GW1--01262_Well Construction - GW1_20240229

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WELL CONSTRUCTION RECORD Fig Noma!UsoptgLY: ' I
This fel:moan bc(BM foi inglOcii ofillSfik wc111 '.,.
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i.Weli.COntraCtor information:
4.t-t-WATERZONEs . . . . 1.
Brian Ewing - . .... . FR031.. . 70 ' 'DStiMPIION
Welt‘ConfractirNante• R. ft..
ft.4240-B . ft , ,
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-- .,13.:OUTER CASING nbrii111114iisitlivellsVOR•LINER Of-tin triable): •
NC WdiConliacicirCertificaion NIIIiiiii • •FROM TO , ' DIAMETER,• THICKNESS. '.MATERIAL
SAEDACCO • .fit . 0). . to. .
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16:1NNEBCASING OR TUBING kanbennal dosed-loin)), •: •
Cotnputy.NAnte- .
'FROM TO . DIAIIIETER. TRIMNESS. MATERIAL
2.Will ConStruitinn 11-4tnit ii:wx 05 0,112 9 ..
• -. .1l • r, cl• ' - )!ht. . .
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/-fst 41 applicable kill priini4,(k..Camigy....S•Igtg;;Variagre.Iglatig41g..)' I ` .
.. :t, fi, "• ' In." ' .
•,Welt the(eltecleiv*If use) , . t7:SCREEN • .
Water Supply Well: , - - — • . . FROM. . vo . -ntvateven SLOT SIZE TiICKNESS •1)1ATERIAT,. . .
. . •ft;
ClAgrkultinal . . CIMOnidipaliPublie ft .
it.,.. • ia: • -
CIGeotheimal OfeatingiCooling•Supply) CIResidential-‘.Ymer Supply(single) " rl' . . . •
Cihidustii*Canintatvial, : - , , : OResidential Water Sulipb'(siluel) , ' • - ..
-14.ost. .GROUT.TO.• . . -•h.LtTERIAL. . - ENTPLA CE.MENT METH CHM AMOUNT
• 0 hituation , . . . . . - .f ..t... - . -ft, i
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NomWatef Stilly t)t:Welk;
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0,Monitoring.
Injection WO: ' . • .ft..- . ft, . 1- . . - .. .- - . .
..,, . • . 1 •,-
C3Agnifdr Recharge • - LIGtoundutner Rentcdiation . ,•193AND./GlIAVELPACK 61,aitplk.ibte.0- . .. ..„. . .- .• ... . -.
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. ..... .,-„.. • - -woos' TOv - • StATRIDAL ' '. •ENIPLACEMENT METHOD
PAiptiferStorag6..and 1.*ovely 1:1Sdliniti EartiCe . ft.,- - ft. • :.
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LIMiiileti-Tesi•. ' PSIOnniratet ifltniti*- . •- . '
- -"ft.. ' ft. .
IDE•cperiracntitl Technology . elSobsidCoce Control . . .. ,.. • . . ... . . : . . , . . . , .. . • '
lo.,DRIL LING'LOG.(allieli addltiorialsbeelg,lf'accessary) • • .
EiGembenual O b(Closed Loop) , Thicet - . .PROSI,• .10 . • : DESCRIPTION(maw.hardncti:unmet ova-traiii 4/e.rk.). . .
. • 1:1G:oaten:tat(Heating/tabling Return) :•MC:0er(explain under RI Rettialkil • !ft. - ft. ,
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' ft.r ft • •
. .. ... . . „ •4.Date WeLl(s)Conipieled:-1-19-24 : Win ID#IP-1 - IP-17 (Odd # Boring ) . .• •
•ft.- f.t...-•-
' r,l"'`'4,"'N:•••••• ' - •
r _,........
SA;Welltoeattitin• . •ft.- tk.:. :• .• L°IL: 'VI"1:• 'i
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Pantry #176 • .11. . ft. I. .r
• . . .... . . FEB. .. 9 2024
fseilitkiiv iune yrerM Fseflity IP?(it Sppl ft ablc) . , . .
fft. . ,
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208 Main St., Clayton, NC, 27520 . . , ',ft— , . ft.: '• , ITIfOrirtkie.n T.3 ,- • • .
i r.P.ZrZairri, LIRY'. 'PlOcal -f..-gi,c•4.:3jid±I.P" z2t:nietttAttICS - - ' •-• ' Qin oc.;.!
Johnston,
INSITU INJECTIONS THROUGH DPT RODS . .
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omit*. ' - Nivel Motincallen NO:(PIN)
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56,14IttstenOit Lcinkitude.i it tlegrocsluilimitei/S)CcOtids fir dieltiVal itegreCs: .22,.calif-L.6,4m::(itvielltiekt,•ent.eitleti IN sutnicot) - - "" ' .'" • • ' ' • •i
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• W • Brian Ewing 1/24/2024
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SigFunueOcettifirdweit eiiiitractar- I- - ., - Dale. .
- . 6.Is(are)the well(s):.ElPettnanent .'Or XITentpornry
•Pr...signing i?O's fanTO her5hy terfey 11140Kinellis.01.yas iiir.T.4 cvnorc.ral Ig.occorthmer
iiith I51 NCAC 02C.0/00 or ISA NCitC102c.-0201?Itreti Constaieriaa Statacinis and tildi a
7,.,Li this a r5paieta,an_e4Stitnisve.11; DVc or "ENO "ceay'of Oh:record hgs riefl•arpyitte‘l.ta'ai?It!?filyirer.
If iNs'Is a repair:Jill eat fiaohii writ COM7Fitahlibifartamon Mil e.tp?ahr•t4e nature Oak . • -. • ' ; • •. . ,.. .
nemir figglerg21 irgiggii:iggigin aeon the bail'ofthis form. 23.Site di4vant or additional w 01 details:.
You-°jay use the back of this page tei provide additional will site details or.Weil
S.Ntunbei-of Wells Oonstreted: 9 • . . COIBItHICtiO8 ilefiiiEs. You May .alSo allachliciditional pages if tiecessmy.
For multiple lalecilon ei amkqyater simer.i.itylif ONLY'with ay same eaastruillaa,you eon
' sostirondorra. " . SI113fIfi"AI,,INSTUiCTIONS. ,
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0.7otal well depth below'land surfatz 2 6.25 .. oll.) ,24a.-Fur AR Wins. Sidnitit this-faint within:ST days of'ample-don of.*It
Far mairlple wtils-list all depths If diffrmnil(marMile-30200and2 •10()) con5liuctiOh to the follotsing-; !' • .
10.Static water level beluw top of easing: 00 bhislan of Water Resiniittes;Information lirucessing Unit,
IPilligi Wells dime mike;axe"+" , .. Scrvic Cciitiir.:Ralcigh,NC 276994617
11:Borehole diameter;2?25" • (hi.) 246.For-titiection WellciONLY: In addition to sending the font to the address,in
24a abose,also submit a copy of this fiitiu within 30 days of completion of well
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12.Well construction Method:DRIVEN . eotistnietion co-the following: .
(t.e zeg.,^i-:vainly,ea*&met postkete:}
'Division of Water Resources Underground Injection Control Pfogivvitt,
FOR WATER SUPPLY WELLS ONLY: - -1636 Mall Service Ceitter.Raleigh;NC 27609-1636
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24e.•For Water Soot*&Injection'wells: •
14...Vicki(Wm) Method-of test: . . _ . •
Also submit one copy of- this:form'within 30:day Cif goaVetion.of
.14b.DiSinfertiontypta. . Amount: •- . well constOtcticin to the county Iknithl,department of the.county.where
where-
FortoGW-t .North Cpillma DcritnUgni.of EnvigNtimp.i.34 Natural Resources-D.ividoo orWater Rmirets .Revised Aggint/Oil
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