GW1--02463_Well Construction - GW1_20240423

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WELL CONSTRUCTION RECORD t
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Fat ntombil ifscONLY: . 1 •
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. This tomcat]b.e•usod tbr ngle or niultipic was• * . ' i . • .
I.Welt CoutrActor Information: . . .
?;.til.WATERI,ONES"
Stefan Smith . • rtloM --0-'TO ' -- ORS CRIP1 ION • •
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W•cti eobiradorrsram0
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ft.- . . ft, _ii ! ' . •
3576A • . H.
NC Well CommeiorCcnificaOrtblimiter • ••IS..016TER'CASING'dliritfuttkisithfirctisf OR LINERtitafilieltbla, .:" •
.. ' ' FtioNI ' To InAmETEft' THIcKNEss mATEtitm.•
. . . .-- SAEDACCO • . •
' . _ . 0 • ..tt.,, 9 ft.- 1" ' ji, SCH--40 '
PVC
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Cortmaay Nap:, - ,,Iti;INNER cASING•DItTUBINGtinithenOid clokitiolijitf,,,:
. • ' . FROM- _TO ' ' Mall:TER', TilICKNESS. MATERIAL
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• ?..‘VIC t.wiitnictiiin-tiertait 0: wm0701315 • '• -ft. ft. •',•.'tit. ' • •
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. 1,fsr 4.'11.akilicafile.ifeftpenines fiLe.:Connty...Stah!,;Variance.If rtc,) . .
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- • -ftt, ft.- • : 'in, ' • •
.3.Weli.Use(cheelt Well use); IWSCRIIEN' - '..- - ' '' ' • , ...,
'WateiSupply Welt:- - • • - - -: • ' mom. -. To . .piAMETEtt, nor size ..-:1•11(CHNMS I MATMOM. , •
• • 9 ft; 14 . •ft. 1" .111.! , .010 CH-40 PVC . • '
.-• PAgticHltitral -, - ,El!Aloi cip.itet. ti?lid! . .
ft. - .-.
Eldttoilttirttat ilicatiligICooling•Supply). OFte6idential.Wotet Supply(440' , . .1 11
CI hidasitial/Cottunercial . • flResidential-WatorSOpplyfshated) ' -'7ts'GROUT'''.''
FRON1 TO . • -'MA LitL EMPLACENIP-NT 111E1110D ikA,1101.1NT
' .. I:Irrigation - ' ' . _ •' - • ft. ft:• ' '
. • . ' NOttMattr Soma,'Well:: .. .
- • ft. ft. - . 1 •
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121Monitotiog, : .0RecoNelY ' • . ..
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Ittjectiott Well: - . ' . . ft. .- ft,
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ClAuttifcrl3celtatge. -1:10oundWater,Remcdiation . .-.19.-!SAND/GRAV.EL PACK tit irttplirlabtel .-..-.:- ----.•..- .••.,-.,,.. _- .. •
iliONI. - 10 - mitTgartu, • Ft:min.:ter:Nit:NT.m 1•1110 ii . •
. bArtuifer.Stortge-and idccOvery. ' 01Salinity Harrier . . n. • ft,- .
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CI AtittifOr.Test• . - • OSIormwatcr.Dtainigc. ft. - •; ' , . .
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1:MNlietlincotal TeChnotomr. 0SubSidence..C.Ontrol • • . •
• _ Ao:•:DRILLINGLOGIattaeleadttitionial irbiePiirorecssarN)-•---- ' - •- .. - '- -
IDGe01114nikai(Closed.Taton) - - Eltraeor - - -FROM• • TO -DESCRBTION(color.linnItioA,stanick typt.Orin gee.fit.1 .
.C1CreOtitentlal afeatino1Cooltua Return) '1:10ther(explain under#1I Retuatkst 0 • -4.. 14 • •ft, Silt ;• ,• ..
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• • • . • •ft.. ft. . i; •
• 4:Date%AIM conipletedi 3/12/24 .wall iromw-1. . . . •, • 1 t - •
. ft... ft: 6—.i. ke )....--. •.
Si;Well Locatroth ' ' ft. • ft. 1 - - APR 2 ::-. 7f174. . •-
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.Speedway .. • • . . " • — . • It: - • ft. r. • '
.. •f'd9ift1y,!thro-or*re . Fdpftity Iftg-t-ifOpplcFIble):. _ ,__-,_- - !. _•
R. • ft. 1:
. . 612 SW Greenville; Blvd., Greenville,. NC,; 27858
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. . . rt.. , . re, b , . trifc,„^;',Fr_.•-d.-.74,/e.....1...;.:5- ,--2,..3. r,.‘•
. •Intytir,a1MdtTss*,7City,And Zip , .
• ' 'IL:REMARKS'I-, ' , . • • • •
Pitt • • • • Grab sample via 1" PVC.;:teraporary well - 2 - •
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' Coma), •. , Parrot tdp.ntifteatioo•NO;(Pirs1) • . ' •- ' . 1: ' '
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.. !,,,.•ftLittitu de a rid Longittitic•ht degreesiminutesAecondS•or decimal degrees:" ..42'.-cirtifi,atiou, -- • ,, •
• (If well rie'ld.:om.latilottts'Sttffielq.01)
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35.572488 • . • N 777398270, • ' - ' Vif th47 '- I: '- - -.. 3/26/2024 •
• . iigiur ofC i tied Well Cotonetor 1: , • Dale
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. . 6.Is(are)the:well(s): IZIFenitanent or XlTemtorary. ' . By.signiag this Ann,1,kreby certify ihni:Iv Ireldf,0 was(st;:r,e),:ciragnftted iir tworrlance.
. . . . .ladr.7 Set N'Ac'02C.01(k)or.15t NC'IC(12 ...0201)1114 CtnntraMan Saiudar.ls.and tint:a
'74s this a repair to an_051ing.wellf . QVc_.4,i •or •ISINo. •. •. • repy.ilf this reCzinf Jai breaptoldried 0:,16niti uwirer, . •
• If Oils a rein*,fill ine know'well moinky?ok.bifonnation and explain tile naiare,.•If rite. - ' - , , ,• ' • ' ;; - ' • .
miqiiiiiidert(21Ternirti.iidi0 or'.rut.rhe boik ofiNiforni. • • 23:S ite diagram or additional,Well details:. • . .
• - • -You mity use:the bach,Of this.page to•proside adclitiotial-well site.detailsor well.
Ntamberof Wells contracted: 1 , consttuetion details'. You itiayalsti itilActi additional Pages itneeesiary.
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Poi mudrAnkfgkedtm'or ana-!;iirer sumily n,Vb-(MIX nirh rile san4 coa4tradian,,voii ova ' • ' I:: '. .
. '.. .gdnait'ang pm, SURMITFA I,INSTiTCTIONS, . • ' • .
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9.Total welt depth II elow land surface: 14 . (ft) 21a. For-All Welk t Submit.0s form within 16 dOyk Of completion of well
• - For antOple iiiellfliit riff depiki ff if Own;(r.yarnp1e,3€1.09.aad2@ I ikey corOttoctio.n to the fb)i0Witi.S;• I: , . •
10.Static ivatericrell below top df easing.: • (ft.) Divisiiin of Water Resources,Inforniatioil'incessinit Unit,
If ni,yer kvil ts ithow casing;as.'•"+" •. - .16 ii Alan ServicelCenter,,Raleigh,NC 7.3699-1617
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. . 11.Borehole ilianiettil.2•25" • (in.) . ' . 2411..Ter Ttijectign Welly ONLY:4,in addition to.sending the form'to the address-in
• 24a•above.also subtitit a copy•of dd.§fanw within.30 days of.completion of well
12,W,elteottstructinti method:DPT . - colistrucitoO(Odle folltvina:. '. .
(i.o.pitger,rotaty,cable,,direct pink cc.) . i .
• 'Division of Water ResattrocsMadergvuod Injection Coutrtilfrog,ram,
• . FOR WATERSUPPLy WELWONLYt • • -1636 NUR Service!'Center,Raleigh,NC 0699-1636 . •
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•"'24e.For Water Supply$t'Injcition Wells:
113a... Yield(gpot) •Illethod ortest:
Also submit ape copy of this form within 30:days Of Completion of
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113b Disinfectian 4-pe . - Anioneti well constniction to tho•county hdalth depannicnt of the county whcre
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constnicted.
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Faint GW-L , North Catolinafkpariment of havironnrat and Natar.t.1Roourees-Dirt Woof Water Rmotras Revised August.1013
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