GW1--00847_Well Construction - GW1_20240205

I 9 1 5 9
- WELL CONSTRUCTION RECORD Fnrtt¢aruaitJseONLY:,
This cannon bc'uscd.fot:Single Eir nwllipk wills' t
1.%Ve)ICuutrtetor htformation:
`.1Ja►iE1ER•ZONIS;
Brian Ewing . .. . „ . . FROM TO DESCRIPTION'
WellCor4iaaarNano. ft.: R. 1 I
•. 4240-B ft. ft.
NC Well Cantina tCcniftcitio1iNnEbcr 1i.0UCER'CASING(foe-euitll asersietls}`ORLINERtifnp'llcnbl)1 - '
-EROSI TO DG MVIER,' THICKNESS ' MAMMAL
SAEDACCO ' . ft. • ft.• i, ,IL ,
Comp;uty Name • ..16:INNHR"CASING.OR.TUBING fteaeberi mitt erased-loan)?
-FROM , TO- DIAMETER. THICKNESS ' MATERIAL
, 2.Witt Construction Permit#: • 0 -ft. .5 • , ft. 2 ' j'in. SCB-40 PVC
l ist all aptilicnblc wellpeigrira,(ic.County;Stare;Arariaare.Ifirr Glei..:J -
44 ft. • 1' pa.
3.WcI1Use(chccf.itc11 aise); 17:5('.RI EN
'Votes!Supply WaitWait `--- •- ---- " - - - E11O;v1. . TO DTApIETER SLOTstr..: T1IICKRtSs I.-MATERIAL. .
15
C1Agricultulal • C11GIuliit:IpallPtcblic 5 ft. ft.- 2 ilt O10 SCH-40, PVC
13Geotheintal(Heatingtooiing Supply) C1ResidentiatWatet Silppl}(single) ' . le . - . . fc in,! .
• cllndustilallCourntercial 1]Residcntial Waters lac GROUT ._ :.
Upply,(skated) FROM ' TM M ATERIAL f. EMPLACEMEVTMEr11OR&A410 INt
. Olttiiation 0 ft. 1 ft. PORTLAND POURED
.Nott,Watcr Supply%%cli: .
t.: f.
®Monitoring. . . . ORccoyty
•InJecllon.Well ' . ...rt.• . f4•
DAquifcr Recharge ElOrotuidtraict Renicdiatiali t9 SANDIGItAVEL PACK-fif nayelkabli.) - -
'FROM . TO • •'.;1rATRIHAG- ' .Hs1P1.ECVAINTME7ilon
fAmilfcr.Sigiagcat l Rcovet3 ASalinit' 13411cr 3 ft.. 15 ft. FILTER!SAND • ,# 2
flAgttifcrrTcst. EIS orlilaatccf}raunage; ft.. ft.
ElE peripiental Ticlmoto. ' • JJSubsidencc Control . ., - - - . .
20 iDRILLTNG•LOG(altneti addlliooal.slicels if ncressan•f
• ❑Geot1tetntal•(ClosedLoop) CITracer. FROM' .70 DESCRIPTION(obi'hardnediwR'nlckty t.uraiasraadr.) .
• EIG,got)temtat(FlealinefoaofingReliant} : DOliter(mink under Zl-Retnalhs) 0 :rt. 5 IG• FILL SILT•AND SAND .
• ' 5 •ft:• 15 ft. WET SANDY. SILT
4.Date Wett(s)Completed; 1-3-24 •.EYeti MO TWB14'01 '
:ft.• ft. •
-
S0.Well Locations .,IL. f.- I;
NCDOT 'ft. ft. i; '
Facfilyt3irricr14ms Factlily III!0fappli:able)
ft ft: . 's L..-h•...,+1 '1 i '•• '
Wallaoe Airport.Rd., Atkinson., NC,'28421 , - ft.. ft.. t..
J-
Phi icalelild[ess.City'..nnd EJP' ;21:RF.IILARK.S 1 La t) i) ?t n l24 .
Ponder . BENTONITE SEAL FROM 1 T0:'3'
County Parcel Notification No,(PS) •
jE 1i:,i;>_~ e"' :
_;>it . ' -�s. ng Uri i
. . - r a:"l,'E � .
• Sli.I4UIIadc a11d Longitude ln'degrcesfmiitutcslseconds or decitnal,degi't 22.CcititieatluQ: . .
(0440liettlionctat4<lougts'srdticianl) • .
r WBritap,,,'ENtrig 1/12/2024 .
Sigmwcq orc.citirie4 W:e1l CanD ctar [)ale
e)6:Is.(artheneli(s):-tJPcniLnent 'or XiTemporary.
lb:signing-lhir fnmr,'I hereby'ertflley fila flue 1110 S1 ITILS(ours)LYnlrlraefed higer rrhalre
icitirr 15r1 AVCAC 4W.0100 or.1 SA NCAC 02G.0200 Well Ceti:Interim,Standards and this a
7.Is•thisa repair to an cgstin);Nell: IDYes or 'KIND • 'cap of Mir'rrrord lilts bcoi prnided rams vvl me-ocr.
ifrbis1%an'palr fill or iwrtv itchfill qat implyi+irell r.rn'i ciloabrforrnrrtharam!raplalirTalcHarareofNye
repel-diid&Er21 iemarfs'srceidu air- the bad ofihie fornL a 23.Site digraln'oradditional well dernffs: •
You niay use the back of this page to provide additional will site details or r pelt
8.ICon herof Wells Consirticted: 1 • • consimetioil details. Von May also.atiacti additional pages if necessary. •
For lnulrlpte Injection arson-niarer siipplr rviilr gm.Y.midi the inanecorrstractlotr.uoii.car1 .
subuurerne}Sarin. ' SCIBl4IITT'LINSTItICTIONS. i
9.Total troll depth below land satiate: 15 - - - (ft.) -21a.-•Far All Wallin •Subunit ibis fawn within 30 days of compteiidu of welt
Firnrdliiple iirlfslisralldcJuhs liciVirani(cxemlllr-5@2(t1r'aru126PAV) Conslniciipnto the-following; i •
10.Static water level below tap,af casing.: (ty-) Division of Water Resoue ct ,Information Processing Unit;
Ifitior'a la'velIsabove casing asc'•+" I617 Mail Scii•icc C pteee;Raleigh,NC 27699-IG17
it,Burchotc•diamctcr:8.25" . , 403 tab.For Infection Wc115ONLY; hi addition to sending the font to the addless:in
24a abase,also.submit a copy of this Mort within 30 days of.cotupietian:of well .
12.Well eonstsuctfoat'1Rethad:BORED constmation to the following:- -
(i.c:oa r.'ralniy.cablin.,dircctIiisltcrc:) - . . ' •
Division of Water Resources,l7ndetground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: •- 1636 Mail Semi tic Center,Raleigh,NC 21'699.1636
13a.It idd- -. 4xcdtod of test; 24e,-Foi•Water Supply bi Injection Wells:
Also subunit one copy-of this fo'nOvitlun 30.daysofcompletion.of
13h.Disinfection type: • _ Amount; • • well•conslniction to the ccomai health dcpanment of the,county where
constmeted.
I
Fonu GW-1 North Carolina Dcpnnuitent of Enviropnr4 aid Natural Resources-D-iui;loo of Waier ROauton Rct•iscd Aygu542O13
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