GW1-2021-07816_Well Construction - GW1_20211102

WELL CONSTRUCTION RECORD For tlftrtld Use ONLY:
Titis foRrta cati be nod Gar sN&or muitijilc.+wtils
1.Wdl Conttwetor Informatlon: 9
14-1
Robert Miller �"�fi 'ter' r}tOat. top tt'ttr3li
�r
U14 Cuwat w Namc?� �.,� ti� ft. rt.
2675
NC Well Coatmemr(°attiCnNttttficr {� ��y t.S: �f1Ti1, .+irtiSEili►ttts lit itrable .
o<'\, FROM TO ZYMMI.'rfsft T1rrCtiNM MATUML
-
SAEDACCO Inc 0 fL 5 (IL 2" SCE-40 PVC
1u.
ConvMyNhnte b"RJIVItE IA11 Y! 't t�f r�uaF.Clii lfd�
FROM M I Dt LNIF R. I MIENNNSS I MATERrAL r
2.W4 Conr<"Mion f'ormit It h
list WI-gw1imblevsaHerrmtts On.C=MV.SArM,Varlawo.Il*etnelf.)
3.Well Use{ebeel:well,ase}.
>i4'at¢r Snpiti 1YWl: FROM.- 74.. 1s1AMIF,11'FR „ &1ZF:.`f: T1ltC9 XM6 hIA !, '
Oftik t1rml 5 M 10 It 2- in. 010 SCE-40 PVC
0GMhe111plt tlie;ttingiCoolitg SWIV) MRes*Mial.EY;ttier Sttppty(sitlSle) & rL in,
�IltrdvsiriaUComttt€tt ial DReslldential Water Supply(sbaled)
HROM TOE TCRBAt v»Er-M ACEMEN'T AIMMM
E3 Irriantion 0 ft. 3 ft. Portland pour
Non-Water Stlppty Well:
� IDrtltttrltt RRec(ta'�. '
_
Inketwoen,:
Ci Aquifer Rccharggc 00toundvter
rNt TO 8lu' -1 ME. igt"fH41ti
0Aoiifcr Stomp;sod ftoveim., 0"'Ahnily$toiler 4 4. 10 It. Silica Sand 20/30
[3AtlttiferTe9 81ommrtter Otaiwi5c
tt, rL
0EWrimertotl'T=hwtogy E3S4sid C,artSmt
❑t;ootlemwl(Closed Loop), [Macey raa>rr TO D 1treTlDfi H2l9Y�At�1tCfi!tra tax k
OGtodten nai tHeatt CCtofte Mum) [30dw ant under#21 Remarks,) 0 fL 3 fL Tan Silt
3 !L 10 ft. Sandy Clay
4.Date,Will(s)Campleted. 9-16-21 WdIID#Pz-52S
tL fL
Stu Vt'etl Lnestil,n: N, It.
Tuscarora Landfill tt< ft.
ft9bp0n- uWa= FaciIih,TIM(dapplic-61 ) It. tti
7400 Old US Hwy 70 West New Bern, NC, 28562 f1. ft,.
Phc-ske1 AMwss..City.and Zip77=73._
�-77 _ S
Craven One foot bentonite seal from 31to 4'
COS* 110M 7 iftolifiotion Nt4.(PIPS)
5b.I.at Mde and 1:,ongkode in degrecOminateslomduds or deeiinal degrees: 2L C.'crtift ation:
tltVIPlf ftatd no larlpne Is sultYcktril ,. -g—9 .-,µ.�z.
1` W* 10/6/2021
6.is(atv)the erell(s)t oPcrin near or XTemporaty Bx s}ymtr dilx,fatm !iFeredn errtgrp that the arid(!)eaay dasrnr)at7n1lrtrc'ted art aeawthmre
u+hr�J S�}trflG rive.a7lfYa tar l=SA,lVGAE'}f3G,liYr�i;'r}J L<"vlr€trNCr}t�r1 Stir rJ[falt�fs r±�iF�'Mt e
7.lS ttti�a rett8fr la rite.tail ding rs sits Mrs or 11 Ntt a rrlrr of(Nir meant han darn pan-4ly4 to*r urthawwr.
/f this is s rep4dr.jlfl f-wr&#it%well mostrm-Mm lrrjo"wih rt and rtplabt the thirare of rhr.
rr.pairWder 01 remrin[s.tirrtdm to on the&V1 cif lhivf"ran 23 Site iliaur m or addidowl well details-
You may use the ist);of Phis page:to provide additional wvfl site del dls or well
S.Xumbcr of wells coas ntcted. 1 Cowatuetion details: Yott ms}akin ail=h adclidotrol pis if test eeaar .
For mW pile Atkakm tw racaa-mme kwPlY x:efls ONLY ndtdt rii�-srrttte orrnar»rrlfaar,,v:ra+a'atk
sr~Mr fora. St1BMFTTAL.It fi 1 Et f}iVC
9.Total well depth bell laud surface: 10 (.ft.) 24a. ftr All '11•'tl Suhmit this farm within 10 days of compkdon of%vil
For ittaft lo,,tedit titrol}urMAs ff derreO tcxtamlr?e-.0200'tyre(20109Y construction to Ilk}foAmirW.
10.Starve waiter k%-el belaw top of casing; tit.;► Ifis'isiou of Water Resources,Information Psatessing Unit,
tf o-wet)ray)is ahate ea.4k .ate"+" 1617 MA Scn ice beaicr,ft*- 0,MC 27699-1617
it.84rgbole diameter:S.25^ ) '24b.i M lniectioe Wei19 ONLi;: IQ MWifi0n to sentltng the fOM to rle:address in
24a above also submit,6 copy of this forte within 30 d4i of contpietion of all
12,Wdl oolLstnxtlon method, 4.25" HSA amisin rction to the following:
(Le.arapra raQtts°whit dins pttsla etc) Dh islnn of Water Itesotlrccs.underground rojeetion Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Ser+1ce tenter,Raleigh,NC 276r194636
130.♦idd ti'ltm) method of tat 24e.Vort'WpterSaptill'dQ tnjca:ttm Reib
AW:MbMit OM cop} 0f this 6110 "Rhin 10 ftfi of C011IlIidion of
13b.tUnfh ton t+V*: _ _ -_- _ Amount: - Yeti construction to the county hcaltb dcparttma of the courtly ere wh
M.. corsmcted.
Form GW-t 'h Camlins I:t.+puttttem of Envtmm w amt Natural Rmtms-Dfv e(Watzi Rtmsom 1'ft&d AugMA 2011