GW1--06847_Well Construction - GW1_20241115

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WELL CONSTRUCTION• .RECORD . .
This form can be:iscd rot singlo ar tntdtiple wells. .
o Fatjtticrml1. ONLY;
I.Well Gintrat ctor 1nforntation: '
=I:1:ASVATERZONES:
Chris Ruffer FROM: To. . oFSCRUPTIoN
Woll oaiataitoiratne R- fit. • ' i i
4223 A •It. fG I
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NC-Well CoittmcyorCcdifitatioithwuli`ci ;•ti'OUTERCASING'.(forrmuh cuvedweTJs)'OR•LINER.(ifiji•atkabky -
FROM ' TO 'DrM%TETER, 'THICKN)SS MAiERTAT.
SAEDACCO •
fit H. .1n:
Voirttimly Mont' ;I6 INNER:CAsii�TG:OR 111311 i':iRiaitiermst eWsed4d4O1):Z.
, .FROM' TO • DIAMETER Ttl1CKRTiSS• MATERIAL
2..Well Construction Pertiut WI • 0 ft. 12 •ft. 2" 'hi: SCH-40 - PVC
msr afl cjy tin plc viceif prmiir$Yi:i,,GbyiltyAve:,lrnrigrsr;keerb'e4 c.Sc,.:)
fit.. ft.. 'in,
'a.;Well Use(eti-cclovcll peel.: :it SCREEN:
Water Supply4Velh•' • •FROM• I,TO :DIAMETER SLOT5i7*. Ttu(SNEJS I MATERIAL •
12 fit: 22 fit; 2" '!n. .010 SCH-40 I PVC
U/'rpttcultutai IJIylnnicipal/Pitbjie. .
CIGeatlietniat(lieatl Coon 5t l'). DResidentialWatei Su (sine) . fit` . fi. • m' .
� ►1a' n1P y t)P1S'. 1�
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QindustiiaUCbtuntereial, • , DResidential.\Patel Sippb•-(spaced). :aa; ; . _•,_' _ _ -,. _ :. .:..
FROST . TO MATERIAL CMPIAC£SIENTSIETHOD:CA000NT
• .Elk Ration. • . • 0 ft., .7 fit; Portland Pour
'Non-Water Supply Welt:;
60Mt)nitQring Clews ry R• .rt,
iujectiott,Welt:' .fL ;fit. i
0Agntfcr`Rc01arge OCimundtrticrRcntediation 'r9::SANDJGRAVELPACK.jifai li tbt'r c)� , .1 :., - : -
FROaf:- . .TO .Sfa'riterat, - tcMPLACI Ati\T METHOD
DAgtiifcrS6,004i d 7tcc'0:•e6' • C0Salinity Rarficr. - 10 ft.- ••22 ft.• Sand' #2 _
❑AifttiferTcst• 'Stormwi to Dtaiiiage. .R. fit:
Al:ayciimcntal7'cchnoto,g S Dobsidc coCoatwi .. '
-•.10 31i/C;iIV'ti>TAG`(dittacli.'additiotiatsliirfs'if=neccssaas}` • -
17Geallrential(Closed Loop) t7Tracer .FROST' ' .To. . 'DESCRIPTION ttobr,han7neti,se irtikktyyt grin are,iic.1
OGeotltennat(Hearine1Caoliug.Retuni) : ❑Oilier(explain uudettA2t Rensat sl ft.. f4 ' ,
(4. ft.
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• 4.Date Wcll(s)Gopipleied:.11-4-2024 Well i i#Dw-58 •
fit,• - fit. • i
. 1. ;` '
5a, .1.0icgtinn:. . .ft See Gem!s, Notes •
ChemoUrs .ft. rt; NOv
FacilitylOn'ocrVanrc. FacBdy IDk(ifappfxable)' -
ft.' fl' ,
• I G"
1248 Hill Hall Rd., Fayetteville, NC, 28306 h ft.,-'.. C ra "> ''i 7
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Plnsiail.rk4d ss Cuyy,and zip 2t REM1MARKS..,.
Cumberland Bentonite seal from 7-10' .
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Z:pltnly PERO At-ritifieailon No,(PIN} - . •
51i,•I i titude,aiiil I nilgitade iii degrees/mintitcatsecns ni;nil ileciitwtl`ctcgrecs: 22.Ccrttiticatutu:•
{lfniell field;ryas liiiiioi .is soffi iain .
1\ . _ Ch ri s•�Ru e.r'i' ' '11/6/2024
'Sigh;tore'ofCcitilicd'4liee',I ctar'' '• pale
6.Is.(:rre)the s1'Ctl(S�: xiPenn&ueDt orD empr1r8C}' IA.r.''$nrng this.form I herrb;certify that the ireigsl was.rrrrr.)cwm7nreteid in rrcxbrrlrmce
u'irlt'74 t JVCtC O2C 0100 or 151+1'CtC 02C,'720:)It ci$C o'tsrrrictrcir Sraiulrards mu(gull 0
7.Is this a repair to'an ezisti.i n ell: Cites- or K..No. cgipnf rlii.T rrconi iurt F«a pint ide4 rq'tlrr iitll int'iPr.
1f this.is'ortpvlr,fill oot.uanvrni1fcio7nictinrahrloaaartla tidi:tplahtihr.ruttureofittc I
repairrrmlr 821.irinarki sierra''or nrr!htfbrek aPehrs fornc •23:Site diagram or atlditionat Well details:.
You spay use 14 back of dub page to prof'-ide•additional'taell site details'.or tt'elt
S.Nuuibeetif welts constructed: 1 • coustmetioii details: You rttar:also.atlaclt additional pages if aaeci ssary.
Forinithlple.iti't th n or ana-»ricer supply'veil:ONL1 with the satrreconsrriwt1oii.:,kuuema '
icabniit am farm.. " 0 SII1314i 1TTAL iNSTUCTiONS
•0.Tend Well'depth bclnr.iand surfitce: 22 (too' 24aa• Nor All Wells: Siibntil_this font' Within 30 day'S:of:ctimpleiien of welt
Poriietiltlpiawellcli3irrUdi=prhsitcli eiviitlayt hpiN3@200'anti.2@W0')' constnictiontDthe:fQltptein5;: •
to.Static water level below top of casing,: • (et.) Dfi i5iun of Water Resources,Information PrneesSing Bait, .
if irurur lrgdl li ahoer rxrstran;rit "+" 1617Mail Sea'iee Critter,Raleigh;NC 27699-16 t7
El.Borehole:diameter.6" . '(in.) 24b,For IOIc„lion Welle.ONLY In addition to sending the fomt to the address in
24a aiboye..also submit a copy of this folio within,;0 days of couipletion'of well
t2,;Well ainslruction.tnethod: sonic - trolistmctiou to tine folloit'ingr '
(i.e.auger.reaary;,cabie::third posh.etc.) i
Disl lau-of Water Resources,Undergi'otittd Irejc n Control Ihberant,
1636 Mall Service Center,Ralei ih ;vClio
27699-1636
TOR'WATER:SGPFLI WGLIS()Miffl I i .
I,3;a,''ic1d(dim) Metthwd of test:
24e,For Water Stun*;Scinjcctibn Welts:
Also submit One.copy of thiS•foitnlwithin.30•daysafeotn(tletionof
tau.tlisinfi�ctiun 0.i?a... _ Amount: • wet'.donstnmciion to the County health deparint iit,or the County where• .
canstnictcd.
' Fenn GWir-1 North Carolina Ek.pdfilD8citi.ofV eymnincpand Nava!Itesources-Division of Woicr Etwtroe= ftp•ised A_tutst.10t:l