HomeMy WebLinkAboutGW1--00856_Well Construction - GW1_20240205 i
19155
WELL CONSTRUCTION.RECORD For'tactual Use ONLY: '
This forma:I be used ceisingle Ot multiple wills'
1.WCIICOntntetuir Information: ,
. -•14:WATER ZONES . .
Brian Ewing FROM. 10 DESCRIPTION
Well Conti-actor-Nam R.. II..
4240-B ' . .
NC.Well Contractbrecrtilicortiori Mantic/ it&MITER CASING(foranuillicasetweilaIORLINER drift lleabkY
FROM •To ,• ' ' DIAMETER, ' 'TRICKNENS- • MATERIAL •
. ' SAEDACCO • • . ft, ft. • lo, ;
COnaptuty Nate. id.'INNER•CASING ORTERINGtsaothe'rosal ellascd.ltsio).:•,'
-mom —10' DIAMETER TIECILNESS• ... MATERIAL
2.Well Construction Permit ii: " . • 0 •R. 5 ft.- 2 ' 111: SCE-40 PVC
f.i.s•i all appliceible led freana*,(Er•Connig:.Siinr.Variance.flea*eir.) '-
-It,' ft. !Ili ..
3,%VOID*(check widl use); 12SatrzN
Water Supply Well:
. - - . FROM. 70 - DIAMETER SLOT SIPE, 711100 uss 1.MATERIAL
•
5 'R. 15 ft. 2 ii.- ',010 ' SCR-40 PVC
ClAgiculitual ClMotheipal/Public: '
•1
EIGeothemal(licatingignoiin,g Supply) ClResidentiatfa Water Supply(single)
1:In .1:ii GROUT dustrial/Contmercial . OResidentialWater Supply(shared/ • • To. NIATERIAL ENWLACEMENT5IEITIOD di AMOUNT
' Elfriiftation . • ' 0 .it. 1 ' ' ft. PORTLAND POURED •. • , .
.N011-Watge Supitb•%YOH: . .
it., t, •
RIMenitoting - ; ' PM:covey . i
Injection Well:. - - it. •. ft. • • : ,' - •
. .
ClAgniferReeitarge CIGthuatIvraicr RcniodiatiOn •19,SAND/GRAVE LPACK tif applicobleY
. .,
. . 'PROM-,- - 'TO- ' -' MATERIAL . ' EMPLACEMENT Mrrnon
i:Aimifcr Stothg0 and Rodovet. 1:1Saliolty Ramcr 3 ft.. 15 ft, FILTER SAND # 2
ciAgtiirci.'Tot EIStormwatcr Ptiiiage .
ft, fi...
fiEkpctimental Technology .1iSubsidenceCori itro
21k,DRIL LING;LOGiallach additional skt,1 if secrwsrvl
t:geothermal(Closed Loop) °Dace.; . TIMM• 'Pa ' DESCRIPTION Rotor.litrdnetti turf nick Pat.'grain sin.OM
oGeothemial(lleating/Coolina Retunt) 130ther(es.plain under.#211letuadvs) .8 .•8.• 5 I . FILL SILT AND SAND
' 5 .11... 15 • ft, WET SANDT.,SILT ,„..
4:Date Weii(s)Completed: 1-5-24 .Weti iip#TitHO 9-01 ' .
'it: ' it. • • i' ; .! : .;•e ',7",--,
.-
". '"....,. +;... .,,
Sa.Well Lticatimi: .
it. . it,'. !: ,
.v y ,i..„- 't
- ...ef„,
• . .
NCDOT It. it. '. . 1-Cd .1
FacilThwerAgno Facility pp iii-4ppiiimbici - __, u e-
0
. .
ft. It: ' • ' ' irl;tr„,---.••
' 6215 Sidbury Rd., Castle Bayne, NC, 28429 . IL IL
,
.Pliksicid'il.. .C16.-and f13' 'It.REMARKS . .1
. -New Hanover • 1. BENTONITE SEAL FROM 1 TO 3' • , .
County . Nrcel lacraikation No,(PIN)
• . .
51.1„Latitiideand Lengilide i4'dcgrecsintirtuicii,scc finds Or deciptial.dOtrfieF „22.Certification:- I.
(11*11 tickloot taloo ofkis'stleleo4. • . • g .'
N • . .
W Etria. a:Ewin 1,12,2024
5 igostort of Cettiticd Well Contractor' ; ' .D0a
. .
6.Is(arc)tftewelfts): OPertnanent .or .20Temporary .By signing iirislonn.:Ilrerrby errly Mar tio. welt )we(tirty)twat:metal trt-mxpaton ce
itith•ISA NCAC 02C.0100 or ISA NCAC 02C..0200 Well Constnietion.raildarcis and lika:a
7,ISi this a rePairtO ait.,Osting well:' Elites or 1113No Ity.yiy..of irliT record has Nen'isroriileti to tire urn owner,
' •1101(sis a repair,fill oar Aiwitig WO cow ructioa infonoraloo owl rAplain the oacare of the ' I
rennii tender#21 irtnarkixi-duig or on the bad of Mir form. 23.Site diagram or additional well details;
. You mayuse the back of this page.to preside additional well site details or well
S.Number of wells coustrticted: 1 . . - constmetimidetails.'YOU May also attach additional pages if neeeskiry.
For main,61e Infecilon or aoo-FOter svpfy wells ONLY with rite same construition,von con . . . • — I
suPonifone fin& ' - SUBMITTAL INSTUCTIONS'. i
. i
,
• 0.1.otal well.depth below Lind surface.. 15 - - - (ft.) -2441. For Ail Wells: "Submit this.forM Within•30-days of•compietien of Well
For milriple'wilislistaff ATMs if differro$(exernafe-3@200'ont12@l00) ' - aOnstiuction to the:Cottoning:.
. . ., . • . 1 ' .
lft.Static water level below top of easing: ' ((1.) Div:ision of Wrater Resourem;Information Prat:easing Unit,
((water.kket is'altutT am*:on'"+" . iG1714141Service Cc:ntrri Raleigh;NC 27.604617 .
11.Dorchote diaincter:8.28" On.. ) 24b.For lidection Welk ONLY: In addition to sending use form to the address in
244 aboYo,also.submit a copy of this fonu within 30 days Tel.completion of Well
12.Well consituction Method:BORED construction to the forloWitig: 1 '
(i.e:auger.rain),enble:dimet push.etc.)
, Division of Water Resource's,Underground Injection ContrOl Program;
- FOR WATER SUPPLY WELLS 1636 Mail Service Center;Raleigh,NC 276946.36
1 ;
,.
'24C.for Water Supply&Injection WeIls:
13a,Yield(gpm) - Method'of test: I •
.A191 submit oni copy.of this'thou within 30,dAys Of comPletion.of
•
I3h.Disinfectio :t n ile ; . Amont:u • ; . well eonstruction to tire county health department of the.countr.Where
constnicted. I
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FanaCW-1 North CatoSna 1"./pariatent of pm:tumult:rut and Natural Itesowees-Division or Woier RtAal/ttn Revised August:1'111i
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