GW1-2022-03681_Well Construction - GW1_20220321

RES DEMM'WELL CONSTRUCTION RECORD
North Carolina DqmunM of Enviromnart and NaVoW Raouwes-Divisioa4.W' W Quatity
WELL CONTRACTOR CERTMCATION#:4119-A
WfrflCONTAACTOP- f. DISINFEC110N Type Arrrorart�'
Sage Dn'ihng and.-Oump Services LLC. d, WATER z6NEs(depth):'
Well Corbactor(Inam)Name From To t'Wn. To -
Michael C,Sage From �To From To
Well Conhador Company Nerne Fronr To From To
-204 Torn Ave 7. CASLNG. Thida►es8/
Castle.Hayne NC_ 28429 D To epth
�50 FL. *lerMO
CAy or Town State Zip Code From. To Ft
91( 0-:}231-6669 Fmff T To.Ft.._
Area code- Phone number
2.WELL INFORMATION-' 8. GROUT. Depth Material IALetlGrod.
FrornTo_3 Ft Bet + D �eue�s
SITE WELL iU#(fi applcebte) h From To=Ft 1 eM
WELLCON!k7WgTIONPERmrr:t
OTHER ASSOCIATED PERMITd applea6le) —- -
-^ ,8. SCREEN: Depth Slot Sim
3.WELL USE(ChedcAppficable Residetmtial WOW Supply I. From To Ft oL 12 In..
DATE DRILLED — —� From . To'- Ft.JrL io.
ME COMPLETED iQ AMP � From - To FL • :pL �_tL
4.WELL LOCAMON: r y 10.SANDIGRAVEL PACK:
CIT,Co �S tC� ca,Nrir e e� r
From To Ft f .7
(Sbod Nerve.Number,Cuff—aft SubOVWM Lot No.;Pacd.ZIP Code) From To Ft,
TOPOGRAPHIC/LAND_SET INGC ,
f Slope t Valley '1 Flat I_Ridge I Olhrx
(� bid 11.1DRI-LING LOG
MSy.6e io degees, From To Formation Description
LATITUDE oinnmres ode
LONGITUDE;_..� in a decimal format -
LatitadeRongaude sow I GPS I Topographic rnap' � Vey
i
(focelfon of well must be shown on a USGS topo map and
attached to this form m7not us►ng,GPS) —
8.WELL OWNER ( • C f�J� A ( i
OWNERS NAME
luc
t fCil,►pr Town -bF+ zip coos '
Area code- Phone number "12, REMARKS: A
aWELI.DETAILS: [an
•
a,TOTAL t>EPTH.,
-.
b, DOES:(I jU REPUM ,t70STi"WELL? YES I NOI
i DO HEFUM CEwnFY TENT Tm WELL w*z ooNsn=Tw im
c. WATER LFV'F.L Below T IMMAC 2C. UCTM STMOMDa.NO OFTHS
oP of FT. RECOM wat awr
(Use +'if Above Top of Ca MM)
-. d. TnP oi=CASING'!S a FT.Above Land SirTfaCe• b
r
'Tap of casing temunewd aUor below land surface may require SIG OF IED WELL CONTRACTOR DATE
ai variance in i,ocordaTroe with t 5A NCAC 24:oi 18. . I ,
MichaelC.Sage.- I
q. YIELD{ppm): mETHOD tlF TEST ,X f'�J= PRINTED NAME OF PERSON CONSTRUCTING THE V4M f
Submit me olginal to the Division of Water Quality within 3a • Attn:Information M
- ilt,
1617 MaN Service Center—Raleiph,-NC 2769961817 Phone No:18191733701c;ex.