GW1--02454_Well Construction - GW1_20240423

WELL CONSTRUCTION'RECORD . Fur(Mental irscONif: '
'fiis form can bc.uscd for singtc of mrrltipk weds• i . ' '
I.Well-Contractor^InfOnitation: , , •
,t4_:tVATER ZONES-
Tyler•Brown : . . . . . . snow. ' TO • • DESCRIPTION
U'cllCorfiactot Namc - ft: - - ft.. I I
4625A • ff. I I . •
NC Wc1IConlr�ctorCectifr�tioaNiu t�cr • -:'ISOUTER'CASING`Ifoi'iiillklied:,sctb):ORLiNER•(Wap-Ikabkf4 -:- •
• • Runt ' ' TO •DIAMETER - Tructou s' ATATERIAL
' SAHDACCO• - - . • . . 0 • ft, 13 fL; 2". '' ' ht.: SCH-40 . • PVC . '
::r6:Il4NER'CASING ORTIIBING.'�eciiTterroyl elf cddtiop); ' -
Congt:ul}'I�imC. �.
. . - . FROM TO DLLtilETER THICKNESS. MATERIAL . .
?.Welt Construction Permit#c-' • "R, ft: -
4/foggily/Wendt,'tcdi penain{i(:.Counn•.:SMi�',Variance.ce.iaier1 qi esr_J
3.WellUse(clrcclt well use) tTs5CRCCN - -- _
WaterSupply'Well:, . ' FIWM- • TO - • , DIAMETER storsln: THICKNESS MATERIAL '
ClAgiicttltittal, •t]MntiicipalfPublic:. • . 13 Ti: 23 ft. 2" iD O10 SCH-40 PVC
. tlGeotltemaalthleaiiug/CooliugSupptyl ' DR:esidentialWater`SunnIi`(singlet R' ft' in'
' , Ofirdusmalf(;blitntetcial . ©Rcsidentint;Water Supply shared. ) -ttt GROUTi, .
FROM! • 70 ' .• )IATERIAL EMPLlCEMLNT METHOD&ANIOUNT
Okiip:itian. . . . 0 - .ft. 1 IL- Portland Pour • •• .
Noti-Water Sultpty Weil::, - •
ft; ft:
IDMonitoring. ' :.
Well: . .11tecov�eiy n. tt - .
IttjecttoWell: -
. C3Aquifci[tccbarge d7GroundtaterRcntcdiation rt9'SANblGtta,VEI:PAC[{ti.'u;rtrlwalite15, -. . -
FUOM. 70 • MATERt4I. r?ipi.A(MINT METHOD '
• ipArpftr Storagc•andRccovcty- : CJSalinity!starrier 10 R. •23 •ft,. Filter Sand #2
. 13AquiferTest . • ElSlommatcr.Drainage, •
. ft. • • ft..
• Otiytciimcninl TcLhiiniogy.. ❑5nhsidcncc.CoMrtrl• 20:1)RMLING,LOG'(ailu{i'additionnt slicNs if'accessary):- --
• DGcotItemtal(Closed Loop) DTracer r • - • . -.FROM- 10 DESCRITTIO t ubr.lianlncv;.wa'nkkht . n t4te.cu:1
InGeotitennat(IleariutlCooling Return). ' Wtlier(explain under#2 if Retnai ksl ,n: ft..
_. ._ % f• ,.t.)
4:Date W ()Canpleted -5-24 Wellm(lMW-Pw02-S t ti E': (t..:� •i V 4.7.ft. <
5a.WTI Cocatur®: `' LU t4
. . ft:. �L_ . . APR . .
•Cheatours . - f4 ft.-
1__ s.;,.:,-may fii
•
Facilit)•,OwpcC Wnma' 'Facility ILO(Jfapplicablc): R.; ft. lfr.O: •: ... .
43.01 Lynbrook Dr.,:Wilmington', NC, 28405 , . ft.:' ft.
• Physical Addrast.-City,and Zip z2taREmmtics'
New Hanover ' Bentonite,seal 1'-10' • - - . - -
•
County - . t'arccl Idceirific.'itionNo;(PIN) . .
. - '511.i atitude and Lgngittdde'in d Mteestminutcsl3ccnnds or decim al degrees:' 2:Ccrtificafi„,', • I -
(Il uollIkW:oil.I.1U'lolaais.idIicknl) I •
„.' ~
i 2/5/2024
• . . . Signitu.-alCeitifred'.W.cI(Ceiittxaor'. Dale '
•
- 6.Is(rare)"the:well(s)I 10Perritauent or LITeutporary'
• N}•,siymuig thirJgmr,I-lgrcl+r'certifyriiru the,n•cll(�,t Parr{xtiir.J Cdr�inrcted in rawnl�rar -
' 'ri'itle 141 NCAC 0<C.0100 or I SA!Vac 0'C.0200*II U Constmcrioir-Suirm'ards and:lvir a
7:Is this a repair to an esittng.vvdl: 0Yes or ENO. .cope ofrfiis rrentnhvcbrsn"pmridrvl to.r ;MI nwiter. -
ifrii{s'is'a ti:pxilr;fil,avt.hiuuvi iirllciominkdoiadiifanru•1:ariind urpraln ihr,wrare'ufate- - • '
repairumler621 wirtrisciiii src!xan or rtn the bark oftliis form. 23:Site diagram or additional well details:
. You ma use the back ofthis page to provide additional ell site details or welt -
S.Nymberof Wells constructed: 1 coustiuctiou deLtits. You inar also,t:tlacli additional pages if fieeessary.
• For taaldpk.ittlecrlon orrrnii-xitirevsupg,s-ei'ff3ONLY with dis miuecoFstructioir .ou can • . '
•
sabmit,onc jarm, - .SL1I MrrrAL INSTCTCTIONS
• .
. 9.Total well depth helow.land surface:• 23 ((I;) •2.la. Far AU Wells:. Submit this Earn,.within 30 days of.coniptetieti of well
For iiiisblplir It,lsliltalldipibsifd( i•rrna(nrsrnpte J11.:08''onrl2@1dki') constmctionto the following;
• 10.Static Water level below top()erasing: (fl,) Division of Water flotilla-lees,s InformittianPrdeesiiug Unit,
. - ifxeinor!curl Is abate cat*.Ilse"+" - 1617 Mall Service`Cdntc h r.Italci ,NC-27699-I617 -
111.Sorchorpiliameter:6" (in.) 24R.Far.Iirjcction Wells ONLY:•din addition to.sending the fomt to the address in
. . • 24a aboi'e,•also submit a•copy of this form within 30 drn's'of completion of well
12.Well con ctibu method:Roto-sonic • cortstntctiontotltefollowing: -
{i.c.5itger.satiny,cable dirtrt pitstr etc:) •
,Division of Water Resources,lr *,r'uder outld Injection Control Program,
FOR WATER SUPPLY WE_LLS_'ONLY:' -1636 Mail Service`Center,Raleigh,NC 27699-1636
i3a,l'icld Otto) 24e.Fnr.WaterSupply&InjectionlWells:
Method of test: • Also submit one copy'of this;faun within 30.daysbfcompletionof
13h.Disinfection typer • Amount: - well construction to the county health department of the courtly whom• • -
constntcted.
Fomi GW-t - NonhCarolina E)cparinrenl'of En irarimentand Natural itesources-ulvi;Ionof Water Reiotrcts Revised August.2813