GW1--02436_Well Construction - GW1_20240422

WELL CONSTRUCTION RECORD Fig tleerimlifso_ONLY;,
This form can be uscd for single or multiple wells
1.W Well ContraetarInformation:
. :Lk-WATER ZONES
Brian Ewing . . . FROM. TO ' DF•SCRtPtH)N'
Well CnIt iaor Name. • R. . it., , ( I .
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. 4240—B . ,ft.- ft. I - .
NCB'dflCaniractarCcnifiditioiiNutiber • :O tStJTERCASiNGtroralnttl-casedw'ethVORL1NERr fleabk
FROST TO DIAMETERDIAMETER THICKNESS- 'MATERIALuTtRUL
sAEDACCO rL. �. • m.
Company Nance • • 16.INNER CASING OR TUBING(i*otbermat etased.1oep). .
.. - FROM TO Du\teTI1R. - THICKNESS ` MATERIAL.
2.Well Constriction Permit#: . . 0 f. 8. . ft.' 1" ht. .SCH-40 - 'PVC '
List oilamlioabfe well penults(Le.County;Saat¢;l arfairce.Ir'atirn efc 1. R f1 M.
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. 3.Wc1LUse(chccl:well use) IT:SCREEN
Water Supply Well:. num. . 10 .•DIAMETER Sr0TSI7.t: THICKNESS. MATERIAL .
• - 8 ft. 18 •ft' 1" in, •.010 SCH-40 PVC
l7Agti'cultinal ❑Hluutcipal/Public- .
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®Gcotheimal(lleating(Cooling Supply)- CIResideutiat Water Supply{single) ft f4 In' . .
• 13lndustrialfConwtcrcial CiRestdential Water Supply(slated) °tA` O
UT
FROM TO . MATERIAL ' EMPLICEMLITMErHD SI O 'AMOUNT
. ❑frtii_ation •• . . . .",ft . ft. .
• Non-Water Supply Well;
ft.. ft... •
IGbtonitoring 17Rccoyety .
• Injection:Well - . . ft-, ft. . .
®AquifcrI ccbarge' DGroundi atcr Rentediation 19.SANDIGRAVEL-PACK of a pplubter . . - .. .
&ROM ' 10- • 'M%IVRL%I tEMPI AC1:HENT\11:T11011
i]Atinifcr.Stotmgc and it covety • • f Salinity Ranier 6 R.: 18 ft. FILTER SAND # 2 .
clAq iifcc Test. t75ivrtmtatcr f}miil8ae' ft. ft
❑E'ipcnmentalTccIinotogl' - ❑SubsidcnceControl -.
• =2tt.DRILLING LOG(attach additional elicetsif necessan•I '
DGeotltenual(Closed Loop) ' i7Trlcer. . : FROM ' TO . . . DESCRIPTION(aobr.harducn.u lt'mcuutpt.',7da.sec..d.I .
OGeothemlal(UeatiugtCaoliug Retool) ❑Oiler(eeplairt under#21 Rettialks) .0 •ft. .5' ft, FILL SILT AND SAND .
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5 fr. 10 ft. SILTY.SAND
4.Date Well(s)Complete 3-28-24 N e 1 iDfi TMW-10' . •
10 ..ft,, 18 ft, SILT CLAY MOIST TD,_WET
Sa;Well Locatinnt ' .ft fL • s --:
Former Edgecombe Genco Plant - ft _ ry, -
Factl'ityKlicrerNamc / =7� C IlL`t Facility 1Dk 6611 liable) it: ft.
6358.Battleboro.Rd., Battleboro,.NC 27809 , .Edgecombe • :ft. ft'• lPr`ifi.iif. i; rr'„r•,s, -,:_o
. . County, NC,• 27809 . • PltwsidnlAatdiess.Ci •,aitdZt / Y
0 p' '2t:RIfl1ARICS - fd.i4rJ:::h3
BENTONITE SEAL 4 TO 6'
County parcel Id lilifie aIi,n No,(PIN)
51i.Latitude atilt Longitude in'deg
rceslminutcs/seconds or decimal degrees: 22.Certification:_. . ,
pruet field,t11u t sprat if:stafielaiu) ;; A� i
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N W Bri aan.iE .i ng 4/3/2024 ' . .
Sigma:eelC.erifirdWe Caiuracter • - Date
. • 6-Is(Ire)the vsell(s): 17Pcrmanent. of %lTemporaq ' . , • '11y.signing thft fa.mil hereby curtifi•rhru the wail.)was(Pyre!cwnrrrucred lit ix.Toni once
frith 1M NG1C 02C,0100 or ISA NCAG•02C.02200 Well Consrrtcton Star darts met:btu a
7.Ls this a repair to aneristing well: i3Ve or ISNo :i<virnf ihis record lios tt'ca provided totlili urn(n ir. •
Ifthls:is n repair:PI oot krtmhvr seenmru7nrctoo-hrfomuuhwt arul raplahr rhe,nrrare oftre • • .
repairtwdcr#21 rrrnarLrsrctinn ar ran Ale&i k of thus form. .23.Site diagram or additional well details:
You may use the back of this page to.provide additional well site details or Well• -
S.Nunther of Wells constttieted: 1 . ' ' - t ousttuetion details. You u may alto anacltadditioual pages if necessary. •
For multi,*In(ectlon'Or non-tearer supply teens ONLY with the same construction,ynn can ' - '
. sudmit One fowl. St11U1fITTAI.INSTiTCPIONS . . . .
9.Total wen depth below land surface: 18 - . (It.) .24Iat.•Pat-All Wells:-Submit this faun within 30 daps of conipletion.of Felt ' .
For mnlrtpidivelfsiisr off depths ifdWtrent(csamplr-3Q200'arul.2es(0$' construction to thefoltgiting:
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id.Static water level below tap of easing: - - 'AI . - Envision of Water Resources;Information Pmeesaing Unite
' ir mini level is above cpsletn;else"+" : 1617 Mali Scn ice Genicr,R• cig y NC 2769!)1617
2.25 i
IL Borehole diameter Om) •• 24b.For Infection Wells ONLY: In addition to sending the font to the address in .
24dabove,also.submit a copy of this fonu within 30 days of.completion.of well
12.Weil construction'method: DRIVEN . .' • • - retbImetion to the following:
(Le:auger.rotary,cable direct push etc
. Division of Water Resources;Underground Injection Contrail Program;
FOR WATER SUPPLY WELLS ONLY: ' . .1636 Mail Semiee Center.Raleigh,NC 27699-1636
p
i3a Yield(gpmj aMlctitodbf test: 24c.For.Watcr Souls-&Injection Welly: .
• . Also subtuit one copy'of'tiais fond ictthin 30•days ofcompletion.of
• 13h.Disinfectiontypm .- Amount: • • well'construction to the county heath department of the.county.where
. ' constricted.
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Fonts OW-I • Norlh Carolina U.parianentofEnvironn lent and NaturalResoWCes—DivbtanofWatetRenat lei .Rs.iscd August 7.0li
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