GW1--04990_Well Construction - GW1_20240828

N
WELL CONSTRUCTION RECORD '1 D For li crtiidt,eONl S'•
This forth can be used for single or multiple%tells 50 !",
1.Well Contractor Information: \
II WATER ZONES
John Eisenrnan 0110M to DPSI'RIFT MN
Well(•moraine Kane ft, II,
4439 R. 1 ft.
NC Well Contractor C'cnifaattnn Number 15,OUTER CASING(fat morn-rased hells)OR LINER(Y Walk)
FROM To PIAME ►N THICKNESS HAT►Ri t
SAEDACCO ft. ff. is.
('ouy,:uq\,;nr .Os!NMI CASING OR TEEING i •enes1 gibes ae)
.FROM----_t_..to DIAMETER THICKNESS MATERIAL
2.Well Construction Permit N: 0 ft• 10 ft. 2 W SCH-40 PVC
List all npphrable rent permits(ire.County St.rle.Variant,. kletliOIT rte.t - -----�-- - -
R. ft. ia.
3.Well 17se Icheck Event acre 17.SCREEN —r
Water SupplyWell: Weird TO DIAMETER MOTS17l t1IK1tNI1NS I NATURAL
OAgtwultuial OMunicipal.Pnblrc 10 ft. 20 ft. 2 k 010 SCH-40 j PVC
OGeothettmal IHeating,Cooling Supply) OResidcntial Water Supply(single) ft. R is.
f
OkiduslriaUCononereial OResidennal Water Supply(shared) IL Gam°
IrROM TO MAURUl. EMPLACEMENT?ammo a AMOUNT
Ohttgatian 0 ft. 5 ft. portland pour
Non-Water Supply Well: ft.
NMonitonne ❑Rreover. .
Injection Well: h. ft.
❑,Agituler Recharge OGroundwater Rcntcdiation 19.SANDI(:RAVELP M(WitslMpN.)
MOM it) MAtteut. EwlitAu_Nrr.Nt Mrr000
❑Aquifer Storage and Rccovcty ❑Salinutc Barrier 8 R. 20 ft. sand 2
El Aquifer Test 05tommater Drairla c
-
fl. ft,
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG(attach addiliunal streets if secs-ears I
❑Geolhemwl(Closed Loopt ❑Trar:er 'NOM to I DPSCRIrtiDN.Tafer.Mardar....ianwL opt."alas sae.rrr.%
OGeotlemral(Heating Cooling Return) OO(her tevplain under 021 Remarks) R• R•
ft. ft.
4.Date We$(a)Completed: 7-22-24 wen IDNmii-1 R. ft
Sa.Well Location: ft. r-- - -•. "
•
Coastal Dry Cleaners ft. ft. 2
Pxtlin,OttncrName Facilih IDS lifappliable) ft. R. AUG S 2024
511 Castle St., Wilmington, NC, 28401 R. R. __,.._„ ',-
lr,.,..,,.,:.:`�; r.::•.;;,✓to
Pin sisal Address.Cin.and Zip `21.RCMARIc3 C'i,i.;?<.v
New Hanover i bentonite from 5-8'
I aarat Terse]ld.,,ids_-,ISil No IPI\1
th.I:ttitudc and Longitude in.leirccclmirortcwsccnndc or decimal degrees: 22.Certification:
(ii acll field.one(:alms is maracurl
N µ' ''- 8/12/2024
Signalrreof r:: etc*.r..,5a"dt.— --- Ddc
6.b tare)the welds): %IPeri anent ur Temporary, 81 signing nkis JtorrR ln;%114 y,.. :;;P: cs:e.s t.it;ii zwurrvrrevl or rnrondmrc,r
With 154 NCAC 02C.•x --T..:..'4 is1C.0200 Wri Coratrertion Starrfool r.end that a
7.Is this a repair to an existing well: DYes or IS No rope of chit reran:terse beryl provided to the twit owner.
11014 it a repair.fill owe Muni rill,-,moors toot rnformuraor turd r%piton the moire of the
rrpuirader1?1 remarks intern or on the bark of this form. 23.Site diagram or additional well details:
You mat use the back of this page to provide additional well site details or well
S.Number of welt uilrmlrwled: 1 construction details. You ma)also attach addinottal pages if tecessan.
For nwhlpte a.dertion or err-corer supple well:ONLY with u,r same r.ur.Nrurram ,,.0 ro.o
Aebmir:.nr a-.,,, SIIEMITTAL INSTUCT)ONS
9.Total well depth Inluw land surface 20 (ft,) 24a. For All Wells: Subnni this lone aiihm MI days of contpktton of well
For m..lople wells tier el.leprht ifJta"errru(crumple-fV 2Ori and 2*lust S construction to the folowing
10.State water level below lap of cashp (ft.) Division of Water Resources,Information Processing Unit.
Uroar,lrrrl it of err.onag u,.•'+' 1617 Mail Sen•icc('cater,Raleigh,NC 27699-1617
I I.Borehole diameter:8.25" (in.) 24b.For(niceties WeW ONLY: In addition to sending the form to the address in
24a abut e. also submit a copy of this form within ?0 days of completion of well
12.Well constrwetion method: SSA colulruction to the following.
tic auger.recto.cable.direct push.eic.l
Division of Water Resources,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh,N( 27699.1636
13a.Yield(R(pnr) Method of Irk `lc.For Rap r Supph &Injection'Wells:
Also subunit one cop) of thus from tt ithn, Ell dat s of completion of
13b.Disinfection n pro Amount: conscount)ction to the co hcahh department of the county where
constructed
Form GW-I \onh Carolina Oepunnrru of Ere.rorurryu and Natural Resources-Dnrstout of N'atcr Rrso,rcrs Ret used Al owe Ns.I