GW1--00852_Well Construction - GW1_20240205

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WELL CONSTRUCTION'RECORD �t5a
Far ldtcrrtnl Use ONLY; i
This fond cap.be used Rif Single sit milltipk wills• I
1.WeitContr wtor Information: `
.WA1ERZONES
Brian Ewing . . - PROMTO- D1rSCRIPt1O,X i
WllContnnnrNanle ft.' R. - I 1
•
4240-B fL rt. I .I.
NC Well Contiac1otCcrtifrcalioiNuntier• AS OUTER CASING troFnulthcasednellsl'OR,LiNEROral)neahk)-, •
• .FR0111 - It) DIAMETER,I -I THICKNESS- - •MA'iERIAL
SAEDACCO fL IL. in.1
Contrast).Nam 16 INNER"CASiNG OR TUBING(t.o ibt rsnal dosed-loop)',.
-FAOnI TO DLAdMETER.; TRICKINESS MATERIAL •
2.Wcli Constluuction hcr'mit$: . •
0 It. 5 ft. 2 ht. SCH-40 PVC
List all apphca*urilprimih fir.County:State•Variasrc.Infer rn etc.l' fl, ft. {t!
•
3.WCIi.Usc(checicWc11 Pfe): . 17:SCREEN • '
Water Supply Well: -PROM. TO DL3MFTBR s LOT Sin.. TittCIt4Irtei 1.MATRRIAt.
DAgticultutal. . • .Inh unieipal/Pliblie 5 It. 15 R. 2 in �'.O10 sCH-40 PVC
°Geotheilnal(IfeatinglCtioting Supply) ®Residential Water Supply(single) rt. ft.' fo, i
• ®hidustiiallConulte,eial • , ®Residential Water Supply(slatted) PROst GROUT TO. AL\TERGL EMPLACE." fENT1IEf1fOD&AhfOIfNT
ElInieation ' . .' 0 '.f.' '1 ' .ft, PORTLAND' ' POURED
Norr Water Suppll Well R., ft
®Monitoring • ORecoveiy 1
Injection Wello- :ft., n. I; .
°Aquifer Recharge • ®GrouridwatcrRcntcdia(ion -19 SANDIGRAVELPACK(ifamilicahlel,
'FROM -. TO - MATERIAL " ltMPLACF:�IEVr�itrnon
LlAgwicr.Storage and Rcco?•'ctp 17Salinity Flakier . 3 'ft.. 15 ft, FILTER SAND (# 2
❑Agri f iTcst °SiommaicrDniiiia e' r .
ft. 1.t. •
pFx}lcamcnlal Technolagtr I]Snbsidcncc Control •
se,DRILLING`LOG.(altach additional sheens if ncvessan•1
•
OGeotltentlat'(ClosetdLoop) 17Tracer. .FROM• .TO . DESCRIPTION(cobr.hawacss.wn'mckt7fleixNaiste.sk:1
' . . DGeothetmal(Heating(Cooliue Retunl) 130ther(Alain under-421 Reuialbs) 0 :fy '5 ft, FILL SILT-AND SAND -
5 ft:. 15 ft, WET SANDY SILT
4.DateWell(,)Completed:•1-10-24 WeltI1/ltTWH1o2-02 . . •r4 tt .
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5a.WclI Liicatlnn: 17, -
NCDOT n.. IL -. lVr ....,__,.
FacllityltlisncrNantc Facility lD#(if applicable) _ ... y... _ „
rt. fL i . 1-Ld I) 52024
5200.Woods.Edge.Rd., Wilmington, NC, 28409 . . f ft,
Address.Cit.mid
d Zip qt.R1nL\Rl:s
' i<.. . ITif_r ._... P.. _:r. 1.!n:
New Hanover BENTONITE SEAL FROM 1 TO 3'i '�.s'"' -`�•' •
County Parcel lastitirie.iuon No,(PIN) I
Sb.1;481 a and Liingitude in ticgreeslminuteslscconds or decimal degrees: 22.Certiticadon: I
(lfti ell field,O .41/1Oogissidflcicnt) 1
' NV' B.i a.n-.EV1l�'. 1f12,2024
Signature of Ceitifa:d Well Coiiiroctar• ` •_ Ikttc
6.Is.(i e)tlienell(jc):.DPermaneat .or. X1Temporary ity,lgaittg it'rit.fium:'I hereby Terrify that xltrlvellip was inrnl wow:gred ln;aruvirfancr
frier I SA NCAC 02C,0100 or 1 SA NCACOW;0i 0•il b)i'if Cmrstreietfoir Smadards and ihre:a
Is'1 7. hiaarepairto-tii existing w lli DYea or LQN° coprbf Oar rrcordhasbccn'proridrdtoilie'11 li[otlier.
IJtMs:ls a,pair:fill oar knaovt tall mrumretion lrtforvaarinn ant!t:iplaln ha miaow oldie I .
' nrmirraider I21icniarlasrrif naradlliebark-[fddsfort, 23 Site diagram or additional u dl details -
You may use the.b ack'of this page to"pies de additional well site details or Well -
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8.Number of wells constructed: 1 colistructioli•detaits.'You May also attacll'addilionat p_ages if necessary.
For Maltlple 10 fecilai or nmi,p'arer supply weds O,YLY irirh the same ea:rstracilor,you o n
sabmit nor Prro. - CU11ML1TALiNSTUCTiONs- 1
9.Total well depth betowland surface: 15 - (ft.) 24a, Far All Wells: Submit this faint within.30 days of coniptetion of't�ell
Far malrlple'acifslist all depths ifdij',i+rent(exampl-3e2(u1•'ant12.01430) constnrctiontothefollotfing;
10.Static water level below top of easing:,' (ft.) I)1 ismn of Water Resaure S,Information Pavicessing Unit,
If water level is above costa::we"+" - 1617 Mall Service Center"Raleigh,NC 27699 1G17
11.Borchatc diametcr:8.25" (in 24b.For'Iliteedon Wells ONLY: in audition to sending the font to the address in
24aaboso.also,submit a copy of this.fonu within 30 da)s''of completion of well12.Well eonstiuctian-method:BORED constmction to the following: 4S' }
- (i.eraugcr.ro y;bable direct Mash.etc.) - I • .. '
DIT'isiou of Water Resources,Underground Injection Control Program,
• FOR WATER SUPPLY WELLS'ONLY: • • 1636MafiSen'iceCenler=Raleigb,NC27699-1636
13a irid(gilmj hleihod of test: 21c,'Fo,'Water Supple.&Injection Welts:;
• Also subunit one cop),of this faint within 30,days ofcompletion.of
13b.Ois(nfcetiun type: Autaunt: well constnrction to the cormty health dcpagment of the caunty.where
constructed.
fanuGW-t Notilt CaRillim ElqktigiteIll:oiEnvimrtnuuandNatualResoiuccs-DtvisionofWaterRewuos Revised August2Ol3