GW1--02747_Well Construction - GW1_20240506

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. . . • • WELL CONS TRUCtibN RECORD . •
Fsr Istcrnal I.TscONLY:,• . - - • •
• . Thh Rain ean bc.used fir sines cir multipin wells,,. . , • . . .
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• - . • 1.Welt.Contraitor htfortuatiott: . • • - -, , ,. .
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14.-,WATER ZONES-. ' ,_ •
. . . , Stefan Smith -- . .• . -. . ' . . , . - . NROM ' - " TO - ' , DESCRIPTION
'- • • Well toriraclar,Nars., . •- . • . • ft.• ft.. . l' i . .' " . - - - • .
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3576A -. • .• . „
.4t. (t..., . ' ,. . •,. • . . •
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' • - - NC Well ContraddrCenitleatithiNuthei .• . • • • •, • . • • • ' V.1S;ADUTER CASING•trormatttlearet1 wells1OR:IANER(trail'linahlel', - • • .-• ., ,
.- FrioAt To ,.• • orAmETF:a.• TriwKNEss• . ALATERML••
• (t, • (L. ' Op.. • • . • '• - . ,
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. . - SAEDACCO " • ' - . •
/6.INNER CASING OR TUBING(gnothermil closed-long)• '... • .
. . . •FROIVI . TO DIAMETER, • THICKNESS , MATERIAL .•
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• • • . 2:WC1ItonStrpction Pitin4 ft: . -:. - . . . . ' . ' "ft.. -. ft: '. Lio,.• - •
./...isr a applicatili u-rl.fpennOx(Li. thr.qty;..9.0i:Varienrce..IrSectieit.0.(7..)' •. .
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" • :(L• ft., 0-1!., - , . .
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. 3.WelI.Use(eIrcelortill im)' - • .
• • xi:SCREE:N. . • .
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-. -7 -.--- . .imoro- - , TO . .utArsturcit .SLOT Sin ThaCROMis I MAIRRLI.t.• • . . r `
Water Supply Wdit. . . . . .
. . . - .• • 0.' ft. 10 -ft 1". •- ..M. ,:.010- SCR-40 - PVC . • ,
El AgricnIthral . • .-, dhluniCipil/Publie' . - -.' •
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1peothermal(lleatiniCaoiing Supp131,: E1Residential Water Supplyfsin-g10 • 14- , _- .
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• -- •- .•-,. '. '18'GROUT
•'-- . -, '• EllintinstriMiComniereial .. -• -. '-- • . : 1:1114:sidential:Water:Supp1y(shated) ' ... . -. .
FROM '. ..TO :MATERIAL '• ' EMPLACEMENT METHOD&AMOUNT' •
•, I:Irrigation - , . . . •. • •
. .It. 'ft.• • ; ..
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•' Iion4Yater-Sunply Well:-.' ' • - . . - • • •
• • .• ft. . ft." . . . .
. . 01vionitoring . • ' . . . . ...bitccoymy. ,.. ' • '. . .. . .
Injection Well -• . . . - . . •. . . .
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. . • .. • 0Aquircr13"ccliEijirge • . . ' • odkotilidivarRenicdtaliini- • -• -,t7ZSAND/GRAVEL•PACKlitapplicabk):,%,
.• , •_. ...... .. - . 1.ROM •• • TO - ' -MATERIAL •• ' - EMI PLACT!AIEST METHOD ' •, • ,'
• • PAintifcrStorage.and Rceovety• - f3Salinity Partici - - - • • . ft;,
• ft.i ,
• - 13AquifcrTest . . . 1:Sion:muter fimitMger- • , . .
• •'ft. , ft - • ' - "- ' •
DExperittiental Tielinoioa • . iti$obsidcood Coidrol • •
• 0:DRILLINGLOG hillach•addltionit'slinetn,if Oorear ) . .
• ' OGeothernintOsserI Loop . '. ' : 17TMcer. . . . . FRONT•. 10 . - ' DESCRIPTIONhardne"suiProck typt.-grsiti rim W.) . ' - -
.- InGeotlimittal(FICatingierioling Return} :'[(Other(elpiaiii miller#21 Retnathi) 0 . ,ft.- 10. 'ft; Sand i,• ". . • i. . . ', . . .
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- - 4.Pate Wel1(s)Coutpleted: 4-17-24 . will m#T2,0 . - -. • • - ii. . . k. . ',‘. • .-• 1•J 1,•!•:.;. .......1.1:r 1/4'"'." ;;I• ', '- • • .•
Well 1 ,
' - Sa. ocation:" - , • • • . ,
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. ft.• . . .-. ' • ' ,' ••
. . .. ft MAY 0 '6. 2024. .• . • • '
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Buckeye • . . ' • ' 'ft. • :. rt: ."- .: :. • • . -: .. • . -, , , :.I. '
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. _.• FacilityiOivnerhEnue. • . • - .. . .Facility IDN.Cita:imitable) .•. •°. • • •
tr.. ' rt, , - ' i. ',:'Ittccr,-,1,1.F.n.Per.vrt,..-zol ui..-:-y, . . • :"
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' . • . 9914.Buffalo Rd.; -Selma, NC, 27576 . ' .' • r5ic),.....flt...h.li
-ft. • ft.,-
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. • •: ' Phkiiial?-190(egs,City..notfmg.. . REMARK • .
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• • . . , .Temp well. for grab sample.; . • . ' . .. .'.. -
Johnston. • . • - . . , . i •
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• Qui* . -. - . Nrnnt IdnMitlemisn No,(PIN} ' ' : ,,' . • • . '
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.. • • SIL•Latilnilearid Llingi-10e1Rdegnac.iftninutestEccon!ls Or decimal-degi'ecil ..22._ectlifientfon: ..
. • 1%;'.0110014.edmi.latqotits'totrIlikill). ' • . .. - • . . . A I J. . ,.. .
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. , . 35555181. . - "•-N' 48.297675 - • VEV - •• 1 '. • --• • . ,. A/22/2024 .
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. . . • •• • - ii no 7d4771Vw:47C.=act '-. . . . a ,. 41 e. IC 4 0 Or. ' ; ''' .Dale • •
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6.Is(are)the well(s) .13Permanent. or ETemporary . •(y stay.itch funrk•I irerrby cerly thilr,the will )tau.(.-irre.)cungnfmed 111 ayxorthyrice- •- • '. ,-
. . . . . . , . • . - ' iith f5A NCAC OW,0100 or ISA NCACO2C;0200 Weil Constonfrion Standards and that a.
7.Is this a rqsaii7fo an existing well: Ell'oi or "12 No • • .ireviiiterhir ovoid'has iitienprovideit ra Me kr;70 iiinper, - • - . . .
lf*Las a n4)0417/oar knaitt tvt..11caaaioctiarilafarraadoo and esplahr the wove ofde • • ' • . 't ,. • .
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muair tinykr 421 kelilftrkirriiiiin or'cm the.bdik of I'll&form. ,.. ' '. • . - •.,23.Site dingrom.or additional weal Reraits;
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-- ..• .1'6u-mny use the back of this page,tO..Ppovide additional WO site details or:Well
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•. • 8:Number of welts coittrticted: 1 . .. . . ••• - • construction deniits: You May also attachadditionat page'R if necessary. . " . -
For'nuddsde SR/coffin orno,i-iprer slip*weirds.0mx Wilt tire same canitruhlon,yea can _, _,_.. l' ' •
. - sulmiire,ne-form.' -: • SUBMITTAL ENSTITTION§. r 1. . . . • - . .
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• • • 9.-Total well:depth below land surface.: (ft) 240.-Fur All Wells:. Submit this form within-30.days.of'completion of welt • . ' ' 1 -
• . -For nadrkile"weits-lisr(ii depths'tic:peen;(murk-3,a,200 and.2@ 1014 .• , -. - .00115troctiOn to Olio following; i. ': • .
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10.Static alder level helow top of toning r•3 • ' • -'-09 . Division of Water Resouireeri,InformurionProcessing Unit,
iflmiet level is dinve corn xnse"+" r - - 1617 Mail Service tenter.Raleigh;NC 17.6%!11617 •• •. • - . •
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• 11.Boreholctlionieter:2'257 • '(iM) ' , . 21b.For tniection Well.ONLY In addition to sending the form to the address-in • . ,
246abOe.also.submit a copy'of thiS',font:within 30 days of.completion of Well -
• • . 12 Well cOostructiou method;DPT •, .. . matistnittiori Co the follolMilg: . LI - ' " . • •
• (Lc:augr.r rotany,.dahle,dime'rash.cte:E . .. • , ' 1 ;- - - •
'Division of Water Resources,Underground Injeclion•ContralProgrant, •. • .
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• • . FOR WATER SUPPLY WELLS ONLY:.
" • .1636 Anil Service Ceritei-.Raleigh;NC 27699-1435
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*-14e,•Fer Water SupplY&Injection Wells: . •
• 14.a.Vicki(gpm) , NIctliod'of test: • •
• • • .Also..subinit one copy-of•this-fannt within.36 0a). Of 66togletion.Of -. .
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.1311 Disinfection tiler Amount
well.construction to the,county health!clepOriment•9t ihc-.conoty.whim
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constructed.
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Form GW-I. . North Carolina D.-Innirnent of Fonimaracm and Nnotral Resources-DiviOns ot•Wotelt4Nntrom- .Re-vised August:P.013
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