GW1--02513_Well Construction - GW1_20240422

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WELL CONSTRUCTION.KECORD For lnrcrttnLuscONLY:
Thn faro can be used cur 5inplc or niultililm stefls • ' - •
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1.We11 Contractor lnfornl.uititc " .. . ' .
IJ:.WATER`'LON ES`
John Eisenman -F.ROM.' • _ To. .
i•PFSCHIPI7!}ti
Well Coi raciurhanre' • rt, rt,
4439 rt. ' ft.
Well 1i;OUTER-CASiNGdrnr'pitulll-cased'n'etlslORLiNFR(ltnf Iicable)' 9
NC C11 CCnlrncioC CCiii@cnliiSnNntriier FROM.- •I.TO • - 'DIAMETER- TItICt{,\'ES5 -I. MATERIAL•
SAEDACCO 0 ' it; 25 ft, 6" I. In. NCH-40' 11 PVC
Camila I•No ii • • • IC INNER CASINC OR TOILING'( eotherrna t ckasedautip) - i
• •FROM ' •i TO . :DL►METER - Tt1ICK F..SS• •AIATERL4L
2,Well Construction Permitil; WM0401509 . . 0 Cl: •30 . - f1. 2" ( SCH-40
PVC • -
J.ut irfl ppriLrnGle v.1111 pm..reitr:(r r:Cmrnrv,Shoe,VailOirct'.Jrry'e Oro rJ,.J '
D. •- EL . in,
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3.Wr1I Use(dwelt well use): I7:S['RLLN
°I\`atCr.Suh111Iy Vlelll::• -.- - • FROA1 ' '•TO 1IAIRET1 R ' SLOT SIM I THICKNESS I -MATP.RIAI:
UA.iicultutnl 'C.N4unieipiliThtbBic so" ft:- 40 rt; 2" i • 010 SCH-40 PVC
OGeothetntal(Ilcating/Cooling Supply) ©Residential Water Supply(singie)• if-I.'
_ It, ;in. . I
Dhidustrial/Conllttercial IJR.esidcntial Water Supply(shamed).. _18,GROUT .. - . _;
FROAr TO. - MATERIAL' i EMPLACEMENT N1ETIIOD 4:AMOUNT
❑triipution • . • .. . • .. -. -- •. • 0. !4 24 ft. Portland !pump' .
Non-Water Supply Well: • .
rt: tt, , . I .
0Moniimring . . . . DRccosry •
' Injection Weil: - f. . .
ft. '
Cl.ettptircr]tcclitirge Dfsvund1stltsr Rcntcdi;itian .I9:SANDICRAVEL IACK Or aptireaDtir-: .
• TROIA • •'in . .'tA'rnitr-i, - • EAIPLACKAIE\TAIrT11nn.
• 17Agnif�r Storage and its ovclp D1Sitlinit}'Raider' .. . .
28 H. 40 , . •ft.' Sand #2
DAgRifcrTcst• CJStorim.utcr Driintle
❑Experinicnt ll TRUnolngs DSabsidcncc•Cottlrol
10;DRILL1NG LOG(uil i h nddi1iodal sheds if-necccsiin•1" '
❑G':otllenn tl(dosed Loop) .❑Tracer .FROM. -TO ' •DESCRIPTION rtnior,I cult-i+,wi11t+kk 9 ii .11 t;±ii e;(IC i Geothermal(•FTeatiuelCoolt0e Return). +piker(esplaitl ulider R2.1•Retuaiksl: i,
❑ ft, •
4,Dote Well(s)Culupleled 3-18724 . tell.11)#MW-147 .. n_��•.%►d.t'+r,^+_ at�r
ft: . It. • -
ft, ft. ``
Si,Welt Location: ft. p. A N fl 2 2 ZG24
Former.Tarheel Army Missile Plant MC7210020544. ft. 'ft. ; .
Fact7it}'a0ic6crNartc Facility lD�•(irappli ablcjI'" -.-"'
W-i4.
ft." fG 'i
•
. . .. L,`yArf`rt��
201 N. .Graham Hopedale Rd., Burlington, NC, 27.217 , it. ` D. . ' •
•
Phssimal Ad&vss.City.anti Zip 1,Ili REMARKS.
Alamance-. _ 139757. bentonite seal from 24-28i
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Cortuly • • • P41n. it}aliffcalipo No,(PIN} • •
•
•
5h.1.}tifiide and Longitude in degecafilinuteesecrinds rir decitnal d} ress: 22,Gcttifir:tHone
(ittielt id,olw.tal,longis sufroiu;itl)
36..0981837- . N . _ 79.4078186. V•' -- 4/8/2'04 '
- „,siZnaltlre or,� - z- - - •_ idle
6.Is(are)tin:Lll(S): xiPcrniattent or ❑Temporary 57`3"13W. e:s -.;+r S -
. Jfi srgnoid.Bits fo„a, F' . .of..r,.,.•� .�..,.rr :.:,t,:c..y:'orrrnrctelri'in rxran•Lrne>"
it inn i6A NCAC OZC: =-i.:.,,ct>A:.::;..i::n P(J 11't�u r onst ii4foifSr ui44onis and:lx.i<r
7.Lsthis,irepairtoanexistinl smell: in'cs. .or No copy eif ibis recnr.11OsIh`c11turii'irtt4InJha irellmere,-.
iJikis'if•a cer 1b,JJlf oaa,kin-inn wcfl cneisrnrciion lirtf,ro tgi0.1i eind cxptah'rile etatrace of Mr •
arl,ciro,ralirelf ieenrerkiisortOie or Lei/lie Lea re-th r heat.- 23.$ite llliitl;l'tumor ildditional well details;
Yon nay use the back of[his page to ploYide additional well site:details•or Well
8.Manlier of hells constructed:•1. . . . . cans!ritettuns details.'You Mg also"-lilt;iclt ltdditional'pages:if necessnty.'
For airathiplc infectloai or next-twine siipphi-welt,ONLY hick rho same,e estileetTtn VO rcrio
.crab,tit olio m% ' G JRM111'AL i1NSTIJCTIONS
9.Tot alWell_depth below I:ttid surface: 4,0 • • . ' . a) 2aa. Fur All Wells: •Snhnni this furin -Otbin 20.days.of aantptelion of well
For,ir triple ivells'li.ir dideprhs d1Jteriot(i,xiirnpf'-'0,309'tieiri VI,IO£J) ' construction lei the.fOilossiag;. i; _
10.Static Water level below top of casing: _ . • (ft.) Dh'isinn of Water.RcsouI es,Infurrnation I"rriceSiting Unil.
• iodine hrvel is rlJove crisfrag;rite"4-"(f 1617 Mail Sen ice Center,Raleigh,NC 2e6�19-1G17
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II.Borehole iam "eter:12 /6" - (in.) 2a6.F'or IORctlorn Wile ONLY:•IR
d addition to sending the form to the address is
24a above;also submit a copy of'this fotin ss ithiit 30.dues of completion of iuell
12.Well constrtictlot'method: HSA/AIR coti5tntelion to IIIC.frlllowitig_`• •
(Lc.avg:r.mini,onblc,dilcct push.c[c.} •
Division of Water Rcsou reel,Uftderground Injection Control Prae,raln,
FOR WATER SUPPLY WELLS ONLY: - - 1636 Mall Se1t'iee Cotter,Raleigh,NC 276994636
1341 Yield(gpni) -Method of test: -24c For Water Supply&injcctilin Wells:
.. Also subunit one copy-of this form isitbiit 30 days ofcatilpleliori:of
14b.1)isinfe&tinn ttipc: Amount• tretl cnnc•tntclion to:the citnnfy health dcpartllienl of the coiuif�'ssltcrc
• constnlctcd.
FennGW-.1 Noah CarolInal patu1tentorEtvirotuticinandNniiralRtcrources-IiivideoofWnicrHewlrom Revised.Atrgusk2oI3