GW1-2021-07806_Well Construction - GW1_20211102

WELL CONSTRUCTION RECORD for tnwnad Use ONLY:
Tide thno can be and felt single a rmritiglc wa's
1.W`dl Cantractor hilbra ation:
Robert Hiller _Pe`; ✓' Fgty� � ogtptyt7.77
W'clt CuctlCactoritli4e ,�-.^�-�`a `� R. fl.
2675 i
NC Well Comm r 0utiftcarmnnn Nbe:r w\(�\� ', 1. }`` "�•�f°� '" .`�E-i�R -y.,....nw..:.y
of il&7ER iFFICKNm I MATMAL
(S�A,�LyD�A,CC�taO Inc , `�,., :\ 0 Obi tL TO ft. 221, IN.. SCH-40, PVC
�'."•Y.."Y`r.If��i' ___. __- _ `i•...e'\'_J.;^�`.i .- V. i 7RK- A^1iFLL1r
YR07lr To OWNIETER ImiCrttress 1frAlrnIAL
2.Wen C onstrialon E'emit#: R. ft.. �
kilt eTff eVj9fifoUr t dipenm is(Le.Comm Aw,11¢1r a#wr.T a&exj
3.Wttl irse Ofiml:veli asc):
WCi UP1Y11, 1 7 VIA1trs'rr M 8t 9 r ih7A 'trtIM11 b PAY F Nt4tr
Oftficultuml t�manieipald mlie 7 fk 12 ft2" irp .016 SCH-40 PVC
eothem at(Flea inn Cootiag Supply) DResidetuhtl Water Supply[sit>glt) tl, it. is
OG
13must_rlalfcV111ttadal OResidcntial Water Supply(sisa) A� ! h�:.5w . .
YR t0 1Ha17 1riAeRArE�i"I'll, oD�itwlaOlRar
flirts Ewa 0 k 4 FL Portland pour
Non'Water Supply Weil:
�lwlorrito'. QRf�xrt
I 'c on Welt:
�7Asltrifcr>er.har DOraum 1water Rernedualon
Oq Rt al tgAT;R, i KmLq.� -M 0r �0aa
�lAgnifer 5latage and Regis n' t Sal pity BaR ct 6 ft. 12 % Silica Sand 20/30
E3Alltt1fer Tcsd �l atumater 1Trnin.� e ft. (t.
J]�zprrritncnCal Tr3chnota,�• t]Std�sitt¢irce Cardmi
�tl„'DR11�i5G eftslr�i G "Ta6e�iii`
OCreothemml(Closes Loop) M i'cer FROM, TO PscKWrmx e
OGmdaettraal(head C o RGr m) 170tlter( aif►mtdef Ol Remastias) 0 fL 3 fk Tan Silt
ft.
4.Date Weft)Comphtted 9-22-21 W C4j M#'MW-263 3 ft. 12 Sandy Clay
Sit.WON Locatinn: (L
Tuscarora Landfill
FssildyANmrWum Facelift-]DO(iEagt,+lkaWet ft, rt:
7400 Old US Hwy 70 West, New Bern, NC, 28562 ii. fk.
Pl4tNsisuiAaf;tcess Cir.uidZip ZLBE_ w . ..77r -
Craven Two foot bentonite seal from V to 6'
(;oagtr parer)lAWluCec�tipo Na.it+IN"3
51.Lilt W&and Lvttgitaddr is Dtgrtx.*%1ovWvA-svds or decimal dam:
(if irdltfir rd,o0g, talno ep_)%suitleferri}
I< y{' 10/6/2021
Sigmtota of w ! �_ it.�+ Date
6.is(are)tbe.`.wt ftp rPetmattekti or oTemparary $p-4gntng MAY.Graf:f hewhr eertrrjr that rbe ow,1 a•7 am(mr)cMnrovezed lit m marfmve
idA 134 JYGAC 02C.t7ftX+nr 154 XC4C I'C-020 W'efd Comftwe v.fen Swwkrds oAd that a
7.Is tins a repair to an ledstint well: Mex or ENO tYW of IfUl mronf+ems berm pia•P41 to Ar wrff comer,
tf this it a I-Opak.fin out#minim UW1 t+a 1oftv{nr,arcforratrf va madrXelailf nhe marat-re of the
retamrWarr-02l rmssrL AWAM earn the Mu:t of this forhf. 23.Site diaVikm nr adffitional RWeD Details:
You tuay use the lately of pals page to pro}side addidotW 11vi1 site details of well
8.Number of w.�emmnwte& 1 construction debik Yon am-also Bch adffitionat ptages if twct aty.
For nwripre ft rtwm or roan-»curer f gply wr(&OUT WWI dr.mte currstxurAm'sma,aura
spbrmter�jarssa. £BIBMtTfAI iA1�7'IIf TidiT+dC
9.Totaal aril depth below 1 1 suxfa= 12 {n) 24a. ft All ftll Suhrrd(Ihts fork%vilhin to 40s of cmMkt olf of well
FOP tW0wedsUsres(1*p1hsitd(ff're (eMWJt1k-j@2W anff Z@ JWt counnactivnto the foltowin):
nil.Static water level below trip of casiw (11t.) ifl-Wd'u of Water Resptrmes,Inta ntation Processing halt,
If water kwf!t abofe ctlafn j ase"t 1617%"a Senim Center,Raleigh,NC 2 7699-16 1 7
11,Burch*di>lmcW-8.25" 010 24b.Ea biagn Wed1a ONLY- i Io addition to sending the form to the addrt:ss in
243abWe. also sUbulkit 8 royy of this form within 30 days of com ction of%sail
12.Well constmalon nai ho4h 4.25" HSA constniction to the toUowing:
(i.e.mWa.rose}',eabit direta pmIL etc.l
FOR WATER SUPPLY WELLS ONLY: Ai�lgion IB 6iater Mail ke C e me r.Rule und Injection 6 Gonn+ail Program,
iplr,ATC 3?K99-1636
13 tdd(gpm) Method of test: 24c.For water Supply&Inj a f
a.S Welts:
Also submit ors crop} of this for►il%thin 30 days of completion of
13b.DiAnfectian type- Amount'_.-. Well consmrciion to the county "It6 departumn of the county 3vkm
comstructea
Penn GW4 Nalm t:4r0mm tops tmlf of£m•imuueau sad Nalml rcmutecs-Di vISfno of Wdi r Ite>sounis Rc&d Ai%Ld V13