GW1--02452_Well Construction - GW1_20240423

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• GGCONS` � ON RECORD - For t�en,ulUsc,ONtv:: '
This form can ttc•uscd.far sink as multiglc arils; ° •
- 4.Welt-Coutrtctoclraformatlatr.
:;tts.WATER'ZONES' -
Tyler Brown . , : . FRO51. TO ' ' •nt*UI UPi1ON - '
1VeltCo,gtagorNanie R; R. 1
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4625-A . .R,. • - •It
. NC\tcllCamract orCcnificatiottNumbei SiOUTER'CASiNGit"oilmull4:eikd'wellsYOR'LiNER:tirap tica6{el -. ._ I
•FROM TO • 'DIAMETER TRIMNESS' IIATEIDAL• •
SAEDACCO - . . - ' . . _ _f4 fL' :Al
4 uq,;u,}Nome, `ttii INVEl3 CA:SING'OR•TuRING:iteoiliiiinafeWs d-tooji►".}��`..;- _._
FROM TO • DIAMETER'• 'rEi1C INFSS. MATERLAL -
. 2.WcitCenstructitm Permit d,:' - -0 ' • -ft. 7 . . ft. 2" . j; m. •SCH-40 ' PVC
f ist trlt.1.71 rralrfe vripennr ,s tu:,Countr.:Sta i 111riarsr&fe dral eh";)
ft, ft. • •. I : .
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3.Welt Gso(checic.wdIuSe):< t7sSCRL'E;N' • - _
. % afe'•rSunplyVVeI L• - •V - - FRO.s1- TO DtantErnts 'SLOTSi7#: TRretiN s •MAI-EWAt,
CJAgr(:ulttnal . . - . CJMt• uiicipal}Polgt .. 7, ft: 17' '.R.- 2" rrt; .010 SCH-40 • PVC
. : ®Genttte:meat(>EieatipgRCooliita•Stippiy). DRcsi •
denttat�'4?atef Suppl}•.(single)' R` I f4 e� I
• DIiidusiitatbConmtercial . ©Residentiat-Watcr Supply(shied). - 'r EArPr VTstETiit}D sA3tauAir •
t8 GRO
FROM =O : MiTERLAL
Olrri ,itian. • . 0 ft.. 3 ft.'- Portland Poured. -
Nnu.Weiler Supply Y ell:;
Lialv$onikaring : .❑ftecoaxrf ft: R . •
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Injection tVelt: rt. •ft.. • i'. .
ClAtptiferRctbargc. CiGroundstiltcr Rentcdiation [i':SANUtt;ti t 4:eL 1 ACKi;t sNrlrticat,te)','
. . 'most- - .rO.- • AtirEa At; • EA IPi.ACi_lnr_4TMI-TROD
dAtinitcr Starage-a d RecoYety . ' ClSalinity Harrier. 5 'R. 18 ' •ft, Filter Sand #2 '
QAgttifcrTest •- - ..•-[]Stone atcrDnikoogC. - • • • i . .. • • .
- ft. •ft-
❑Ey,camcntal Tcchnolo •. ❑Snhsidcn e.,C.oa1n 1. • . ..
. - • . •20:DRILL I G'LOG•iaitaelfadditional sheets'i(irma>an') - - • . .
❑Ceotltenual(Closed Loop) . • tJTracer . . 'FROM• TO DescR[RnON(robr.hart,isle,wW nekorc,s`ain site.&A .
❑Geot ennal(IleatinriCuolini Return} ❑taller(e spluitt under#21_Reivart s) ,to fL
., ft.. ft. 1, •
•4:DateWell(s)Completed 1-23-24 well 1iDtRmi-PO6-S dt.. ft: i i +�
$a1,lard)Gtcatiii u_ • • > ti t , 1..r .iJ I--t.
Cheaionrs •
fri • ft - APR 2 :-20Z4 -
Pscdit}+itesocrName Facility(DN(ifappiicablo}. ft.' ft, j a't s
. • ' . • ►r<, ...e•in'f ...4-✓•1 r;,3 ,� .-i
4000 Chapra.Drive,;Wilmington, NC, 28412 • ft. •ft, ,., 'Tc6,;,.—..j ' .
. '. . - -PISy teat,Addeest.City.andZip, •21-i.:RENIARICS: '
New Hanover Bentonite.seal- 3'-5• I.
Gonna}' - l Ertel kteiGfiC,',IlonNo;(FIN) ' 'I . .
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•5b..1.atitndcandR,4ngttudeindegiteStminutes/accandsor decittiildcgiccs: , z�C 1 •
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tea tina: •
. . (llwel1f etd ow t atllonalS•sultlei4.a} . .
15 ., '�~ • , 1/25/2024 - :
.• St"tutu s.dfCc.iliftcd Well Conrra:.tar• i• . Data . .
6�Is.darr.).thervetl(s}: XlPenitsitent or.'.aTemiwrar}•. : • '' •
• Nr;�igrtnf�thfrJirrm•P herel.c r rlrJ}tLui;ll,r vcll(.vl kvr fMr'ittJ'Ora:rutted fir ftermiiirldner.
. - . si it1f 15et NCrSC 02C,0100 ar•I s,t NC tC.02C.,O20 Pelt Constr actiou'§tarrdards abet siutta
. • 7.Isl tall%a:repair to an,existing-wdt: DL4r •or KIND. rorry,.afrllr rircon11i c Cn prin•GTrd ra J7ir.;i 11'when .
if This is'ri ietsrlr fill cartfii:t i Weil crnruaninsioi,biforrr,arlvn dad a aialn sir auri rrs'ofrite
' r4liurruiukr2BI nernrirtrareiewi erari rlu hoehark..of hi.Jnrnr. 23.Site dily;rsm at addltionitd sigh detilshh
' You may ost.the.back,of this page ta•provide additional tall site:de ails o r.0 well.
8:Number of Welts:cotisirutted: 1 - cotistiui:tian details:Yon mat alsotuaeit additional pages if i eeessaiy-
. Form rlaipte:li rrlan aratm-,ii iree s,igtth 1u ll O,YLY u irlr rlir�.snriecotrstructiosr,you scan - Bht[TTAI.iNS'I t7CTIONS •' .. Firbnnl on form,. - -. . N -
.Total well depth-9betolt land surface: 18 (fl) 24a. 'Far All Wells Submit tins*inn aeuilhm 30 tktvs of completion of wed.
For-as iisI k ii ellt?isr ntlrlipths lfdOemia fcxnroiplr 3T200''owl 24'ltt0'M' construction Co the follotlina; i
• .10.Static water level below top Of easing: - • • .• . •(ft.) . Division of Water Resi uirces,Information Prncesftiiig Unit,- . .
/f unlrr hsgiq!s irLa,ti editn,;,:au;• ,• 4617 Atoll Scnicc 4.ntcr.,Raleigh,NC 27699-1617
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11.Borehole diameter:6". (fn,) 2411.For T ejection Weds ONLY: ire addition to sending the fomt to the'address•in
24a at>•ot also sub.fint a-capv fainttin 30-d •
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12. Wll cotistruction method:Roto-sonic- ••. ..• • construction to the f llowiiig_. aof n f'dais within, at•s campl,:tio of welt
(i.C.aug,L.iotaty,cubic di,cc.pusb.etc.} _._ -- •
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• DEVI3110itof Water Resources,.Undergnaund Injection Control-Program,
• FOR WATER SUPPLY WELLS ONLY:' . ,1636 Alai)Sen ice tenter,Raleigh,NC 27699-I636 -
13. ..Yield(gym) Method of•test: 24ts For Water Si pill.&Injeetiti Welts:
Also subtuit ape copy of this feral ist•ithiu 30 days of completion of
13b.Ilisinfcction,tpe,, Amounti Well constriction to the-county h'al h department of the coimhy where
consttnetcd• • . •
' Fame GRr-I. Non),Caroliiia Depariment:of Erfe•irarm i a aad Natural Resat-Imes-DhislogofWaierRsotsem . ' Revised AtrgustIOI.A •
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