GW1--02514_Well Construction - GW1_20240422

WELL GONsntu.c ION RECORD Far lr_cntn lUs .BNLi^. . . . . ..
This fona can bo ow/COisinglc ar tmdtipk Was' .
I.Wc11 Contractor Iufariinitiotc 4
•'1 I:.N'A'fER°ZONES
John Eiseninan . l•FROM.- - TO '" f.at ettUP;rlOS•. . .
. . ft, ft, . '
1!"ellCorGrlcturNarne _I
4439 . .
ft, . rt:
NC WclJ ConlrtciorCcrliftcatioo Nurrlter AS:OUTER CASING tfnr'siltl i-a seilNialst,OR LINER(if:ap flcabkl
ti it. : .. .
1HICKXESt•• �.hIATEP1AI 1 FROM:'
SAEDACCO' TO. DTADfI TF.R in.
t:ontir;Gtr h':mw' 1C INNER C ASING•OR TUSING'(t.eothennal closed-0unli►:' ' -
FRO11. TO • DLAMETEIt s '. TIiICiu\F.SS S4t7ERL4L . •
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2.Welt Construction Permit l: WM0401509 . - 0 ft. 6 ft. ' 2" ; A. SCH-40 .PVC
filooltomileibhr weir pmreiu.(Ec.•Cniinic.Sgr)e:.sari mess;Wald;Wald;etr))
.. it. 0. 1'
•
'3.Weli.ifsc{ehedtrr•gli use):
IT.SCREEN. - • .
t•afer Supph•.Wc11t • _. FROM. 1•TO DIAMETER'1 St.OTS17F, i TliICr(NESN I MATERIAL '
6 •ft: 16 'ft; 2" in.• .010 SC11-40 1'PVC
ElAgiicultilr11 .D tinicipal/I'atl?)ic
l�Geoclienital(F3eathigiCoolinl;Supply) OResideilrial WaterSupply(single) : It. ' ft in, , : • 1 _ .
. ❑IndustcialfCbnunercial ' DResidential Water Supply(shared) GROUT -. " _ .
FRO\f i-•TO MATERIAL 1 EMPLACEMENT 511:7110D S AI OUN'T
❑Irrigation • - 0 tl 3 ti Portland Pour,
- Noti-WaterStippiyWelt:' •
• . it. rt ' gg
ilMonitodng . . . . Oltecoyery . . . • . . . • - 1
IrijeeIlon Well: • • ft. H. • . . .
{
• lJAquifer Rccbtirge -1;lOroilridwiter Reimer;lotion 19.SAND/GRAVEL PACK(if apliiiLJbk) . '
• •F'ROM' ' .`Tyr • :.1L9'rEltrAr. .. • EN1Pt:ACEMERTSIETFIUTh. -• •
• f3Agiufer Stamp and Rcccivcry IJSalinity Ranier
5 ft.. 16 fl. Sand - i #2'
.G:IAgnifcrTest .DStornoNratcrlDrt nags • ft, ft, r .,
DEWCrintcnljilTechnology- DSiitisidcnuc C.oitirpl
.2t1kDRILL1NG LOG'(tittach ndililioatilsIcels if nrccscnrst ' . .
❑G othenital(ClosedLoop) - ID. Tracer • .FROM • TO" .tw cituPiiONroirar:ittntn:_ki.w' nick 13 DegkitItira+u:cic.1
❑Gootltennal(Hcatutg1Coo[In Return). ❑Outer(espkiiti under 112•t Retuaih). :ti. • ft; - - ^
ft:. R .l • I'
• ;.. t-:r.I-.i i s X �.
4.DateYeF1(i)Completcd 3-14-24 Weil mkt MN-16 'ft. '
ft. - • - - . LG2
Sit.Will Location: It. rt - .A F R 2 :2. 4
Former Tarhee1 Army Missile Plant NC7210020544 it. .'ft, c.,_,.,---..;.)q•^,;• F•qk e-
tifn,.;.
•FadfUyOivri:rNam Facilill•ID#(II appliamble) ft. • R. . . •• Me/5t"'
201 N. Graham Hopedale Rd., Burlington, NC, 27217 , . . it, ft.
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Phrsi:al Addt„sy,C4-,rind zip '21:RLRIARKS'
Alamance 139757.- Bentonite seal from 3-5ci, • •
.
Con*. . 1'aret]hk:utitL u.loir:No.t11INl . .
Sh.i.ititilde.antl Longitude.in dsi_Ireslminutes/sccnndspi decimal degrees: 22.Ccititirrtittna
(if r tt9 bald,one 14/Ioug iF Stcllih,:•.1 I) ;
36.0981851. .. N . 7.9.4078399. .. . �}' -r 4/8/2024
SIgrotur:. �f:\.— ,r, " '— � Date •• .
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•6.Is(:tre)the'ieLII(s): XIPerinanent or .rJTLllitiornr% it•irstdti rtisiiibifit i6.ti4"'rx.1 iv.,.1.: .'•ilavinVI&Iarm'eitrttmcti ..
ii,ttir 13A NCitC 02e;�1-'_•i —i,-70-x—a wmti:0209 thil eoutriL.ilotiStaridcTrrfstoi(9r/Kr a . •
7.Lvthinarepair tit art custingli'eat _ E75rr..i .or ®Necopyet, this:recOrTJ/its`krrr nrivr,G•r mill W11Owu•r
If ibisls,a repair,fill ruu>si?uoa rs'eldcnosi,uc:ian iiUoraiariwi oral c*plaiii iliaa rprc of the •
. rrpairrnieera21 renina%.rr tfua oriur the hark.of rids form.' 23.S'tte itingr'anr•or;rultlitio nor well details:
• Yon.[nay usL.•th a back of this pale to,pi-ozvdeadditibnrij well site;details•or•uell
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8.Ninitherofrti•ells,etlnsirrirted• 1. . . • • coustnlctiondetails.•You nisiy`alsotitttrchrdditiotiatpages'ifnecessary.
For ma41ple-lojrcrimi urriai-i,w(er sirrtplvtrells ONNLY.irdrh.the some coarsiraiitdotr.Situ earn
.cu¢mirriuc prin. . . SUBMITTAL INSTUCTIONS
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9:Total Well depth hetou I roil surfacer '16 . . (fl.) 24a. l:or All Wells: •Sabot l this form WILIILn 30 days of coniptetion'of)yell
For rirailriplLicei'd?liarOfItteoiii ifdi,Ci+rinrlrseraaptc-3 00`aiuf2@d00) . .Ctinstmctipn to:tIte'fc)Llotcin :,.
.10.Statie water loti'cl beluti'tap.of easing: .- (ft.) Ili*,'ision Of Water.Restiu ices;lnformation.Proiessiug pot,•
i,if :i level is dines eosin,;:rite;.+" I6l7 Mail Sevr1•icc Center.Raleigh.NC'27Gh9-1G17
8.25" t •.
11.Borehole diamcte= • • (in.) 2ab.For infection Vvclic ONLY: in addition to smiling the form to the address.in
2-la above. also subatil a copy of this feint as ithiit 30 days of completion of well
12:Well eaitstLTlctian method: USA Lroosinictipia to theaollau'itie.
(Le.meet ra!aai%cable.direct push etc-)
I?iv'isiolt of Water Rcsou rces,Utidergr•uuud Injeetlon Contr01 Program, •
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center,Raleigh,NC 27699-1636 '
13;1 Yield$iTnrj Method'of test: •24e.For Water Supply&injtretitin Wells: . . •
Also submit one copy of this•faunInithin 30 day's'ofcotilpletionof
131r.Uisitifeetinn ttipct-. mount: a ctl'cnnslnictian to the county health depnnni nt of the county where
.
. consintcted.
Foam GW-t - o orii Curollna 0.p uurcnt oC Environment t and Natural Resources—I(viiIon ofWaier Elmo utes 1te,,iscd August 2013