GW1--02502_Well Construction - GW1_20240422

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•- - WELL CoNSTRUCIION-RECORD , . • • •. -,
Fc r[tactual 1.Ise ONLN: • 1 : • •
. . This form can IN mai for single Or ontltipk wells.
1.Weil Cnntractor Information: •
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Chris Buffer ' _. ' ' Faust TO •• ' •OnSt.atunittS '
Well Colaractor Nam ft. . ft.
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4223A ' . , 1
NC Well Contractor Certifreatieti Niutircr . . • • AS:OUTER CASING(forturilksiscrfluills)OR LINER(Walt tleable), •
. FROM TO-" ' • DIA3IETER• TRIMNESS TATERLAI.
SAEDACCO • . 1 . 0 . ft. 13. ft.. 6.25" in. SCH.-40 - PVC
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- ' 16.•:INNER7CASING OR TUBING(Anathema:Id:wed-kap).
crtapany --'
FROM TO DULNIE THI
CKNESS 3I_ ATERIAL• 2,WeliConstruction Perotit#: - -- . . - - . .
. . . . 0 . .••R.• 27 • . R. 2" . ['hi; SCH-4 0 PVC
list an apigicalge woll pohnits(ix.County..Vtor:O;Ifoll'auro.fleatii sr f rier.).,
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3.•Well•Use(eheele well use); . ' • . . 17:SCREEN. ,
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Water Siipp1y Weitz • - -• - - • •
. - - EttoNt.. . TO . .DIAMETER st,crrsur. THICKNESS. I MATERIAL
, • 27-•f , .t. 37 'ft. 2" ' •in, :010 SCH-4 0 PVC
" . °Agricultural . . • . • ' CJMunidipaliPublic . .. . •
.ft. .
°Geothermal(Heatini'Cooling Supply) °Residential Water Supply(single) ' ft. irt.
-.ttt GROUT- .• ' _ -..,' •
. - Elludustrial1Conintercial - °Residential Water Supply(shared)
TO " MATERIAL . EMPLA CESIENT1IETROD IQ AMOUNT •
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". • Ofrtipation . . • 0 _ft. 13 ' '•114 Portland• . Pour
Min-Wake Su ppl,*Welk. • . • . .
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• • 0 ft, 20 ft. Portland Pour
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IllMonitoring. • . . prtecoyet). .. • • ; •
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Injection•Weit: • . . . ' ' . ft,' 0.• ' •
• - I' • . . .• ClAquifer Recharge" . • C3diouridivater RentediatiOn . •- t9.SAND1GILWEL-PACK(if annlieabtel— • - . .
. . . • • , FROM •'TO' •i st.vrtratat. - • EN unAccur.Nr mution ' _
0 Aquifer Storage,and Recavety- OSalittity Barrier , • , - 25 ft;.• 38 Ilk Sand #2 -
13Aquifer.Test . • .. : • . " -
. . 108101TM-titer Drlliklat:W' . . . .
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. - 171E'iperituctfial Technolo •-gy - °Subsidence Coutroi ' -• • .. .. • . ... . . .. • •• • , •• . .
•`10:11•RILLING LOG fittaehriddilloital streeli if-ems-caul ' • ' •
. ' OCemitemtal(Closed Loop) . ' ° . . . .Tracer, •
• . .taw'-. it) - DESCRIPTION Icobr.lardneti.sailEnitk tyre.ttsiu site.elc.1 .
OCivathetinal(11e'ating(Cooling Return) . DOther(explain under(i21 Rettiatks) . . .
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. . 4.Date Well(s)Completed: 1/.18/2024 ,welt 1Dribira-B088D , • . • ft, . ft.. . . • ' . . - !t .l..iv—A.,'L.i V )",,- '.i,,,::• -.
. , Sa.Wdl Ltreatinnt : . _
' ' _-.I.L See Gefw'a Notes.
' APR 2 '2 20?4 .
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ChemOurs . ' . ft. .. ft, . . .• . ..
: Facllit);t3ivarblimle ' . .Facaity ID.(ifappitable) . •. ' ' ft, ft lcifo;'-s1.1.,...7.:7FIT•-:,:'.14,2,,i2 Uotai -
2815.Green.Hill.Rd. NE , Leland, .NC , 28451 • .- - . . :ft. , - Ft,.'
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. .1316SICid'Adlic§s.City.aint•Zip '•,2.I...liEIRARKS • • , .. , . ' ' ' . .
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Brunswick' ,., , •Ben topi te pellets from.38-208' & 20-25'
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- Cetnoy • . . . Parcel Ideniificatien No,(110N) . .
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. . SIL-1-ittitirde.and Longitude in degree-stroloutesfsccOnds or decimal degrees: •.22,,ecilifitation, . . • , . . .- . •
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or o eii fietd,imiii braolig.i$•suilreiciur • .
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• . • N . W. ChrisRuffer . . 1/16/2024
• • . ' - • • Signal=of Certified Well Contractor• - • • Dale - ' •
6.1s(are)the well(s)r.XIPertnanent .or' Effenipor.ity , • By signelm ilrir fono;I kereby vergfy thai div irellis)Van 4w:oil cem-yatirczed,to arFontancr
irith FM NCAC 02C MOO or ISA NOIC.03C.0200 Weil Constnection Standards and that ci . . .
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7,Ls this a repair to an existing well ' EIVits or KIM, • • re.riy iif Mil record hos liecoproyitio41(.1,4i um giowr, •
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If thislv o repalr4111 nut Art1;1171wcil canantalan brfoomairtt and explado the nature of Mc . . .
repair duff&rit2.1 ienmrks.ti-aion M-an the bail:reiltixfoim.. 23.Site diagram or additional well details: ' . •
• You may use the back of this page th.provide additional well site details or Well
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8:Number of wells cortstrticted: 1 •• ' . • • construction details. Yoitinay also attach additional pages if necessary.
. For.MLItriplc fojecihni or non-water sup*wefts ONLY with the-sortie cousin-eon,you can '
• submit One form. • SUBMITTAL iNSTUCT1ONS. ' . . .
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- • 9.Total well depth below land surface: 208 • .. . _ . (ft) -24a.-For All Wells: Suhnut this:form within 30 daysof completion of well
Far multiple ivelklist all depths If dWrent(examptc-3@2(10'and 203(00) ' - • tonstruction to the folIortirG:
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10.Stalk water level below top of casing: ' • ' (ft.) Division of Witter Riotiire61,Information Frueessing Unit, •
if nuke iekel is above Ewing;age"+" • ' L617 ALTRService Center,Raleigh.NC 2769946E7 , , •
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IL Borehole diameter:1°r'/6" (in.) ' • 24h.For infeellon Welk ONLIii: in addition to sending-the fonn to the address in
. .246 above.also.subnit a copy of this form within 30 days of completion of mil
12.Well cOustitiction'
method Sonic coostmaion to the following: 1 : •-
lie.anger.rotary.Cable.direct visit.MO•
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LIIIIELliou of Water Resources;Underground Injection Control'Program,
FOR WATER SUPPLY WELLS ONLY: • 1636 Mail Service Center.Raleigh;NC 27699-1636
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. '4.4c.For Water Supply St Injectina'.WcIts:
14a.Yield(Mill) - Method of test:. : -
Also submit otie copy-'orthis fOnn'Within 30 days of eoutPletion of
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13h.Disinfection t3-pc: Amount: • ' - . well to the coimly health department of the cnainty.whetc
constructed.
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FunaGW-i Noph Carolina Ek.Tatiturnt of Euvirotuttent and Natural licsoturcs-Diion or Water Rmt ,ircm. •Revised Angust`2013
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