GW1--02630_Well Construction - GW1_20240501

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WELL CONSTRUCTION:RECORD' For tricntiI Use ONLY: I
This.form cats nc. cd Rifainttle.or nniltipk►cclts':•• -
'1 VVddl Cgntr.ictor Informations
?Ii:.WATER LONEC
Brian Ewing FROM- ,10 -DESCRIP11ON
Wen Conaiitciort 10..: ft.. It. .I
4240-H t., ft:. -
NG\Vdl ContrttlarCceificalio'pNnnlicr I3.OUTERVASING i�muhi ciiscvl ndlsl oR LTNERVIiit bci;bla •- • -
FROM 1 TO ° DIAMETER ': 'THICKNESS 'MATERIAL--
SAEDACCO tt i 11. . •t t.
411-41:uroName• . • 1b:11+1NERCASINGOR-TOBIN4if voIbcrmatctimed.1 i, . •' '
LFROMt •TO OLAMt1ER THICKNESS •.MATERIAL
2:WitlCiirstruetion'Pertnitlit:.70003196.... 0 ft 20 ft.•' 1" li ':'tl1. SCH-40 • PVC •
list all a1>Pli.-ably i r li,p:-mars(r c:Cotnuc: 'tai.,;Yiiriarrre.IPJEc1 f/f c:r,.)
. fl. ft 'in:
. 3.•VVelliisc(chceblf'cll ucc); 1�:SGRLLN ;;
NraterSupph Went*, 'FI:O1 1 TO ,DIAMETER i SLOT SIZE . THICKNESS 11iATEAI RI
OOAgrrcultitnit 1]hlunicipaVPulilhc zo :II; 30 fl.; 1" Ito; 010 SCH-40• PVC
OGeothemial(He itiiiglCoolii)5 Supply) lIResidenttaf1�'oterSuppi)(single). fiz( fu i ,io
Ilindustn IUCommelllal,•• ORt sidalltWlll'aterSPl►pl}'(shared) FRO 1R0 - TO MATERLA[ EAiPLACESIG\T METItOD C AMOUNT
Non;Water-Supply Will:r •
6i1$1oiutnring: . bite innety•-
injection Well:. :f!.° ft:
DA9utfcrRechargc:. CtGronnd)ihtciitemcdiaiion "19SAND)GRtVEL-PAC.Ktd•nrtilkubto) • .
•• . FROM . ,,10 ' .MLATERI.AL- F:Atpt ACLAII:NT METIIOn
OAg111fi.FStontsC aPd RCC01'Cly, []Salinity ShiTicf • 18 fir 3 0 fl. FILTER SAND #' 2
DAqutfcr Test OStornn ittcrDniinagg fl; It. i`
Dl:\p drncntal echnotoo D4nlisidcltt.c Coiilrtil •
20:•DRII:LING°°LOG`(uttachadditioonlslicetiifnccccstirs5 -•''•'
fGeotltentwl(CinsedLoop)' ❑Traedt'' .FROM. .TO ' DESCI1IPTIOSrtolorharoncoi.witntrkhpt.,rrn.Sar.ttal
•
' DGi [Nitta l(FCeatiiiikeoli ii R'iaum)- ❑Other(explain under P2 t,Reinaiks)' o :ti:, 5 U. FILL'SILT AND SAND
' 5 :ft 10 ft. SILTY SAND
..L.r Dae:Well(s)Contiildeil:'_4-3-24 ' ;WCi1TDNW IlT -1 10 :(j,', 20 fL WET SILTY SAND
5a:'-,Wclllr.(icatiu[ 20 ft;:. 30 ft:. SANDY SILT/SAPROLITE/PWR
Gallimore, Gallimore & Eller, LLC :Yt;' If;
Facitil)6060./..finic'_ Faciltis ID?(ifayphablc); .fL; fl.
620 Atando Ave., Charlotte, NC -, 28206 --
fl• fl:• � � ti? t
•Pins[at Mdress'City tn1 Zip 21:'.RI M:1RKS ,i `s A., t 1P, . Ea-;'..
Mecklenburg 08507331 BENTONITE SEAL 16 TO 113' MAY s1 1 /Q/4
(tunih" Ptcct Itktiiatic:.ttw N(:(PI tl
56:latitude'andlongitudein•ileimccstminuteitsevonilfn'ralecimafili ree5 '. Irrfic'.+"r•�r•' r• -r .:,,s1 '''""
(if'ieltf0.1i1;nil Iitnot .ie ctelrck 1)• - .22.'Certifi .110 :. ,i. . p,:.Q«:,c
,v. ,lBr ,n Ewes 4/5/2024
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Sigtniurti oICcnibcd Well Ceti[for,: ;pate
6.:Is(11 .)fire N'eil(O 'OPeniieucnt tii 5rlTenlporrrs; tt,,);i1ntk tltts(vprr 1 hift0: tt ifif laut rlic;rci)j,)i:vs'{;rrn)tc ni nirrrerl tr tMCOIsfa ue
ilah'litNeACO2C 01(k)or1SANCtC(PC.0'0)IteftCon,lm'z'kui ozsdsriils unit Mil i,
7:s this d rcpatr to an c isti lgmill:'. Dl'es nor h8l Nic i rgvy.ofday record has Is.en pm"fe d to the n li rnrncc
IJtir(i Li a repair fall to;Loonet ugi11 trtaumrrttyq hrfar41ni(on and:r.cialair tini,inn:see of die 1'.
relics turder8?I r rnar)Lr tnlraa nr ran.thr Lai[r f alrn farm.. 23.Sit diagram or.addhtional ss ill lit uls .
-l'on mas nst.th4 back of this pag to pros�idL addi06,0i AMell site details:or sell
$:.?lumber of Asi,Ils COnstructed: 1 .. consu lLtroit dci.nls YOu'in is alao,ftltacil'adchtional pagRS if IlC .sari:
Purnadi)ph'Iiili a)oat:0r'jri-t..a eliuoplt`it I/s ONLY 9iirT gto wine;consrruMiora;.yell cc)r!' • :1 - '
inEinnciie form. -SU1tMfTTAI;:INStjJCTIONS'•
2.1otal ss elldepth•below I tnt1•surface:• 30 (ft;) 2•.i. For all Welk Subnat tins form within IO.:dss's of coinplction•of; i'ell
tirngiifripiiiiiiishifttill'r'epths;i;di,{t-rellaciilaipl'-.30200;iiiit2 /001 <opstnictiomtodiefotlowing,'.• I ,
10:Staticw atirlwel beluis top ofcasiut.' •• ' '(ff.) Dii ision of)Yater Resources;Information Pnitacsing tip it,
1/.rah i lit el Is rf oit caste„ nu."-"' 1617 Mail Sen ice center Raleigh;S(.•2 7699-1 6 17 '
11:Bortholediameter:2.25" (in.) 'Jb."-•Fnt infection 1ViAc ONE 1'v•In addition to send in,the form to the address.in
24aatios e also'submit':a"•cops:.off,tins form ithin•30 daj's:of completion of utll
I2:Well consinsetion method:'DRIVEN •Constutctioi►to the folk[s ing; , 1 '
o:.ang,.r rotnn cable di*I.'
ct Fush die j }
• 'DIY islonofW'stcr•Resoulecs,undergground°:injectionCoitrolPro ritn..
FOR 1VATER SUPPLY WELLS ONLY 1636 Mall Sirsice Cuuter Raleigh NC 2 t699-1636 - -
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13:t, fell(tryry►m) ;licfhod�f tCd:. 4c.Fnl Water Suplls•sk in,cttio h Sells .
rlkti'"subnu(on cop)';of this:forpi ssrthu :st)d�}s;ofconiplOitonof
I31i Plimfe isoa 15-pt. • Amount sicil:constntclion to:the coiutts hc•iltlt dcralnm-at:.or tlic•cowits nhete
constlncted.
Form4S1'1 NorthCta,alntaapantriuttofErnuotuitciiiytdNatunIResources. .Dliiitonofllral:Roi).trt.6 i41iscdi'I(rLits!'2013.