GW1-2021-07810_Well Construction - GW1_20211102

WELL CONSTRUCTION RECORD For trlicr MI Use ONLY:
7M f�r a cads ix owd rash*of natiph Woos
1.tVdl Contractor Informatlow..
Robert Miller MO t[r R�iRrpTiQ1
We Clar>#rocW Name �\j ft, n.
7C0�� ft. %
2675C- 'of + r iQC1
NC -otCcrtifmtionNtunbff ;r y,.J:�� f[iTBri; S# di®atTtt vl ettf ifRt RR IkafiUel,. ,.,. _-
�' ON 0at TG titAN6T6tt Tium-MS MA L
SAEDACCO Inc 0 4 ft 2" in. SCH-40 PVC
tctroporl tt 16 lti iNG" h[vtRtl4`t91 `
FROM 'to DL#Ateren TOTCKNM I AtA1LRLCL
2.Well Cvnctruction Pertmit t ft. h ht.
!Tear'gV11rUN.-."WrenrOx fi_o' UaOa arc 11t&dCa Or.0
3.we"Use(ebmh-Well usel
WatergapplyVM1. FROM TO MME MM T1ttt IMS5 arP104. .
MAgtictdtutnl Cih1aD Fftblic 4 6 ft, 2" iR .010 SCH-40 PVC
MV01hemert iifeatingfCoofing Sttp O Oltesi&nEiat WhW Supply(sinLge}
stel rt, 1t, tr,
i lndustria(�Cetllnlercial Olk Mial Water S►ipply-Mated}
irRQAf TO AtATERtfL t►tltr'te1 fMSfR &,t410tTRi
Dian Lion 0 it. 2 IL Portland Pour
Ikon-Water Supply Welk
tt. tt,
wMani#arin Qitccac ,
action n Well:
QAc u*rRcchargo Mrotlnilvnz let Remcftaion T#0 } : tid 1C r
raOn 10 r,r' eratt, F �r N n
QAtroter.SErs>n,¢c and,Raxovvi3' usalintvvSorrier 3 R 6 IL Silica Sand 20/30
QAgaifcrl'ca OStommmaterDrain.7g ft. ft,
MKiiincntal Tmintology QSa"c€cocc Coatttnt
�'lital11t1f" 'CID'IAGfaPiarih�ihfi0tyn°i'fsTit��N
nG:auEirt xl(Closed i,00p) DTra FROM TO DLSCtttPltDNtt�r,tmrrina��m�cs * �
OG o lmmal Retool OQtlrer( ain onder#21 Reulatl 0 t4 3 ft. Tan Silt
3 ft.. 6 ft. Sandy Clay
4.pate Wells!Cbtnpleted: 9-21-21 WeH mpPZ-53S R. R.
Sr4 Well Lntx0on
Tuscarora Landfill
F�ititF,rOu'ncrNa� FaccloR,•lIfn6ifegplic+ibleR k �
7400 Old US Hwy 70 West, New Bern, NC, 28562
Msizd Adftss.04t,ear!Zip Z1i•RL'M11 x
Craven One foot bentonite seal from 4'to x31
5b,14tiladc and Longitude in degrtcOmirmte0secondsordecimal dcgrm' 22 Cctifleatittn:
ofttett last,Mk.tpaow is sum ciao
fi R` 10/6/2021 rri
5it;rsatutz Qf�....:._xe�,rr�+ h-'�''4'•� I}s1r
6.h(arc)the wel[O),. OFermanent or Memporary
�•�igrrin�t rhis,tirrm.1 hs'rrl!u rertii±.•fdauJ the xrfd/sd awa f�srmd ctrrutnrrlyd+its trra'mutfimtre
rufrfr 154 NCAC 02C.0100 ar.d 1r1 n1'C,4G 03C td[ V►+sff Gtancfxkrit.,Srdrxirtrals aAtl err a
7.16-this a repair W an Wsting well: O'f°eS or M Nu a opyJ of ALT rrtwrd haw brat nrm*kd rn lhr><v!d msrrrr.
l/rfiis d�a rrr>Izr, if rxarinvura tf�tl tmtsanrttart ht(arr�arxtrarrd rx�tnfn rltr,Harare rr/rile
rrfmir wnlnr#27 rexnarEv.+uelinn ar rar the Ytr �nd"tJiir iris ar 23.Ske dicram 0r additional 41 eH detaf17f;
You tlW.use the back of this page to peanide lddifi.mal ut it site derails or weR
B.Numberofwettseonsi �ted: 1 tttittint►�+a;�. v�ll.rt�era�tta��l.adorn p retlrc n.
For w4drir&in*c4xi orroam irtwr ngoy r.-rils OjVLV>t'frh rileamnanatrstaarrfiinr,vt#a ens
Fubsiftmw form. CETRNIICTAIN±'i'1tC3MS
9.Tout well depth bokm land susi'ace:. 6 itt,) 24a. Fhr All HLid Subaaait this form within.30 daj`s of con4 tetion of Wen
FnF wit p n,Ws Els WI WOOu r if Mrww,teY< fay M2W MAI?0 for) constttactron to(hC..f Row ng:
M.Static water Intl below top of cai ft tft,l ft'ision Of Water Resou rases,Information Pn Kvising Unit,
1/mW(tevei Is abow cndf%.W."+" 1617 NAB Se ice Ccntcr,ltalci*NC'27649-1617
Bt�11. rehgle 4i*Ndcr%S.25" tin,} tab.For Iniectforc Wens ONLY., to addition to sending the fame to the address in
243 above. also salmi a copy of this force u-itb in 30 darts of completion 6f well
11.Well Qongir r illon method: 4.25" NSA construction to thefoilow*:
(i.e.mgm ru(M,cabtc diner pwketc:t 1fNislon of Water Reaourres,Underground Injection Controlfrogrinnr
FOR WATER SUPPLY WELLS ONLY. 1636 Mail St7'rlt'e Center,Rolrioh.NC.276"-1636
13a.Yield(gptn) Method of tat 23c.For Water.St g&.&lniartion Wells:
Also submit one COM of this fauna within 30 days of completion of
136.Disinfection qpe. Amount: wcil construction to the coamay Health dgmn-mrast of tk cwnrty u-heac
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