GW1--02429_Well Construction - GW1_20240422

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WELL CONSTRUCTION RECORD - . . .
r Fig Intirind Osc ONLY:
This form can be mod for single or multiple wells..
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1.Well-COutraetnr InfOrmation:
•. .. • . . ,•/4.19Allin ZONILS
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Brian*Ewing . . , . • .. • • vtiost•• tO • DESCRIFTIONI ' •
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Well Contractor Name • • ft.: • rt. 1 I . . .
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NC Well Contractor CortiftdItion Norther. •' . . - •7•1•S.OUTER CASING(forntalll-etierthrins)OR,LINER(UV(itleatdel" .
Prow -To • DIAMETER, . TRIMNESS. MATENtAl.. .
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• SAEDACCO •
Company Name, . - - • Id:INNER CASING OR TUBING(geothermal dosed-loop).•'
PROM - TO DLCAIETER THICKNESS MATERIAL
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- . 2.Well Constroctinn Fern-tit h: . .. . ., .. . 0 •R. 8 ft. 1" '..;•',M. SCH-4 0 • ' i PVC . . , . .. . .
fist an andiadde wen prim.04(Lc.County.State.Varlorxe,fryecdort mr.), . . . . . .
-ft. ft, .in.• .
. 3.Ve1l Use(dice':well use): . , • 17.SCREEN • • ,
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Ftwlf.• 70 .•otAatr.itit st,01'St7g I 111tChisitiSS. I MATERIAL
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Voter Supply Welit . • i •
. . . . 8 ft. 18• :ft; 1" 'im' .•.010 SCR-4 0' ' PVC
0 Agricultural . . .Oldunkipalieublic . •
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ClGeothemial(EleatingiCooling Supply), CIResidential Water Supply(single) - _ ft. Lin.
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Elludustrialiconunercial ' • - . OResidentiat Water SuPply 1 shared)• '711 '
•. FROM-• •-• TO ' . . MATERIAL •I EMPLACEMENT AIERIOD&AAIOUNT
• CI hiigation • ' • . . - , , . • ft.'. - ' . ft. • i .
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• Non-Watce Supply Well ' • . ft.. .-
Moniforing . . . . .pltecoyery . - . • rt
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Inject lon:Welt:• . . . . . .• . .It.- . ft. '• - • .. •
- ClAquiferRecharge" • . . 001ottridwiticr Rerticdiation- -- 49.SAND/GILILVEL•PACKtill applicabla • . ..,. .. -
. . . „ 'mom'- ' TO• • MATERIAL . " . ' EMPLACEMENT Mr[11011 - • "
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E/Aipiii(crSion*t atx1Rcorety • E3Salinity Harrici • 6 ft.. 18 ft.. FILTER 'SAND . # 2 • .
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CI AquiferTcst ' OStottnnater 12ru(tosg.
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. .. - IDH:9)ctinicnIttl Tochnoiogy • • CISubSidence Cworot. • • • • . . . ... . . .. .
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. . 20:DRILLING LOGiattach additional sheeli,if necessarvl
['Geothermal-Closeci Loop) • • • bTracer. . . . • , .VROM• I TO ' : DEscittPTI0tircobr.hardneri,.so RAiltk Dcg.Osin!ate.dt.I .
EIGeothetmal(lleating+Ccioling Return) •ElOther(expliin under#21 Reniatis) .0 ' .'f!* 5' ft, FILL SILT AND'SAND . '
. . . •• - • 5 ' ft, 10 ft. SILTY SAND
• 4.Date WeU(s)Completed:.3-28-24 • -,Well 1D/1'14w-4' - . .
10 ft, 18. rf., SILT CLAY MOIST TO WET. ' ' ' • -•
So.Wt.41 Location': - • • .rt. It.. ,
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. . . c'. i:..- -' -.t '•. Former-E•dgecornbe Genco Plant 'ft; . . ' ft. ,. ....
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. FacililyA7DocrNtuu.c. ' ... . Facility ID#(itappiicablo).,. ....- . '- - • • -
. ft:• ' ft. " " '• " - • APR 2. 2 2024' -. - •
. 6358.Battleboro Rd., Battleboro, NC 27809 , .EdgecoMbe . .rt. ft;
County, NC, 27809 ' . P167iIart1 Midi-cis.City.awl Zip, ,.21...R•Eri•IARKs, .. . •• ''''•---e--; u eik •
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. - BENTONITE SEAL 4 .TO 6' . LIVVisra-:.`-l-P"...i ..
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• • County • 1.'arce]litnitificatino No,(PIN) . - - •
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5b.1.itudeand LOngirude hi degroeitminuteitsecOndsOr deeit11 degrue 2 - ' • - . .
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prWell fild,one taMong hulielnn .. . : . .. 2 .t.e• . .• _. •
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. . . . N • -' • • ' W. •.. ,.Brian .E ,4/3/2024
' - • S rciiiiignatu Cettified•Vielf Contractor '''. ,• . - ' ••.-Date -- • , -• -- • •
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6.Is(ire)the well(S):.OPettnatient. or ETemporary . ,
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ay signing grit faun.I hereby c'Trey filar The irell(s)VMS Diw-e)ceingnrczed lit accordance•
. . . -. with 15A ArCAC 02C.0100 or.151 NC4C62C.0200 Well Conitmetion kandares and that a " '
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7.Is this a repair to aitexliting svelb ElYtei• or 11No • Aiy-Of this record has 1.11'm proyirled ta thi!$.1r11 miner.
If thisit it if lr fill oar knoVei 40 constntaton httorniarion tread explahrthe swreire of the '
• ' repair tinder e21 tentarksirciiaii.or an the bark ofthii form. . 23.Site di grain or additional well details; - . • • •
• , • . You-may use tlie,back Of this page to.provide additional well site detail's or well
S.Numberof wells constructed: 1 " . - • - gotistnictioil details,-You;nay alki2tiacitaddiliOnal pages if isecesSary. '
For'inhipp Infecilon or holearee skpplywells ONLY with'the at consiruillon,yo#eon . ____ ____.._. ' : •. ... .. !. ' .
sadmitene.Prip. ' " : SUMarni . .INSTUC.TIONS • •
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9.Total well depth below land surfilec 18• - •. . - . (f ) 2lii. 1'ur Alt wits.; .Submit this loon within.30 days of completion of.Well• •
-Far nraWArt,i.:,ells-lisr ell tlepths if Mimi):(e.rample-3.2,200'mut 2@ WO) - ' - Construction to the following: .
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• 10.Static water let-el below top of casitig:' ..610 biyiiion of Water Resourees,Information Processing Unit,. . •
if utuer level Is&aye casfilx we"+" • '• . 1617 Mail Service CeAter,Raleigh;NC 27699L1617.. . .
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11,Borehole diameter:2 7 25 • -(in.) - • 246.For Injecjign Wells ONLY: In addition to sending the fomi to the address-in
24a above.also,submit a copy of this i form within 30 days of cotupktion,Of well • .
12.Well construction Method; DRIVEN• . - . •
. . . consItuition to the folloWing: • I
(in.auger.rinary,Cable,direct push,cm.) . . i' ._ •
. Division of Water ilesources;Undergyolind Injection Control Program; •.
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FOR WATER SUPPLY WELLS ONLY: • 1636 Mail Service Center,Raleigh,NC 27699-1636
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, • . • ' 24e...For-Water Supply&Injection Wells: .
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13a.Yield Iwo!) Method of test: • • •,Also submit One copy of'this form within 30 daysot6otuoletioit,of
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Amount 136 Disinfection type. wctl.construction to the county liruithdepartment of the.county_where
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constructed. - t 1 • - '
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Foim GW-L .- ' - North CarOlina Dcpiut Mont of Encironnecrit and Nn tarot Resources-Dleirioa of Water'Rmoorors -• Re•idsed Augmit 2013
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