GW1-2021-07815_Well Construction - GW1_20211102

WELL CONSTRUCTION RECORD 'For ltcntalekmONLY:
M ram Gail tie sued fo ftle at tmtltis&saps
1.Well Contnnar .lnformatlorr. f
3
Robert Miller MOM rWit N
2675
NC WetiCataractarCcrtifiCatttomNumber F"Ar T9 01MM . `r 0 MATMAL
\SAEDACCO ^; \.':�1� 0 R. 24 ft, 2" 1s. SCH 40 PVC
Inc �(�� t
Cetttp:att4•tvasx �,�t� � ,C.\ Q IN
IRCAt J 14 Dt41tt YM TnR—MRS& KATMAL
2.Wall r+rtnsttttetion t*erDalt 1 ,,,;� ; , s` Gb ft.
MIT 4111 mM-&UQ11`c RW1 POTMft W.C'mrntr,SAI,i nriniu-r,lgwd a Or a,
3.Witdl.lase{ebQd �'cll uscY
t`stet Snnpl We11t t=an�i_ t(3 � gr(►t snr fine. ?ttartafttat
OAgkttlttttal l7Mtnti ipalTPttblic 24 34 ft 2" 1% old SCH-40 PVC
IL
Meademl llieattngCboCtttg SttppttA Elltesidential Water Sitpptl}°isboel to
131tfuatfhtKoittomial OReside"Watel supply(sh l)
tattUbt i@ i L MFLACEbtMY1 MEMODA AMOM
�1rri tints 0 1't. 20 ft. Portland trimi
Nan-Water Sum WOO:
ZhtaaAtt►ein C1lCot
cti84 wew.
�1A+gsttfcf lia:slt�rgt l�Ct9tlntltrater Rttt�haittrtr � «� �`.� ` �» ..� . ':"" -n �
MAquifcr Sick ark Rmw Lawin ty=Barr cr eraMi u stA 44 M _M
22 ft. 34 M Silica Sand 20/30
13AquiferTest 0$tonavv terDminage
ft. fiL
❑EXt,crinscrol"Ttmin oso&V 13"ubs+dcrtec Cantmi .
;= .[1;. i r131>etl
❑Geaailteemtstl(Closed .saapt ❑7in= ratt�t � Matt IN fft1w.sA vHh"W. n 100t.,_
[7GeOd I t fCvail Retum) E30dcr inmWer#21Rotttasl€ 0 R. 3 ft,. Tan Silt
3 ft. 22 ft. Sandy Clay
4.Date Wtft)Completed: 9-16-21 WagU111trPZ-51D 22 ft 34 (L Tan :Sand
Sa.%11 Lnestiuu:
Tuscarora Landfill ft tt
Fac11ki0uwrNw= FkMit€WN Cif aWtieable! it.
7400 Old VS Hwy 70 West, New Bern, NC, 28562 R. n.
tnitrsical AMmss Cjty.and Lip
Craven Two foot bentonite seal from 201to 22'
�<iaas{t, lrarmo ldeja lr4a on No.(MI-1
Sn.1,01tu;+de and t. ngitttdc In depmethnimumhe aonds or dccimal dt rt+es: 22,Ctrs:
tltasril fiew orte Wong gumcteta)
't?W 10/6/2021
6.h(at�)the avetl(sy uParmanem or zTemporury &,se grh'ru fiat f+om.7!}errin•rvertt/A that thr rtrd!{a`)tsrtr a`tscir)cultWtnrc'aed in maVrdwv.°r
ivA 15A.YCAC MW AM etr MA XC.AC MY-02M WeV Camfracdmr RharAmis wtd A4at a
i'.Isthiaaarigk*tostntxistlntrvtlla O`!O or MNo 4aytcOfthigrrtratyihttsfirmjrtm4rfrd10,*,c4WI"It WT,
If*0 h a mpair,fsH ow Ammn wrM a m-rka br/orrx+Mkaa amd e,ptaAt tdae rtantre of the
reprdr tander021 mmar&.v sec&w or an tha b I of I t farsr. 23.She dtamram or additional rrrll dt taftr:
You may use the bae-of ibis wipe Lto pfo%i .addiiiauW%aril site details or well
8.iF us rof wells eutsatt a ed: 1 usWtinndeta Es. Yott saga ri attae(i ndditi+ p if ecsar :
for+waattrtpaYr aaeaY wt ram,-trtax r rttpplt tds ONLY trith tkr aaraMF cu»str�r�rka±r. cu crr� [#1�7'[T!C`i�idAl3
No wit ����_f
9.Total trell deph below land surrace 34 (fl;) Zia. For All,Well* Submit tidy to=-within 36 dzq�s of omimleboa of trees
For ma&tdphrawr h3rat41epo-T fd4frrrmklr TPe { "YK7'taM 1pff i CfF174Bt7iCtitJ1ltrDtls�f4tl€svtit ,
10.Starf:ie watcsr level below trap of colour (M) Division of Water Ro aurces,information VractsOng Unit,
if nat r leut l it rn a tr�.�ttd a"+" 1617 AW,Soviet C.tattr.Raltiph,XC 2T69aJ-16V
1 t,Bgt't taolaa di un r:8.25" tttr l 24b.FAX jMkX gA W cllg ONLYt In addition to at,Aug the forth to the aMrm in
24a abmv. alto 90mit a ' of ttd8 fatm w0in 30 d*%of completion of well
12 i�.WdI I1B&fiWl1o0 Mgtho&- 4.25" BSA �>t1ISl1y!>4�16(0 llS'ItillisYkitlg:
(ic.2apt.rotark,cabte direct push etc.)
Dhision of Water R rucs.;Underground Injection Central Program,
FOR WATER SUPPLY WELLS ONLY 1636 Mall Serviee'i Center,Ralekh,',NC 276"-1636
1 # 7a'tdd tgpnt? :Yletltttd ttt ttst 24c.for MAM Stt &1pj t Wvft
Also submit one cM of this farns %MWn 34t daps of completion of
13h.1lislnl`at.tntn tilt¢:._ Atmuutt• rt'411 construction to the county ltacsRh dcpanu=17 of tltc County uhoe
€oamuctvd.
Form GW-t Nattli Catalina 04pann"of Emmo mmat mW Nat w%J Rtmasr.acs Dtvtsfo of wster ttesh toz Rftisctl MOM:ttim