GW1--02517_Well Construction - GW1_20240422

WELL CONS`I RUCTION.R CORD`- .. . . - ; ,
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Fvs lMcantil1.1,ONl l':.
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This farm con be asetl for stnglo tir inultiptc niclls . •
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1.Well Contri torinlornlation:
1-1:WATER!ZON kS • -
John Eisenman • ['Rost.' . . 7p . nF.ti(REP77t?Y
. - NMI Coivtrad onN,an,c ' ft,
It. It. .
4439 . . . - . , . . .
NCRc13ContriclorCcrlf'1'oiNiurttcr i:S.OUTER.CAStWI.formutt}=easi tiVe1151'OIR'L1NER(it:iiiiotlisible)�
. FROM:• •II.TO- DL4,tilETER . :THICKNESS• -.MATERIAL• '
SAEDACCO
0 It. 35 PI, : '6" i.e : SCHr40' PVC
�cn,griiiv 1 crir . • - • ' 16;INNER t"ASING.ORT iING"eemhennal closed-oar ••^ -
FRo;11.' . To• :DLAN/ET t • ^THICKNESS IATERLAL
Writ Constivction Pu'not#`: •WM0401509 - - - • . . . • 0 ft 40 ft: : .2" _ "ut. SCH-40. ` PVC '
1isr47l7(7pp11,10r,V IiJrnmits:{rr Coiinh Srtle yorfeircc;IPJacOcxtetc,). ..
3.W+:11I,a{shpil.MdiONO..: t7:SCI11EN_
Water Suppl .Well:, FRom. _To• • : .PIXUETER• Sior817.* Tit1C1tM s t IVIATERIAI:
. CIAg.ilcultttral, .. Ci�rlituieipalf ..- ' . 4o it:•'•so tt. '2 1� .oio' • SCH-40. I.PI/C
ft.. • ft in i
i�Geoclietptal(Ileating/Coolinn^'Supply) ®I?esideoctal Rrater Supply(single) : .. . - 0 - • . ..-- . • . .: .. . .. .I . . .
Illndustria 1Conrntcreial . • 11R.+sijsnttal Water Sup.piy(slated).•_ 'i LEQ Ro[rl -i---Y • •
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T0.' •MATERIhI i•EMPL.ACEMENTINIEfllOD&AA
- . D1rrtp.ttinn .. • • • •- . • . - .. . . 0 at 34 ft. Portland , 1P�P. • ,,
NotiW.itcrgSupply:Mtft . . • . .
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f q.• i
MMondonn • L711ccmet}' . . - • .. • • -
1tjectlipti,WelL• :.it. rl -
• latquiforRCchar• go - fX oundwticrR.enledintlwn . .19.SANod(ltA F.LIA(K(ilaIilaltubti.):- .
- atViiititcf S(051.2 aiK11 ovet}' • :I:Mali:01 fiiricr
FR017' .TO 'to ft-Rrst• E.Stri"AC'F1tE'\T N}Tut-oh,
38 •. !1.- •50 fi Sand #2
•• cMquifcrtest . . •.G15dortmti'aterDrdtetage
• • is
17.E*.:tinnental.TLx,1u1Qla ! :i SitliSiitenCC Cnnlrol , • •
• 20 :IRILUNG'iAG ittaelCmitlitionti Rheilfifitecovan:1 : •.
DGcotltenual(CJUsed Loop) •:l7Ttaeer • .FRO 1.' ..TU' ' -DES C.RIPTIo"ro$r;h.rrlatw;544n,'rtiiihlbm>r +rr;ale;dc t .
DGOo[lienstal(HeatinglCoollue Reiutnl. • •ClOtiter:(e tilaitt ranter kit•Retu;tib). : . .fi. ;•ft, ; ..1 • .- .
4.Date Well(s)Completed:-3-3-. 7 2'1 ' WC1.ID#MW-142 .
tt. rt
So.Wt_WII Location:,. • •• :It ft,. •. .- ,, ; 4
:Former.Tarheel Army Missile Plant NC7210020544• 7r;�'
Facilti)•a3Ctyt,i rNattrc - •Fnci1B1.1Dm(Capplr:able). ft, ft. >n R I-2 2[Jt
p 4 it. rt, ti. 1r ., t':+:.,v!rw U.
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204.N. ,Graham-Ho":dale. Rd., •Burlin ton, NC; 27217 f, t--ram - n .,
•I1It-st,:a1 Add[pss City.and Zip RL kfi I►1,tR - • 5',r i1 ac _ ..-
Iti
Alamance' . .. . • 139757 :. - ;
• bentonite seal from 34 3,8'
C(,unte 1'.*IR471ti rgirct iir)o NQ,Ii°lt'll - :
fib.L.ttiftrdc'aiiil 1,nngttude in ilegtr cslntinutcslsecotids r r'dccimal;dejrcci: 2
(If r L119III4 OngJ;i9�lqu i s,rltlr*rri}' Z.(clTifiratione ,
. 36,.0983908 i. 79'..4094595 W. 4/8/2024•
.. - ' tut^ f •f _.v'i:c a- --- 1)41 I.
. Gas(are)the tti•cll(s)r ]2iPLrinattcnt or Ellietiiporat%' .. - • r nri, ua,i ii:*.e.r.,it" ' 'A'u . n•:-' 1. tui3:meted j,r•trea tirraci
s . a . f 1,r::a .
Writ f5ANCACO2'C=; :,t3,..,t iati''-,54:0200 reitCai;seradaiorSrcui4urrtst;rirfttitit '
7.ISt11444npitirtoanctI titg•i'cll; .D`L', .or :HINO . . ',rrjiyn,fi1iisr4'Cakil4 0ln0ptktiifrrtilunar.lI'lcstur,i•.
1,fi is fs•a repadr,lit skit Otint well construction iiVorrnnrdpn cold ealInd!t die roarure,of riio •
riliirlrriiirlerri2'.l rernzi-L .nrai/n ors.i foie brio ifdin foriar '23 Stte diagram am of atl[lltionitt 44N11 ddLt{11I4:•- ., ,
You nia4'use the p410e,baeli of thib to ptoYidp.additiouai well site detaiis,or tsell
. 8.NuiilbLr of wells.coitstriicted 1. .. • - ,COOSfliteti011 details. You ttt. ulso'atlaclradditliooal pates if n:cesSat3+,
For laiidtdplc 1pjeerlon to nori-loafeesitpph it. tfi ONLYmlrh rfie straw ioarstrucfion,cr-ar cxrn
ie fnnir eili P&P.i, SU13hTITTA 1s 11,1%1FT IJCTIONS
9;Total Isoll:dcpth hctni-iatid surface: 56 ' • (f ) 2d1a. I tit ill `14'e)Ist Sabnnt this form within'30.da3ts of cotupteci4ti:oe:vrell
-For liraidadpfe irellaiir a(Ideptds iiitie.r:'nr{rsrrnPfe.-'3@201)'cunt 2413IO0y ' con5trllotio4 tic dic fottoisinS,: I -
his static.-watLr level belays'top of easinat• . .•. . .. : ' . . (ft,) Dii-ihian of Watcr.Respurtr:r;Information Phnczsinit doll;
/ ti%LW?tii r 1i rrhovr tvisitag,aice."+" I617 h1ail.5trsicc Ccntcr,Raleigh,i�1C'2761J-1617 - -
11.Buithok.diantctc1112 7/6" - : (itt.) -2lb.Forsitfeelitiii vlrt lit ONLY: In addiliott to sending the fomi to tltt addn ss:in-
24a aboi'c also subillit a copy of this(Olin 1,vitliut 30.days of campletioti of-irdll
2.Welt o 1 ustrtietiou method:.HSA/AIR . . conhlmcliult try the•follav lag' • •
{Lc.Ougcr.rat ir}",Ohl&direct• • -'ctc:) �' 'Dlvisioti of 14`ater Resources,Undcrgrouud ht is ion Contra}Program, :
FOR WATER SUPPLY 14'I1L1.,8 ONLY • 1Ci36 hiitil Sesl ice Center,Rale411t,NC 27699-I636
'r ion iW'ills:•
13a. 'lcltt.ttgpnt)• • Method:nftest: • - • • • 23c Fm Water.. . lrl 8c......t •
• • . Also submit one,copy'of this•Soren I tlun 0'days of completion:of
13b.I)isinfcetmo t3Pet ... ... _ Amounts sccll.constnpction to••the cintnty Itculilt'dcprtltuient of the county is
constructed,
Penn Gfid.-1 . Noilh Caiulina l7t:p riine:nc of EtiviraruI 1a and Ni imiiRea-gyres-Duvnlon ofWaIi tit crow E4o Ised:Atrzust 2t+til3 -•