HomeMy WebLinkAboutGW1--00902_Well Construction - GW1_20240205 14161
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WELL CONSTRUCTION RECORD •
- For'aged Use EINVI:
This form cantcusc4 fortsir•igk Mr=MO;W-CUS• '
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1.Well eintractor Information:
••Ili WATER ZONES .
Brian.Ewing FROM.• 10 • •arscuirtioN•
Well comrade:Name: • ft. ft.
.ft. It
4240-B . .
NC Weft ContratarCerti8ciation Nardi& ' A&OUTER CASiNG(PwrinuttkuisclUellsi OR LINER Mita.Ilkabk):
FROM .TO • , DIAMETER.. THICKNESS' MATERIAL
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SAEDACCO ' in.
Comp Nano. t&INNER CASING.ORTUBING keothermul closatfonp). '
'FROM , 10 DIAMETER THICKNESS MATERIAL
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2.Wc,111 toustrnetion Oerttlit i: . 0 R. 15' ft; 2 '- 1-14. •SCE-40 ' •PVC
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Liauflapyiticirkie woRpermin,fi.c.enure:v.Sittle;Voriarrce.Injecting r.fcj .- •
-• .kr!.4-
3.Wcii.Use(chcckwfil tise): • 17.'SEREEN
- •Water Supply Well: • ,_FROM'.' TO__ . -DIAMETER SLOT Mill. TifICXNKci-. MATERIAL'
. • .•_ . .. 15 ft. 25 ft; 2 •Iri ',`.010 ' SCH-40 PVC
bAgtiOulturall 1.1MunicipaliNblit .
ElGeothetmat(EfeatingiCdaiing Supply), °Residential Water Supply(siugle) rt. I. ft, in, •
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f3 industrial/Commercial • C3Residential Water Supply(shared) r GROUT l'osr .10.
...MATERIAL . • EMPLACEIMT METHOD.4 AMOUNT
Elfriigation •. . . 0' ' 'It, 11 -ft. PORTLAND TREMIE ' .
• Non-Water Supply Welk' '
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• . . It
...
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.,Moniloring . ItIR ft
Y SCRYV - . '
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Inject ion Welt: • . ft.• ..ft. .. . . . . . .
bAquifer8cchargii - • CIGioulidwatcr Reitiedfatiou •t9.SAN D/GRAVELPACK(if uppliesble)• . ... . .... . - •
_.... . ,..
'Prow •TO' . ---• 3f PAPAW. • ENIPI...%C.TAIENT!unarm
. . ....
• liAtpdfcr Stotaue and krON1,t' 1:1SultuIty. Riiiief • 13 ft.. 25 ft. FILTER SAND # 2
. .. •
ICIAquirei:k§t- . MiefiMuitet Dratia&
ft, •ft. I . •
0Experinicnhd Teclioolog . 0Subsidence.Coutrol• ... --
:Itu'DRILLeriG:LOG lattack additiorfili heck It necessarVI
bGeodtennal(Closed Loop) . 13Tracer: FROM. .M . • - DESCRIPTION feobn Ward.wilImak Oim:grAin sit&&A.
Clavthennal(Heating/Cabling Return) . 1:10Iher(explain inkier#21.Reniatks) ,ft. 5 :ft, FILL SILTY SAND
5 IL 10 ft. MOIST SILTY SAND
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.4.;bite'wetio)co mple-ged: 12-21-23 Weil Tim T88304-01 •10 I). 25 (1., -WET SILTY.SAND CLAY ,,...,' .-.- p s . , c-- .
. 1 - ' . 1 I, . "").
Sa.Well Location: -ff- k-. !'.• ...-\L:‘.,,,r.. V r-L,
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• NCDOT • It, ft, - i
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FacilityMiutr,rName. - . Facnity Ey!(it.uppikabiej - _
It - • ----
ft. •• - !' • • •
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8884.St. Phillips -Rd. SE, Winnabow,; NC, 28479 ".ft, - ft.- ' Informs:Usn Pmcorstk-1-9 UFA
pisicid...i.oi.i,City,and iip' i.21.RREMARKS • CiV1 JO0-k.;
Brunswick . .
BENTONITE SEAL FROM 11 TO 13'
Counts' Nrce/ItIctiliticull'ou No.(PIN) 1
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5b.Litiitude.itid LOnetude in Itegreciiro inuteitSecood or dccItioil degree 22.Certifiration:
omen fie td,..ono jahloug Is sufficiso0
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- N • W Brian Evripg 1/4/2024 .
Siguture if CortifiedWell Lanuacto;. i, , .s Dale '
6.Is(are)the well(s)::pPermanent or ETemporaty
• gning.iltt:rfrtntr;1'h&c-by certify thoi.Mr ireflfs)isas(itr,:r)committed ht,actord.q!cr
with ISA AVCAC 02C.0100 orLiTA NC4C;02C.9200 Well CoM1Met(on.tatstlards-and altar a
•7.Is this a rePair to air Oclik' ElYes' Or 'El No .-copiof illir n co ill/kV 647.1provklerftfr ilk Iicli on?fer.
- ffaWs1.1 a ifFtql;rill ow Anoint led/aniviOrdoa Information and r.tplahr die oatare of the
' repairtindEr#2.1 irtnatts,:irciilig Grin,the boil of;thir foine. .23.Site diagram or additional wail'details:
You may nse the back of this page in provide additional will site details or Well
8.Number of wells constricted: 1 . cousttuction detAil.s. You may also iiiadluaddifional pages if neeesSniy. '
For nth1:11*!rejection as IJAII:lyarer sititAi welfs QA'LY with Me sortie catritrukiloo.ytnt co-a
submit anc form' . SUBMITTAL INSTUCTIONS" 1. .
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9.Total weB;deptIt Wm*land stirfacc 25 - • (It) .24a. For All Wells:."Submit this fawn within 30 days of•coinpfetion of Will -
For maltiple'wells list ail dephs if dWiroa(example-3.2,200"itad 2e wo) constnlctlolS to('IC following: I,
10.Static water level below,tap-of casing: • Division of Water ResatireeS,Information Processing,Unit, -
thrum.,:level is above calfag ase"+" ' 1617 Mail Service Cettoer,Raleight NC 276994617
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11.Borehole diaincter.18 r 25" -• (in.) 246.Far Infection Wells ONLY: in addition to sending the fomt to the addom.in
24a aboYe.also,submit a copy of this-loan within 30 days-of.completion of will
12.'Well cisustruction.inethoth BORED conswiation ti)tite foileMing: 1 '
(.c.auger.Maury,ea*duct posh.cm) I ,_ .
. 'Division of Water Resources,Underground Injection-Control PO
gram,
FOR WATER SUPPLY WELLS ONLY:, ' 1636 Malt Service°Atter.Raleigh,NC 27699-1636
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itc.-For Water Sopulv&InkcdooVetts:
13:t.Yield(ppm}. Method'of test: _ •
Also-submit one copy of this ftitui iCithin.36.dayt of Completiinlif
- 13h.DiSittfectian‘tytte: - 'Amount:, well construction to the county lictilth department of the county,where
constructed. I
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Faim.GW-t . NoTth Carolina ElT.aripccill.of Entinwutryi.Anil Natural Resources-Dtvkion of Wafer Rem Leon .nivised August 2013
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