GW1-2021-07813_Well Construction - GW1_20211102

WELL CONSTRUMON RECORD Firlrucr•r Use ONLY:
M form co be ewd tar sigh or mdt1}tic week
1.Welt Centracttar Information:
err77777=7=77=
Robert Miller ? met YCI_ rats tFtti
tYdi Ca!l4ntEtm N"aitte '`�`;,,,t ''u •.',,
2675
NCWell t osaim[tnt Certification Number \ I `l�� ::Y1t . '`.� � �1fl i 4r�
FROM, To I DJAMKM. 'ttt(MNM n ATAWRIAL
`J
3AEDACCO Inc 0 rL 23 rt, 2" hL SCE-40 PVC
` �C°'Uv � -
t]un4rutciYAea r �is"� P�.`�3 .. . T ltt�itt ._ �16if _
+•� , FROM ire M&MVIER I 7It(C7GNM ".43"EAL
2.Wdl Construction permit to: tr. A.
List arl nryrfiruble xrfl fWM#'r fir.Colwty star,Madalwe,flf eewe rr fvr.l
3.W41 tier:(sheckwelt use):
Water Supply VM.- tapM 7U AtAMF•A'FR via YMV.r IrMC iK SS XATt?ML_
DAeA cultural oNf naicipat7olic 23 fr. 33 rL 2" 1� .010 SCH-40 PVC
ciGco t(HeatingACooling Supply t3Rtsidemial Water Supph•(single) IL re. in
DhldusuriallCommmial OftsideniM Water Stlppb-{St d)
stcot<r MX 4; LjiC-MMr.mrjvon&A aL'44'Tj
C] tiuu 0 t. 19 ft. Portland trimi
Non-Water Supply Wen: � �-
QGtrl9iaitp.' Qketrc►�t •
tt on Well: fL n.
DAcluft itccharge DGraiutxlirater RcuiediaatitaaaMM
s ;1
p,4qori1cf Stoiae and ltifets' ( aliniiy farrier eta Rat Mom,+ txt+can -
21 rt- 33 ft Silica Sand 20/30
❑Aquifer Tzo DStoanmstcr DrnuiagD
ft. M.
C71.:gperiinciat:il7'cchruato•� OStatisidenccCt»ttraai ���R pG: gttraddlfi
DGnodte mialMaud.Loop) Hite t FROM[ TO o&StR[Rlri3Rff, :t®rdncrr�uAaneR .
DGeodiennal etlti �lCtruh. Reluna DGdwrf sinutida#21 Remade} 0 f1. 3 A. Tan Silt
3 ft. 20 rL Sandy Clay
4.Date Well(s)Completed. 9-21-21 Wetl ID#PZ-50D 20 ft. 33 fr. Tan Sand
U Will Location: H. fL
Tuscarora Landfill
Fmilfty�Gw acrNan Faclin IIIk t r tptic le)
7400 Old US Hwy 70 West, New Bern, NC, 29562 fL
Physkol Addles,Gil.and Zip Z1r1zi
Craven Two foot bentonite seal from 19'to 21,
�fraiitr' }�httEf J4l:iatiCeir,9litrra CIA:lt�i
Sb.I abludc and t ongitodc in dcg=f/riiirtt;tes.''escoads or declmal degrees, 2L Ceri fimition:
(if isett 1kid,roue f tidbot-Is lrifrnticid)
>4 K 10/6/2021
6.is(irl)the weff(s): EPermanent or Memporaty By eFgnmA!alrir;fumr,f.hemf+r rerrjb}(bar Ike aawllf vl wm f►nrret ex+nrrmaerl an#ftVndvaer
uv'rla i_id NCAC 402C A100 or t,r•,t NCAC aX,02M'1*1j("orr3rrrul*w S dwf:,rr[ls frill Owl rI
7.Is this ar repair to an odsting well: f7Yes or ENo en r offkir wow+hen twern prmhlsvd ra Ar urll miner.
//ft 4. the leaf ra of der
mpair uWfrr dt'f mmarks.serti m or qn Lye br l of Mrs form: 23.Site dicer m or eddifional well delaits:
YOU mat'use die,tuck of WE page to provide additional uA site details or well
8.Number of avtb constructed: 1 eonsicuction detuits: Ybn as'a�aisu attach addidtmnl p 'if tir�sarj.
Ff,ramaftftde brpJre�nrar amr-arsrrer sa�pfic rr'rt8s Gt,YL.Y ar+ttb t1iE+srtme'smtrrHat<,vt.tr a'eare
saE:rxitmurr frma,. ���'��A�icT Ii.�;'�N�c
9.Total well.depth bed land suarfaee;. 33 A) 34a.. For All Well Shoaled[this fa na►ithin 30 dz-s of camptetiou of well
For,arrahipfe,well;Wrididip*sofdWrrentfe°ror;p -@2t'afi'a&41QAVI CaWAMdonteaftf2itowicu-;
10.Staft aster level below trip of Casing: Divisiion of Water Resources,Information Pteatesging 11nk,
tf water Mvelir alcove edd ag ape"+" 1617 Illgrft Semite Center.R.*W NC 276994611
11.Horeholc diamckin.8.25" (in') 24b.Egr 10MgM V gh ONLY, in addition to sending Foie farm to the address in
24a above. also stilataxit a copy of this fonn n'ifti 30 days of completion of well
12.t�'cll ax►r�t�mait,rr nnettlnd: 4.25" HSA e'onstnietion to the foilownto:
(i.e.anpr.noitsy,cable.digest push.ctc,)
Dft'rvlan of Water Rewurc&.Un&rgmund Injection Cmrtr6l Program.
FOR WATER SVIMLY fi VULA ONLY- 1636 Mail Service 6nitr,R,Heig j.WC 27699-1636
13»,Vidd(Rpm) Method of test: ter.For Waiter'Su A in'cccfi'6m fit' :
Also submit one W' of this li i m w shut 30 daps of completion of
13h.Di3infi cdon q . ____ Amount- hell cansrructian to the crnmly health dcpattwmat Of the ca uurp whem
Fmim fs'llir-t 4wit t:.ar:rim:s DepaffFOL+.11i.of Ernuvruocnt wd Matta)11:ew arces—Div"n of Warts ReMuvEss Revised At g=1tl1 i