GW1--02432_Well Construction - GW1_20240422

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WELL CONSTRUCTION RECORD • FprtiaerwlllscpNLY:
• This form On be usod for single sir midtipk wells -
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. 1,'Yell Ctintnictor Information: .
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. . . . . . , 'I4:WATER ZONIS 1
Brian Ewing FROS1 TO I DESCRIPTION!.
• Well COiiltaCtor NORM, ft.: . ft.. , p - •
4240-B ft. ft, I .
NC Wdl ContmelarCcdiftealionMoilier • • •LS:OUTER CASiNG(fot muhiI4 htdKcpsl`OR-LINER(irap 19c.Ie)'
FROST "TO • DIAMETER• TRIM/MESS. SrATERtAL, •
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SAEDACCO ft. ft. Am. -
Cnnipiuty N;inio• 16.•iNNER'CASING OR TUBING(geothermal ciosed-loop) -
• ••FROST •- • 1O•• DIAMETER' THICKNESS MATERIAL .
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2.Weil-Construction Permit q: ' . . 0 , "ft. 8. ' ft. 1" : 'in: SCH-40 PVC '
flu oft applicable krllprimits.fix.Coua;Stare•.Yariarrrr.frOcilrterr..) "
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• ft.. rt: it*
3.Wcli:Use(.heel:well use): • 17:SCRi EN
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. •• • Water Supply Went. .- • • FROM"- . 10 .-DiAMI:R ET ;51.OTSIM TIIICKNI 5 MATERIAL .
: DAgticulntral ' CDMunicipaIPublic a ft. 18 (t. 1" in .010 • SCH-40 PVC
EIGeothetrnal(Heating`Coolu�Supply) OResidentialWater Supply(single) • ft. ft. in i
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!!I
' .171ndustrialfConnttercial .• " - ©Residential Water Supply(shared) -Ta;GRO[FT'
FROS! TO -.MATERIAL LSIPLACEMENTSIETHODR AMOUNT'
. ' ❑Itngation . . . ft. it,
'Noti Water Supply 1VelI:, .
ft. ' re. .
®Monitoring .Rcc wety- , .
Injedlota%Vdt:- • . . , R tt . . • . . . .
ClAgtiifcrRccharge LJGroundniicrRcnicdialion 19:SAND/GRAVELI'ACK fir¢ppncabtcl°
• -FROM •TO' • 'SI TRRtsL - ' RMPLt(TMMENT Sit:riOD • - .I •
pAgaifcrStorage abet RcCoycry CJSalinity Barrier • , ' 6 f.- 18 ft. FILTER SAND # 2
IAgiiiferTest . &Stout:aterthainagq .
.:ft. It . I .
Dl:.yiedmental Technology ❑Subsidence Coijrol" . . .• . . .
. '2a:DRILLiNG'LOG.(ntiacb hdditionnl gticNsif iseiti surs1 . - 1
C]Geodretwal(Closed Loop) . • . DTricer, .FROM: TO • DESCRIPTION((obi*.hardner4soleoick Doe.grids i&e.cu:) . i : ' .
. EIGeothettnal(Heatiig'Cooling Ream) DOdier(explain under ll2l Reitiat6s) 0 :ft. 5 ft, -FILL SILT AND SAND , ' .
5 ft.. 10 • fL SILTY SAND
• 4.Date Well(s)completed: 3-28-24 well ID not-.1. • 10 ;(t, 18 it,. •SILT CLAY MOIST TO WET
• $a.Well Locatlnn: :fL ft
Former Edgecombe Genco Plant ft. ft, )a 1
i
_ , 4�t 6L r` �
6358+Battleboro.Rd Fact3it}W.(ifapplicnble1 • ft. ft
} p 2
., Battleboro, NC 27809 ; .Edgecoinbe ''. . :rt rQ: .. APR 2 2024
County; NC, 27809 P16.ilealAddmss,City'.nnd zip- ,.21RLMUlIS' • �.._ ..:_:. i.• '
• BENTONITE SEAL 4 TO 6'. i is :�•::"': , n�I4
. . Li:fi C.i33' ' .
• cum.*: Nir o I i,tirrc;tliou Np,(PINi
Sb.i iuitudc and Longitude in dcgrces/minutcsJscconds or deemed*.glees: 22.Crtftit* Lion,
(if wit!!field,one 1'rtrlougis'sufnckirl) . . - ' •
1, WY Br-Ga n, Evwri n • . .4/3/2029
' • - SigrutureofCradled Wen onrrxtdr• -i Date • - - . '
• 6.is.(ore)tin.sreli(s):.OPennaitent. or RTemporIIn • •ily-srgniitg i4ir.fan,,1 I herd,1 cerly Martha nidifsl was(i:rrej marina-led Li mrotrlmicr •
• • irirh I5A NCAC OW,0100 or 15A NCAC m_C.0200 Ws U Constrrietiog Sraiklards and ilkrr a • .
, 7.G this a repair fie an eristiny;lt'eIL• OYe,. or 181Nu • ca)irafMir record has¢nira'pnnrided rai;h4 nrllmr'iirr.
if rhis'is a irpalr.fill air i;rrfiu'i,ii4l corutnrerloa hrfonnarlon and explain the nature oldie
• repair wider P21 iri,wrki Seriiin e r en the bad of dii4 farm. • 23.Site diagram or additional well details: -
1'ou may`use the barb of this page to.p'rocide additional wet)site details or.nell
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' S,I'umberof dells constructed: 1 • ' cansttuctiott deloils,'You.nlay also attach additional pages if te'cessary.
For ntrhlple ir8'ecrlon oron,-i,arer siipplig urlls"ONLY with the sorecanstruirion,Veil eijo 1 '
siibinir one fano. .• RCIBM(iTTALiNSTUCTIONS. -
9.Total well depth below laud surfacer 18 - . To 21a. Fur Alt Wells:. Submit this-fares within 30 days of completion of Well - .
• . For marlplriiillslisr off depths ifdi01.rcnl(cmmple-3@2t1D•ami.2@WO) • - - Conalnietianto the foilossing; " • - ' • ' •
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10.Static water level heluw top of easing: • (f.) - Division of Water Resource's,Information Processing Unit,
• • if wak a kn 1 is adoer cos*rue"+•' • I617 Mail Service Colter,Raleigh,NC 277699 1617. .
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it.Boreholydiaatetcr.2.25_ - -(in . - 24b.For infection Weilr ONLY: in addition to sending-the fomr to the address-in
"24aaboi'e,also submit a copy of this form within 30 days of comph.tton of well . '
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12.Well eonsteuction method! DRIVEN . -_ consimetioui to the following: I - - .
(Lc,auger.rotary,cable.diced push era}. . k '
. - Divislou of Water Resources;Underground Injection-Control Program;
FOR WATER SUPPLY WELLS ONLY: • I636 Mail Senlec'Centei:Raleigh,NC 27699-1636 '
13a Yield WOMethod of test: 2'IG-Fos'Water Supply&In�cctton Weals: - •
- Also submit one copy-of"thisfornm,witltin 30.daysofcomplelion.of
well construction to the county healtti,depanment of the.connly.w•heio
' 13b.Disinfection type:. ,'�mauoh ,
eonsinicted.
.FaunGW-L . NorthCarollnaDepaiuiicruofFmmiioiwcntmidVanua:Resources-DivisionofWalerRnatres • RevisedAugust:N/13