HomeMy WebLinkAboutGW1--00857_Well Construction - GW1_20240205 pp
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WELL CONSTRUCTION RECORD 'menial Usc ONLY: U
'Otis form can bc•uscd for single();multiple wills•
1.Welt Contractor Information: •
44..WATIERZONES• .• I .. .
Brian Ewing F14051 ' '' 10 - ''Dt CIttPtiON •
Well Contractor)ante ! ft. ft.
4240-B f4 fL 1 ; '
NC Well auc1orctifttIortNiuter IS:'Ou1ER'CAI.NG'(fiatSiidtkasidecps)OR11NER'firtii flcabkl`. .: �.
root To DL1dreTER IIIICBCd IRS MATERIAL
SAEDACCO II. (L : 'in..
•
Cdn.tpanybrant4 ,`-.1( INNER CASING'OR'TLBING-“Oilicrinaleinsrd-loiii,)'r---_. ;
FROM . TO DIAMETER TRIMNESS.IMNE.SS. MATERIAL '
2,Welt Construction Permit#: 0 -ft. 5 ft. 2 ' I :fit. SCR-4 0 • PVC
140.all applicribhr rseUpr-rmits li•'..Cauntt.:Shah',•Vdrins-e.lrlreCtiC#.eh%) .•ft. ft. I •ht.
3,'Well Use(check well use);. 17:SCREEN' - .
NatcrSupplgWcl)t - PROM It) nrtslrTt:t: 81,t1TStri: Ill rCtCNritiS h 41ATF:n1Rl,
5 ft. 15 ft, 2 ilL, .010 . SCH-40 . PVC a
ClAgti'cultiuul CJMnnicipaUPublic.
DGeothemtal(Ileating/Cooling Supply) ®Residential Water Supply(single) . ft ft;- in,'
®lndustrial(Corimiercial DResidcutiat Wolof Supply-famed) '-la:Fttort 40--m - T'•: -
srATERrhl. EMPLACEMENT\IEIItan s A►rotor
❑krigntion . . .' . 0 ft. 1' ft, PORTLAND POURED '
Non-Water Suppt}Well:•
h. ft.
®htnnitcyting ❑1 ecorety
Injection Well: - . - .- - n.' ft.
nAgtrifeiRecharge 1:36roundoaterltentediatlon - t9 SANDlGRAVELPACK(itaitollabter, --' --=_...- - --—. - .-• FICOsf 10 • MATRfLSI. EMPLACEMENT
❑Aquifcr Storage-and tceovety 17Salinity Rattier 3 . ft. 15 ft, FILTER, SAND " # 2 '
❑Aonifcr Test ❑Slormwatcr Drainage
'ft. ft ' .
❑>~Ve in,cntal T hntrtogr ❑SUbsidcncc.Coniiol- .. ' .
3o;:DRJLLING'LOG'fiitlaeli'addiliomdrNs rerifrme.Llr l . - .
❑Geotltenta l(Closed Leap) CDTracer -.FROM TO DESCRlPrIOY(tmtnr.uurane.,.tOrt k,,nP:cr rnsite,co.)
LIGeodtennal(lleatimsiCooline Return) 170tirer(explain under 021 Retnarks) 0 •ft. 5 ft. FILL SILT AND SAND •
5 ft.. 15 ft, WET SANDY SILT
•4.DateWelh(s)Cautpleled: 1-8,24 *at IDfiTWH101-01 • - ,
ft,. ft. r' r
5a.Wc1I Location: .ft. ft. i, - ,.,' ,r. yV]' ) ;1 •
NCDOT . ft; It C D 0.5
factlity.thy er Nun_rc Facility lDk(ifapplicabic).
1 . [024 .
li. ft.
g ft. 4. In .; '1 ;'::,..1...�.:,u tits'
301 Harris Rd., Wilmington, NC, 28405 1. D1sai'.13 `tic
Phyikal rtddipss City..and Zip -2t-REMARKS- - . - -
New Hanover • . BENTONITE SEAL FROM 1 TO 3'
County -Parcel ldcritit tliou No.(PIN)
. 5b,LOOM de and Luiigitude'in degvicesiminutes/seconds or decimal dcgt`ecs:
Of melt fkekQ,,�M l;nilong'i4 Std11C1ent} 2-,Ccrtilhutln:
N W • _Bra:n...Ewing . 1/12/2024
Sigmtur afCeittlicd Well Contractor 1 Dare
6.Is(ore)the eell(s): t7Permanent or .siTenporan° (
its signing this funrr,1 prerieby certify fy that the nellis.l tars•(rutty rinssimetrd in vixen-to:nice
with.15A NCAC rla'C,0100 or f 5A NC4G;82C.,1/200 Well r:orrstrrrtio',Skurdants mid:hart a
7.Lti this a repair to an cxisting.well: IDYex or t INo .cope of this rrrrrcrl bar breri piorirle f to rhw arll owner.
ifthts'is a(i purls,fill oafL anw rid!conorivioa htforaiation and&Main the)aware of the
repair under4,21 remar4 sriiiun ar rut the bock of this faint. 23.Site diagram or additional Well detaits:
You may use the back of this page to provide additional well site detailsor welt
S.Nnntberof Wills constructed: 1 construction details. You roar also await additional pates if accessing.
For nri,liiplc i'tle&on or alai-noirer supply wellyONLi with rho trove cotrstrurtiwr.y'n eiju
submitonc'forrn. STIR IITTAL INSTCTCTIONS 1
9.Total well depth herow land surface.' 15 (fL) 2141. Fur'all Welly: Submitthis form within 30 days of completion of 1i-ell
For mt(hlplo iL•lJ'1i3r off depths tldifj?rcrrt ierompfe-J@200'oat?2@ fafrY eonstiactipn to the following: I -
10.Static water level below tap of easing: (ft.) Division of Water Resources,Information Prviceysing Unit.
If miter legi.I 1s aboiv.msha;,:rase"+" 180 MALL Service C i ter.Raleigh,NC 27699-1617
11.Dorchn1e diameter:8.25" (in.) 24b.For fit[m inn Wells ONLY: In addition to sending the fort to the address in
24a above.also submit a copy-of this''foam within 30 days of completion of well
12.Well constrnetiou method:BORED Conslllictinit to the following.
(Lc.auger._rats¢,cable.dike)push.etc:) - ; .
'Divlsloit of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center;Raleigh,NC 27699-1636
13;r Yield(gym) 24e.For.Water Supply&Injection NVetts:
(gym) Method of -- -
Also submit one copy of this fortn}l Within 30 days of completion ofi
• 13b.Disinfection types Amount:
well consinietion to the.county lrealthi department of the county whom
--- constmctcd.
Fano GW-I . North Carolina I5panment of En1•irarn sail and Natural Resources-Division ofWater litrIrem Revised August?913