GW1--00858_Well Construction - GW1_20240205

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WELL CONSTiRUCION RECORD' Fcrtiscrnulusc0NLY:
This form canbc•assd for single or tmdtiplc wills`: I
1.Well Cintrnitar1tifornuitinn: . [ '
- .r1.WATER ZONES
Brian Ewing FROM ..70 ' DESCRIPTION ,
Weil ContianorNarne: ft.' R. ( 1 .
4240-B ft. • fG. +; 1
NC Well CamraciorCcrtificetion Nmriic! 45.OUTER CASING(rorautli-cased%sells)OR LINER life SOAK'.
FROM TO DIAME,TER..;' TiHCTSNESS MATERIAL•
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SAEDACCO f[. ft. Ili.
Cooktuu y Noma - 16.INNER CASING OR TUBING(teo/herma(elasedaonii): :'
•FROM TO DLLIIETER. . THICKrcEss MATERIAL.
2.Welt ConStruetion PCi'fitit i .. . 0 ft: 5 • ft. 2 'in,. sCH-40 PVC
ListonGEO/Icable isrll permits fi. County.State;•Uarlanct.flrfaadrrl etr...i'. .H �.. • ,
3.Wc1I.Use(check.,well Use); • 17:SCREEN
Water SupplyWell: . -_ " FRon. ,, TO -DIAMETER stOrSIZE TIticiNrSs l 141411RtAt,
DA(TiCalttiCal 5 ft. 15 ft; 2 'I . 010 SCH-40 PVC
D111unic1 ll•Publie
t7Geothetm i Ca al(Hearin oting Supply} 17Residential Water Supply(single) ft. ft. in,
I lndustiiaVConmiercial BResidential Water Supply,(shared) :ta:GR®IfF :-_
FROM TO.. 11LATHRIAL . • LMPLAC'EMEVTMEIIIOD.&AMOUNT'
. ' ❑m 1lltion . 0 ft. '1. ' ft, PORTLAND • ' POURED
NOR-Wake Supiilir Wrga:_•
:ft, ft."
• Monitoring I]Recoscty t
InJecdon Welt: It. rt. I '
•CT Aquifer Recharge CGmundimierRenicdiation •,19YSAND!GRAVEL•PACK(if upplicabtel"
' 'FROM' 'TO' 1ftTKRIAI, I- PMPIACF:MDNT METHOD "
DAmt`rfcrStonigcatid}recovery ElSalindy Bonier3 R,: 15 ft. FILTER SAND # 2
❑A(nitcrTcst. DStommatcruiaivage- R. ft. 1`
DExperimcntal Technology I7Subsidci c Control ' . . . •. • . .. .' . . • - . •
7 20:DRILLING WG.(anaeh-irdditionul slicers if ilcccssarv1
OGeotltennal(Closed Loop) . DTracer. .FROM•. TO . _ DESCRIPrnON Carob JmrdncN,,aivreck tl'Ix.1100 nire.dt 1
DGeodtenua1(ITeatioglCooling Return) DOtker,(explain under.# l Reuiarhs) o ;rt." .5 ri,. FILL SILT AND SAND
• 5 It.. 15 R. WET SANDY SILT
4.Dote.SVLU(s)Completed:'1-5-24 ,well IDM TWB11-01 • •
5a WdI Ltieatinn. ft. h.
. fL, a.: I.1 . ti
Fncilit},Qlivneriluuc Fiidilo}LDI(ifappllcubte) _ R. ft. •' 1't a ( 4
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5403.Eggert Ave., Castle Rayne, NC, 28429 c
. Physical Addis.City,and Zip '•2t: R. f L lllsi.ln ;%` . L
REMARKS' y(')',` ,.,�• �
New Hanover • BENTONITE SEAL FROM 1 TO 31-
I, •
County Pai>el Idenlifecalion No,(Per} I'
Sri,l<artitudc•anti F ongitude lit deg cs/minutcslsecands fir decimal:itci;l ecs , 22_Ce ea n:: I'
omen fieid,•onciatiloi>S is suf 1a kN) ■ •
N' �Y E1d111:11, 1/12/2024
SignaurtorCortincr'Wclicantrattar_ - Bare •
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6.Is(are)the.uell(s): DPermanent ar• .ETemporarV s b f )avidly �1 f 1
fry.i tun.&It ore;',f Irerrb y a e thin the'refs ai tsur Nrre conrfnraed br arxordseicr •
With 1M NCAC 02C.0100 or ISA NCAC(.7.0,0200 Iva Constnierfftr SfarnIards and/bar a
7.Is this a repair to an cisting\\'ctl: DYer or KIN) "r p ofthis►twirl has bi n Prnri114 r,-t ie this order,
Ifthfs'Is a npalr.Jill on knonvt a e l consmrctlon brfatrnnrlon and riplahtdie Harare of the
repair carder Ali rcmarLr srcrirni or an Mc bail-of this form. 23.Site dugs amor additio nal well details:
You ivay use Die back of this page to pn*ide additional well site details"or Well
8.Nunrberaf hells constmeted: 1 • COnsDttictiondeldils, You may also atiaetl'addillotial pages if necessary.
For millrlple iri fecrlon arnaii-`inter nipple wells ONLY with the same cmrstruition.}nti eon •
.rrbmitonefarm. SIiBMWFAGit4sTtiC:'1'iONS I•
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9.Total well depth beta*land surface: 15 - • . (R.) 2la. For Alt Wells: Submit this-foel't r�ithin_30-days of completion of well
mild
* 00'anr12@@1L0) eonstiuctionto the Cottoning;
10.Static water level below top-of easing: • (l ) Dihisian of Water Resources,Information Processing Unit,
ff nutrr kwel is above casing:age"+" 1611 Mail Scrt•icc Center;Raleigh,NC 27699=1617.
8.25"
IL Borctlotc diame(er: (in.) 24b.For Infection Welic ONLY: In addition to sending the femi to the address:in
.24a above..also.submit a copy of this fonu rsithi t 30 days completion of well
12.Well conslivaion Method:BORED constntetion to the following: , i .
(ic:auger.•rotary.'cable:din ct Fish.etc:} - • i
Diclsion of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: - 1636 Mail Service Center.Raleigh,NC 27699-1636
J.
13a Yield(>pm) • Method`of test: 24c.For-Wales-Sulinh:tit Injection Wctlls:
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• - Also submit one copy of'ttiis fonts wiihiis 30•daysofcoutpletiou.of -
1311.Disinfection type: Amount: . . sects construction to the county health department of the.counfi.whherc
constructed.
Fonu 0W-I North Carolina Fkpauliicm of EIMIIITi s and Natural Resources-Dtvision of\VnicrRewuttes Rcy.isni AugiatNB