GW1-2022-03225_Well Construction - GW1_20220311

WELL CONSTRUCTION RECORD For tranial Use ONLY:
This form can be used for single or mdltipk ncns
1.Well Contractor Information:
la« 'ATE1r:7A14>FS
Robert Miller VROM TO WR$RrMTp\
Well Coniradar Nam
2675
err rt.
r ]S OUIER;:CASlNG orrnutti a4cilnel)s1OR-UPNER Na``ticabk ;
NC 1�cl9 Cammctar Cenifxation Nua�bcr
!!�
TO DIAMFTER THICi:NEss ftMATLRIAL
SAEDACCO Inc 43' fL 6" ! io. Sch40 c
(:oav;tnl•Name 76:114NL1t:CAS1NG'QR:TI QVG ' tint itekisidahri`
FROM TO 1DULN ETER TnTCGNES4 MATERIAL
a.Wdl ConstructionPcrmit 0: A. rt w
list all apt UMblc uxff penrotr li a.Crnmry..S}IPA',Ydrlarwe.frocdcri eve I ft. f4
3:Well Use(ch"Icwell ascy
Water Snippy'Welk FROST To .31FUB sxc►x era: TNtttiN.F SI h)Arrslar.
OAgriccultural ClMnnicipaUFttbliC 43' rt. 63' ft 6" in. 0 .02 Sch40 Stainless
OC.kotkimal INealing ool Supply) ft. rL©Residential Rater Supply(single
®bldusMalfCounmerciai ❑1tesidential Water Supply tsl.mmd) FROM [F1 __ `: _ •
FROM TO MATERIAL EPtPutTMevtc 11fEr11OD a Atrtotnvr
13 Irripition 0 ft. 37' ft. Portland trimi
Non-Water SupplyWell:
olvionitoripg 1011.cco►ety R ft
___.
Injeetiae Well: rL (L
QA qyilcFRcc.h0Fp CBGmnndW;ttcr RcTTIediafion 5."SAND VACS '`t°,t9tric
_ .
❑ rufer.5to vaOrt- -__ nraxektat, _ _ _ ..RMrHA, t�xl►ttxFlOtr
Atl roc and)Z�[r{'eT}' QSalinitg E3atsiCr 40' fu 66' G. Silica Sand 20/40
❑Aquifrrlest ❑StorrmVctManagr f ft.
DExperimcatal Technology ❑Srdasidcncc Control
"3[t;=1kR1C4aL1Cr1(iOGCi+il�cb iifrfi(iana'leherialfiRcce3snry
OGeofhetmal(closed Lode) ❑Tracer :FROM To DE-SCRIPTTOS color.harduc. .rlirmcR n etrt.e4r.
❑Geolheunat(Heath fCool• Return) ❑Outer(etc ainunder#21 Retnatls) ft. A.
fL ft.
k Date Wel1(s)Complefed. 2/5/22 Well III#EW-60
ft. (t.
Sa.Well I.ocatirni fL ft.
ft. rl.
Factlily0wricrName Facility IDk 61'appliaablr) Ft. fr. MAR 1
1248 Bill Hall Rd, White Oak, NC, 28399 rt. ti
Pktical Addmss.City.and Zip .21 1t1 T1iA1t1."$
Cumberland Three feet bentonite Seal f=om 37'to 40' Five
Goinl' N mel ldanlIN.111on No,(PIN) foo
5b.IAtitude and Longitude in dcgr ecshninuteslseeonds or decimal ftev s: 2L ColiSration:
(If»fill field,one lalong,is�rdGciCtrl)
2/17/2022
Date
6.is(arc)the vrell(s): RIPernianettf ar ❑Temporary ln•ergnfn�thus form,1 herder•earo-Mar the wrIA(Yi hwy(mr r)LY%Ylnreled rlr aYY'Orrknre
W?h M NCAC f12C.t 10n or 15A NCAC MC A=Well Calsomedmi Sraridards and fimaa
7.Is this a repair to an existing nell: OVes or R Ni) <'raplr dirhx�gft+rll bRFlJCN�ph�Pldr t m rhr.irll nw,rer,
if f6is is a repair,fill our A.aiwr well tvairlwdev irrformmr)cvr awl expldln rite rmrrsre of the
repair prmlcr B21 lrnrarxs sectivm or cut the brx•&of tltfs form. 23.Site diagram.or additional well details:
You may use the back of Ws page to proride additional Well site details or i+'ell
8.Number of wells constructed: 1 consltuction details. You mat,also attach additional pages if rtecessary.
For rmafdllfe ig(ecllon dr Ivan-rarer slWy wells ONLY with fie saava eorratruerdan,}rrw eon
sr/hmir ame form. SETB6f[TTAL[h'STUC7TONS
9.Total well depth below land surface: 101, fp(,) 24a. For All W'eltu Submit this farm milbin 3b dot's of completion of Well
For rmuhiple wells Un tell tleprhs itdorrew fe.remple-:I@209'druf 2@ llut y eonstruawn to the foltosinG:
ill.Static water levei below top of casin8: {(y,j Divisido of Water Resourrctt,Information Processing Unit,
Owater level is4bove casOjg;die"+" 1617 Mail So-vice Center,Ralciglr,NC 276"4617
11.Borehoic diameter.10 {in.) 24b.For la art Wells ONLY: In addition to sending the form to Me address in
24aaboi'e. also submit a wO of this form within 10 days of completion of well
12.Well coustrartion method: Sonic construction to the 1601ming.,
(i.e.migm mtary.cable,direct pask ctc.)
Division of Water RoGuryes,i)adergroond.injection Control Vrogmm,
FOR WATER SUPPLY WELLS ONLY: 1636 Mild Service Center.Raleigh,NC 276"4636
13a.Vidd(igpm) Method of test. 24c.For W'aterSaDnly&Inic4i"a Wells:
Also subddt one copy of this;form ivithin 30 days.of completion of
13h.Disinke iulu type:� _ . Amount: Well constnlction to the county health department of the county svh=
comtstTTtcted,
Form GW-t North Camllna D„pattmcne of Em•imimem and Narwal Resources-Division of-Miter Re,omms Revised August 20 t3