GW1--05749_Well Construction - GW1_20240926

WELL CONSTRUCTION RECORD For hiernel Use ONLY:
Thus form can he used for singk or nmltipk stclis
I.Well Contractor Information:
14wAIuwONlII
Brian Ewing PROM ,TO nem'RIP IKON
Wcll('nrrrtcpw Nana h. h.
4240-B h. h.
NC Well Contractor Ccnifaatmot Number 15.OUTER CASING(for null.awd ee1s1_OR LINER Y 'cable
roost 1 To rosstrrrl TNN7(NTSS MATTntsI SAEDACCO n I It u.
y
('omFo,, '..,sir In.INNER CASING ORTL'RINGj ierual dned�ep)
iNost � - to DU.MPTFR r TflN'MNFsS MIT RLtI
2.Well Construction Permit N: WI0501142 O. 1 ft. is
Liu all apphr-able aril penults fur.(?mnry.Slate.funam'r.fqa b q.s -- - ,
ft. ft. in.
3.Well Loc(cheek well user
1'.MALIN!
W'atrrSuppl,,Well: , PROM ,, TO DIAMETER SLOTS17P TNi(a:Nrot 1 MATERIAL
❑Agrwultutal DMunicipal'Public It. h. ra
❑Geothenital IHeating,'Coolilig Supply) ❑Residcntwl WakvSttpph tsing1,-, ft. h in..
ObdustriaLComntcrcial ❑Rcsiden al Water Supph Ishars.l 18 GROUT
PROM TO MATER1M. EMPLACEMENT METHOD a AMOUNT
❑Irrigation h• h.
Non-Water Supply Well: ft. re. -,
❑Motutonnl, ['Recovery ,
Injection Well: Ii. II.
LIAquifer Recharge LiCimunda.atcr Rcnscdl:uion 1'..s s'n 1,K ss I I. P s(I.l,r apphc.btel
,.1t4111 _ lit ,I‘II Ell,l CMM.t(TMrNT MVTNOn
cm❑Aquifer Storage and Rm%cn ❑Saunin Flamer li fi.
❑Aquifer Test ElSlomm;der Drainage •-
o n,
❑Espenmental 1"echnolott ❑Suhsidco c('maml
In.ilkil I I\i:TOG'Misch additional sheets Nrfeelotenl
❑GeudtcnualiC•losed Loup t Di racer YRO%1 1 Itl nsSCRWUO%(osier.bardur.r,tnWnwlu yr.train*,r.ea.I
❑Gccttlicnnal(Heating:tooling Return) ®Other Icsplant udder 021 Remarks; ft. ft.
ttr- --
8-28-24 B-1 - B-8 h. h. II . L:.., . .`.1,-V_..
4.Date Well(s1 Completed: Well 1DO R. rt. tl..i
5a.Well Location: r ft. h. SEP 2 b 2024
R. it.
Pinkston Property
Partin OtsrocrNantc Facility IDN(ifapplicabkl R jr14r1Cit:4'': ?Irr'r.swa-1 Uot
Utfr'C.a20
1915 Chapel Hill Rd., Durham, NC, 27707 R. h.
PIKsical Address.Cm and7lp 21.RCMARKS
Durham DPT injection through tooling
fawn) hand Idcmldxalon;N.. IPt\l
5h.Latitude and Longitude in degt'ecsimimrtcslsecnnds nr decimal degrees: 22.Cerrificanion:
dl well field.Ina I:along Is suficient)
W Brian Ewing 9/11/2024
Sigaawr,tit Ccnolo:J Well(outr.ntor Dust
6.blare)the wd11s1: Permanent or X 1(moo rsn It signing ihu Juno, I hereby crrnfr that the Huff Isl elm Borer)rmmr,rv<rrd In aa'urdanrr
with f SA NCAC 02C,0100 or 154 NCAC 02C.0200 Well Constrm'tioe Saandatdt and API a
7.b this a repair to an existing;well: _71 es or K No a-,ap,o(rhi,rernrd has hrrn pnwiilyd re,thr arN trance.
!f tins it a repair,bN out Moms Kra,eauNe Ilan lnlorerinan tact.44001 OW i rere of rit,
repair larder a2!remarks Art lien or um the heart of Ma form. 23.Site diagram or additional well details:
You Olin use die back of this pragx to pros de additional well site details or well
8.Number of wells constructed: 8 conceit u ion details. You may also attach additional pages if tfes:essan.
for mainp!.'InjrerbO to non-water iappl t wells OA'I.r wall the donee rottarforritro „,a,tin
.tadolf one forma. SUBMITTAL INSTUCTIONS
9.Total well depth bekar land surface 14.25 (n,) 21a. for A11 Wells: Submit this font within RI dais of completion of well
For mrahipk wells list all*mitt ifdfretu(etarnpre•30200'and 2*loth construction to the following-
In.Static water keel below top of casing: (ft.) Division of Water Resources,Information Processing t nil.
it With,h',A 11,lien r,t,v; ,,.. . 1617 Mail Service Crater,Raleigh,NC 27699-1617
I I.Borehole diameter:2.25" tin.) 22b.For(Notion Welly ONLY: In addition to sending the form to the address in
24a abos e. also submit a cops of this form within 30 days of completion of well
t2,Well conatttwetion method: DRIVEN cotutnirtion to the following.
tic.auger.moo.cable.direct r.,
Dhislon of Water Resources,Underground(ajectiom Control Praogram,
FOR WATER SUPPLY WELLS ONLY: 163E Mail Seri ice Center.Raleigh.NC 2'699-1636
2k•.for Water So pith st Injection Wells:
13a.% id lgpnrl Method of test___
Also submit one cops of this form aithm to dais of completion of
I311.Disinfection ts pea Amman: sell consmrcnon to the counn health deportmentof the counts where
constructed
Fonn OW-1 \ont('aroma Usyannani of Ens Imwuru and Natural Resources-Disown of Water Resotres RCN used Atgtm 201