HomeMy WebLinkAboutGW1--00848_Well Construction - GW1_20240205 1
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WELL CONSTRUCTION'RECORD FCIf InIqualtrsc ONLY:
This form=tc•nued for Or multiple wells• '
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1.Well Coutnittor Information:
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• '.14:WATER ZONES .
Brian Ewing MOM, To orsournox
Well Coliactet Name ' ft. ft. I I ' •
4240-B . • .
'NC Well Ccintracicir CcriificatisnNuibbil AS:OUTER CASING;do Vimutl kisettitillsfORLINER Olin'WARY'.
trlioM " To • ' DIAMETER '4 ' THICKNESS- MATERIAL. .
SAEDACCO . , .
Company tsiaino 16:INNER"CASING OR WRING fgeotbernial&and-lona.;.
FROM 70 . DEMETER 'RUMNESS MATERIAL
2.Weil ConStrnetion Permit . • 0 R. 10 . it; 2 !yin. SCH-40 PVC
,Li'sr(dtapplien6le weit petnits fix.County.Stade;11a0fairce.flection ric..) .... ' ..
•11. ft. • • .tn.' -
3.Well,Use(check 1ell use): 17:SCREEN •
Water Supply Well: ----- FROM% TO .• WitAattTnii a LOT sozz 'RUCKS Es..'s. •MATERIAL
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• • • 10. ft. 20 It; 2 lit ..010 SCH-4 6 PVC
ClApieultutul CINItutidipaVPublic•
I is ft. , .
ijgeothettnal alcating(Ccioling Supply) CIResidential Water Supply(single) • . ft
fitii GROUT- .. ,
OludusttialiConuitorcial I:Residential Water Supply(Owed) "nom , TO
• '•-NLATERIAL •, -I HMPIACEMLNT mrinfoRA AMOUNT-
• Mitigation . . . 0 ft. 6 ft. PORTLAND TREMIE
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• Nott-Water Supply Well: • . 'ft,
Monitoring ,.1±IlieCO'ClY;
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Injgction Vigil:. :ft. ft.
LiAguifer Recharge . Eldroundwaicr Acinediation :19...'SANIWGRAVELPACKtif applieabteV
.. . ..... .. ,vit051• - TO' ' - MATERIAL ' EMPLACKAVENT SIETHOII
1:1AtipifctSCoTti&AR4 1*m-0 13Ralioity Dania 8 - 11.. 20 ft. FILTER'SAND # 2
ElAquiirifeSt• . CISiOrneRitcf 1010i.atige• •
•' I. ft..
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EiNierinicnial Tselmoiog 14obsidence Control .. . . . . .. : . . . . .
••202DRILL1?iG.LOG kitsch a dill tiorial.'sbliel if neemami
tiCeothennal(Closed Loop) DTiicer. .FROM• ina • DESCRIPTION folAr.hardncm.toillowk ow:Oen aire.tte.)
EIGeothettual(HeatingiCooline Return) I:Other(expiaitt under#21 Retinas) ° 'it• 5. ft, FILL SILT AND SAND
• . 5 : fL• 20 " ft. WET SANDY SILT
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,4.Date Well(s)Completed: 1-3-24 .well mg Tms15-01 . • ,, , . • • •
'(t. • ft.
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5a.Well Location: ft. • ft. '
NCDOT - . • ft.. , , ,,,,
f,
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Facfloburblame . Faciltiy TO Otappiieable) . . —' _
II. ft. F E 5
215 N. Sunset St.,• Atkinson, NC,.28421 •• ':fi.. ft.-
--i,..-, 7 ,`"i "r1. ' ' •
Rktielli i41dkcs,06.-.00 2IP.' 21:.RE111ARICS• . Inf;r7r,::•.!:Kil r....,--,,,,--.0 ,..'
Pender . .• BENTONITE SEAL FROM 6 TO,8' DV'XI;f.::\....Y.,::
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Comity . paiee]likidifitatiou No,(PEI)
51i.:I...UW*1e and binglinde in tlegrecifutinutestscetinds or dccimai degreci: - 2,,Cation.
orn•ell field,.ouetitiloUg IN.infildellO
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N • r • . . W. . By i a'rt, Ew 1 n g . 1/12/2024
, . • SigrunireptecitiiicdIVellCoituacta; i. -• - Date
6.Is(are)the well(s) oPermattent or K1Temporary - I • •
ity„Mgning OD tom I Irercby certify that ihr ir4lis)war DIEM cur4itucreit ire atwordrpire •
. . with15A 4VCAC 02C.9100 or ISA NOiC de,0200 Wel/Consurietion Standards and theta
. 7,1sthis a mak-tit an.elisiing weIl: ClItes' or kg No :revisof dal wohl has becnirlwided ro fin;Well t;wner.
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giPtal 0 repair:fill ova Anthill well COUSUUCI6711 bff0f17471408 mut op fat the nature oldie •
repair eisukr#21'ramifies,:irciicin fir on Mg bad of eh&form .23.Site diagram or additional well•detalls:
You may use the back of this page to provide additional well site details or tivell
• 8.'Ntimberof wells koitStructed: 1 • - ' - •- • Coustructiondelails',,Youtnay also attachadditiOnaipagei if tteeesSaly.
For nnilrip1e Ittfeerion ir oon-iyarer suppJ).-wells ONLY with the same conitruition,.you can
• suepitifone form.' t_ifilidiTTA.L INSTUCTIo 'NS ! '
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9.Total well depth below land surface: 20 . (II) 21a.Fur All was: -Submit this-farm within SO days of:completion of Well
F6r nuitripleW•ells list alldepthr if differem 16,.tornsite-3@200'and 2@l00) ' - . Coh5toictitak to the following; I '•
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10.static water level below top of casing:' '(lt) DIvIsiou of Water ResOunf61,Inforniation Processing Unit,
If Itwei hill is above cosh.%use"+" ' 1617 Mail Service Centii4.;ItalciAi,NC 276994617
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11.Borehole diameter:8.25^ • 'and 246.PorToiteetion Weill ONLY: hi addition to sending the form to the address,in
.24a above.also submit a copy of this Otto within 30 days'of.cotupletion.of well
12.Well cOnStructioninethod:BORED ' . counIttietiMI to the following: , 1
(Lc:super ratif).cable.aired push.MO ' I ; . •
'Divlislait of Water Resources,Underground Injection Control Program,
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FOR WATERSUPPINWELI,S ONLY:. - 1636 Mail Service Center,Raleigh,NC 27699-1636
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• ite.-For Water Supply Lit Injection Wig'
13a.Yield(Om) Method of test: .
Also sainnit one copy'of tins flint:Jiiithin 30:days Of completion.of
i3b.Disinfection ty-per • • • - Amount:
well-construction in the county health del:ailment of the-co tothe b,.wre
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constructed.
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FfinoGi.V-1. Noah Carolina Department of Efteireimumt and Normal Resumes-DIvidou of\ValerRoLrc Revised August 2oli