GW1--00851_Well Construction - GW1_20240205

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WELL CONSTRUCITON•RECORD • . .
Foil mpel Vss UN.I.`i:. 1 i
Thirs forme*be used.far Single Ot multiple wells
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I.Wel!!Contractor'Information:
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141 WATER ZONES
Brian Ewing . . . .. FROM. ' 30 arlreiPTION 'Well Conti-41ot.Name. ' R." ft..
rt. rt. I ;
4240-B
NC.Weif Contractor Certifreltioa Noah& IS OUTER CASING fforinutti.eaSederllsf OR-LINER arab-lleabler
FROM IMF . . DIAMETER. • MUTENESS. • STATERIAL-
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SAEDACCO ft.. fi. . lc- •
Company Name, - 6.INNERCASING OR.TURING tgeotherinst closed-loop) ••' .
. 7110m ,.10 DIAMETER. THICKNESS MATERIAL
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2,Well Constrnethin Perinit#: . .. 0 'R. 5 ft. 2 ,i'ht. 'SCH-4 0 PVC
,Lirt at,aFpricable welt penults fix.t'intney.Sta ,•Variatree,/Orem etc.).
3,Wilttise(elteelc Well use): • 17:SCRUM
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Water SuppliWell1' tra0n. . 70 DIAMETER SLOT SIM ' 'TIIICKNMS •MATERIAL
• 5 ft. .15 ft; 2 •ii- ...Di° - SCH-4 0 PVC
' .ClAglieullutal• ' CINIttaidipaliPublic „
ft. .: - in.
06eotheimai(lleatingiCooli rig Supply). • I:Residential Water Supply(single) . ft. . I.
. . ,C3Indusliial/Conuttercial • allesidential Water Supply(sbatid) .:Trnu'oGRm.°.uT',f6L
MATERIAL . • ' EMPLACEMENT METHOD.4 AMOUNT
1:11trination •. . - . 0- ft. 1 "ft. PORTLAND POURED
Non-Water Supply Welt::- • .
. it • ft.•
OW:Mori:4 _ : ttlitecm ,sety
Injection Wo.,l6, • • R. . .ft. .r . • .
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LlAquifer Recharge L3Gioundwaier RenicdiatiOn • ,1.9:''SAND/GRAVELVACK(if applieabte)'. .... . .
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`FROM'• TO' •' MATERIAL. '" ESIPLACEMENT SiETROn
ElAilltiferS109gt and ReCovety 1:1Salinity ROHM' ,
3 .• ft, 15 R. FILTER.. .SAND # 2
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• 13Agnifer Test • . '
13SIOmm-ater Ortfht.
ft.. ff. • .
• ljEworintental :plum: 0,Snbsidence Conittol- • " - • -
202 DRH,LINGLOG kitsch a ddllionall Sheet if access:all
1:10e0theinik(ClaSett Loop) tifraer • 1110S1,. .70 DESCRIPTION(taw;hardnett.sahmk 011*.-pytitt Pfte.tit.)
ElGoothenual(Heating/Cooling Return) ' 1:10ther(explain under Ii21•Rentat ) . 0 'ft. 5 ft, FILL SILT AND SAND
5 It., 15 ft, WET SANDY SILT
4,ilite vii.e1100,ctimpiiicil: 1-11-24 wett m#mm303-01 -
(f.' ft.
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SMWell,Location: ,ft.i ill• • .•._
NCDOT ' - • I • V.;,,. ". `,„..-.1 L..i, t•,7 I— ,;,.F •
Facility/Oonerifamo . - • .Fachity 10 fif 46:able), „
. ft. - ft, " - I' '• -,..
r ri “ /074
Ocean Blvd. & Dow Rd..S., Carolina Beach, NC, 28428 . '.ft.. . ft.: I
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. Plgticit AOeSs.City„said zip, qt.RENIARKs I• • -.., 1-i r-.•-•:-/,.,ii.:-..'j
New Hanover BENTONITE SEAL FROM 1 TO 3' OW C:PLOG
Cooly • ' ' Nrcet 1de:4M:canon No,(PIN)
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56..Latititde'arid Lnnittn de itiilegrces'iminnteitSeiliMis 6F decflildetit'es;.
Of veil 641,-oat aloag inorricidoo • - - - .2'1 Certititathin:• 1
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• - 'NT . • BelAPENI ng.. 12/2024
• Signatuge of CenundlliellConuaeco; '•l• ,•• 7------ Dale
W a
6.Is(are)the well(S): OPermanent "a r .XITemporary. .
. - Op signiog dr..ir lam I 1reTby ere*thac.rho uwills)vgis-(i4re41 ctimofructed air OFC07471 CC
tad:15A NcAC 02C,01(10 or 15et NalC.02CO2119.14`e11 Constnicrian kaikfaris and llbai a
7.L.this a repair to an.0isting Well: Mks- Or KIN, :r4.yiy of Mk Taint lid th!cri p rovided 67 lke kli7II inyner.
ilifrisli a"fix*:fill oat knoitiq well caasnualoa lahremarlo.n oral explalailic;ware of the
repair thider 921 iinifitki•iagiin dean the bail;ofthis form. . 23.Site diagram or athlltional well de:htlits: . .
• • You*Ate the 6aelf of this page to pros additional well site details Or WO
S.Nmuhertif Wells enistnu.-ted: 1 coustmetiowdetails: You May alto attachadditianal pages' if necestaty.
. koi inillripte
lajeclt or rm• -waer iippti we.lsONLY with di.! mcansptillon,lo#ay
• - sewitoneMtn. • " . • SUBMITTAL ENSTIICTIONS- I
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9..iotal well depth below land surface: 1-5 - . (01) 24a.•For All Wells:.'Submit this form within 30 days of:completion:of Well
For inalrlpfc ii•ells-list athleprla if cliOroo.(ample-3@200'and 2g,100) ' . tonstioction to the•follos$ing; 1.l' .' •
.•,10.Static water level below trip of easing: 40 blvfsiun of Water ResOurs ,'Informatioa Pi:messing
. If myer level&above castag;use"+" -1617 Mail Service tent-i,Raleigh,NC-276904617 •
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IL.Borehole(Banister:8 r.257_ • .411.) 246.ForinJection Well ONLY: In addition to sending the fomt to the address-in
• 24a above.also submit a copy of this butt within 30 days'of completion of well
11.Well conitinction Method:WRED constnietioit to the follthidiug:.
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(Le:auger.fatly,Osb!e,direct pack etc) • 1
'Phi*a of Water Resources.Underground baJectiott•CantrOl Program,
. FOR WATER SUPPLY WELLS ONLY: • - • .1636 Pettit SereleiCenter,Raleigh,NC 27699-1636
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•24e.FOi•Wake Supply&Injection Vict4:
ila..Yield(WO . •. Method'of test •• Also submit Cone copy of'thil fonn Within 30.,flayS of comfiletionof
13h.Disinfection type.: . • Amount:
well construction to the county.health'department of the.counly.where
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constmcicd.
FaCH,GW-1 Norih Carothu 8....^pasauent cf Eatironmem and Naomi Resources-Dhisioa otWoiergmoort6 • .Revised August 20 li
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