GW1--02431_Well Construction - GW1_20240422

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• -.WELL CONSTRUCTION RECORD . •. . .
Fig ligeritnlOso ONLY: •-
. This form can t •used Rd single Or multiple wells•... .
1.Well COntraCtor htformation: . , •
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. . . .-ti:wATER ZONIS-. . • ' '
Brian Ewing • • - - ' FROM. .TO orsciummx - -
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Well Contractot Nante . ' . . •ft.: ft.. • r ,' •42 4 0-B - - .
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NC Well Cantractot Cm:Motion Mutter. • • . • :.15401.1TE' R CASING tforMulti-ausethieRsIORLENER(If PP'fleable)
. - FRoM To ' ,: DIASITIER, . .111ICKNESS. . SIATEMAL•. .
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SAEDACCO . , - •
, .• Company Nom • •, . 16.•INNER CASING OR TUBING fgepthermst elnialonp). ,
• . • . ' • -.. -FROM To• DIAMETER. . TIIICKNESS . MATERIAL
2.Well tonStruction 1,eriiiit If; '- .. . • . . . 0 • •R. 13' ft,' 1" ' .111. BCH-4 0 'PVC' ' .. . .
' list all applicable icelIpeintat,(4e.Caunty.Sttee;Yoder:re.Byeakit ac.).. . ft . . . .
. 17:SCREEN
:ft, . .in,
3.Well..the(clItiNlr WEI1111S.Oit' ' . . •
. . . :- FROM. .'70 • •DIAMETER st m:wrst ilitctoms. I MATERIAL . •
Water Supply Well:, •-• - - 13 2 ft. 23 •ft,• 1 - -in.- :.010 SCH-4 0 - PVC • : . -
. 0Agtfeuitinal . • • CIMunitipil/Public-. . . . ,
ft. ft. - .
GiGeoilteimal(lleatingeoofing Supply), '; OResidential Water Supply(Single) .' to. . .
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- CO Industrial/Conuitemial „. pResidential Water Supply(shared) - 118:ost?UT' iii. • • •:NIATER/AL, - EMPLACENIENTSIEITIOD&AMOUNT - -
- . ' Ofrtiention •. • • •• . - • . '• ft.• ' ft. ' , ' • .
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Non-WaMr Supply Welk-. -
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:it... ft.:
. IllMoniforing . • Clftecovety- •
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Inject low Well: . . • ft.- . . ft. • - .. .. .
OM.niter fteeliare - Clantinderater*Mediation' • • . ,19.SAN D/GRAVEL PACK(if appliepbte)", • .. . ., . '
. .. .. .. •• •. - FROM - - TO" . - stm-tintm: • . PAIN ACEMENT METHOD •. •
• El AiptifcrStotagc and Rceovcty OStilinity Hamer - . • 11 • R,.- 23 ft, FILTER SAND P 2
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• .13 Aquifer Test.
, • -- 056min-titer Dmtiizigc-- , ' - -
- - • • • -ft. ft. • , . . . . • .
ClEklierimental Toehoolti&v , .- • , 11Subsidence-Conftol- •‘ • . . . .. . . - - • • .
:20:DRILLING'LOG•fnItach tultlitional OM I f Pecessani , ' .
. ElGentltemuil(Closed Loop) . • • liTmcer •. . . FROM-.. TO . -. DESCRIPTION(robi...lintIncri,tutProek line.prtin tiee.dra
OGoothennal(FleatinetCcioling Return) Mater(espiain under P2 I Rethinks) . 0 - It.--5 ft. FILL SILT AND SAND . . .
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. • . ft• : • 5 , ... 10 ' (C. SILTY SAND .
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4.Date Well(s)Completed: 3-28-24 ,Well miTMW-7• • .
10 ...ft:•• 23. rt,, •SILT CLAY MOIST•TO WET• •- - '
5a.Well Location': • • • . . .ft.• • . ft... ..I'__:._.. •:- ,,, ., . 1':',, ,.''-,..;
1.,'4..-- .....•L. i 1,f
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Former Edge cornbe Genco Plant t, - .
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. . Facilit)KlimerNanie . . . - . . .Faciltly 1D#(irapplinabla) - ft; ---- - - —--- - . AP43-±22-..4'i • •
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6358.Battleboro Rd., Battleboro, NC 27809 , .Edgecoinbe ' . . •Ii. ft,. lit.faim. ".P. P.:',7,r.I.,.34,..•jj lief.-Y,
County; NC; 27809 • • ' • ' Physical Address. ity.anil Zip• :
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., . , 21.R1.111ARLS " . .
BENTONITE SEAL 9 TO 11' i . - . •
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Quitoy • • • Pamel Ideplificaltpn Nir,(PIN) •
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• 5li iiiitittideandLtinfittide in.tlegreciiminutes/sectinds or decimal*fifties: . . •- .. . •
21 CertifiCatiiiii: . . ,
" . • Of WPII fleltl,enin•tiltelOng IS tartneleni) " . . .• . • '. . . '
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- •• ; W'. Brian..twing 4/3/2024 . .
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• '- ' - - Sign:tap erCeltifiedVicll Cant:Mtn; . •- ' .Date •
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G.Is(ore)the well(s):.EIPermancnt or ETemporary : . •
•Ity bightes drisfunrr,-1 freTby ertrify did'14 rrellf4vars(were)crniimwied irr fietql*IJCV • -
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. . . id&1511AVCAC 02C 00100r o-154 NCAC 02C.02110 Well Constrrierion Staiidards mkt thea a ' .
7,Is this a repair to anexisting well; E1Yes or 'KIN° • :cevricrfrifir word.has.N.improyitted AT';hi!yr!?owner. '
- 110?5.1%aivair;fill our krwirii willnicnn.ifornai/éi,calm nicOn informailen and explaputhe okarare of the . . .
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' repair Linder 021 tetnark.s.:iretirea ai-on the hark of Mix farm. . : - - 23.Site diagrantor addirional well details: • . - V . •.
• • _ \ may use the back of this page to..ptovide additional well site.detaits or.Well •
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8.NT-ober:of wells constrUcted: 1 • ' - . , . . ConsItuction details. You may also attach additional pages if necessary. ..
' Far multIpl.e Irtlevikm or 0011.-iydit'r app.ri iceils ONLY it lift'Me untie conitruilton,',oli am .
' .512.61.111finic form. . SUBMIVFAL INSTUCTIONS. . . .
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9.Total well.deplli below laud surface.. 23 . .
' (Cg.) •Sia.•For Ad Welts; Submit this•fonn within 30.sLns of completion of well • -
For ntahipriteells-lisr di.11.7fils if di3Oi rot(exampre-3@.700 and 2@.1470) ' Constniationto the following:
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. 10.Static water level below top of casingi-- - -'(ft) • Divi'sion of Water Resources,Information Processing Unit,
If worer level is above casfax am"+" ' V ' 160 hlaif Service tenter.Raleigh;Ne2769!)-1617 V •
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11;Borehole diameter,2 r 23 . 'On.) . . 24b.For Infection Wills ONLY: In addition to sending the form to the address in
. .24a above also.submit a copy of this lontt within 30 days of completion.of well •
12.Well cionStructIon'method: DRIVEN • '. . COnstniclimi In Site following: - ; '. •
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(Let aneer rotary,Cable,dime:rash.de.) . - . . , . . •.
. . . , 'Divislou of Water ROOD rcrs;Underground Infection Control Program,
- FOR WATER SUPPLY WELLS ONLY:. . . • . . • . • .' 1636 Mail Service Cente'r,Raleiglt,NC 27699-1636
. •. •24e.Tot Water- Supply&Injection Wefts: . . . •
. 13a,Yield'two) ' - Method of test: .
• • - • - . .A1So submit Otte copy'of this fa*.within 30 days Of Cotnfiletionnf - -
• 13h.Disinfection type: - - Amount: - well construction to the county health!department of the,coonty.where
constructed,
.FointGW,1 .i%zorib carolina 1Xportnientof Envionairm and Mural Resources-Division orfflnietFt urees. .Ritised AtigiM2013
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