:ase"+" - ' /Gil Mail Service Ceder;Italeb*,NC 276994617
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11.Borehole diaineter;8!257 •(Ia.) 24b.Vim Infection Welly ONLY: In;taddition to sending the font to the address in
24a above.also.submit a.copy of this form within 30 days-of,completion.of well
12.Well construction method!HSA . coustnidion to the folloWing:- • . .
•ti.e..auger;Mary,table,direit pink ctc.y -. • .
'Division of Water ilesources,Underground fnjecliott•ContrOl Prograni;
'FOR WATER SUPPLY WELLS'ONLY: " • 1636 Mall Service Centie4-Ittleigh,NC 27699-1636
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21e.-For.Water Sootily&rwieerrou Welts:
14x Yield(ginn) , Method of test:
Also submit one,cOpy of this form within 30.daysof con:Pie/ion of •
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23b.Disinfeetion type _ Amount: , . well construction to the county health department of the.connly.Wherc
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constructed,
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FortoGW-1 NoilliCartilbut Department of ply:roan:eat and Natural Resources-Division of Water Resoircis • Raised August20l3
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