GW1-2022-05127_Well Construction - GW1_20220531

WELL CONSTRUC flON'RECORD
This form can be used,fbi 4rigIc or mWfi0ksvclls' For Ir-fznatirse,014�Y:
1.W* 611 tiintraetor hiformallort:
W.V*ATER ZONES
Robert Miller FROM .70 DFSRIPrIOY
NYC)I'C 0 rimicl V,T Na mi� ft. ft.
2675
NC.Mrdl Contmclor Ccftjfwa1if o Nfinbeir i.t5.OUTER,C.ASt1IG(for'mitlika!oeil' 11s) at
I TO DMAIRTER-
bkh
FRONT TRI-1111-91! iL
SAEDACCO Inc 0 fL 1 45 1, (L 6" in. Sch40 Pvc
ctutg{anp.Nar»v &INNER CASING OR'WHING'1geother aleNced4000I.
FRONT To DIAMETER TFIWKNESS
2,Well Construction Permit"r. ft. ft,
lilt all 1tftrdc4 ofcj,
3.welLuse-(C It cc]C Wd I D s e): I -. —
17.S(IREEN.
NYatcr SuppLy%V01t FRONJ 1170— DIAMETER I 51.0-T%17Y. 1 71 V NZATrRIAL
CiAgricultural Mfuriicipa-MI;j I i.c 45. ft. 65. ff. 6- irl, 0 h46 Stainless
MGmtheratal(HeidrigtooliDg Supply) 011iesidential WhIcr Supply(single) R. ft.
Oladusffial/CbnutiercjIl ORtsidential Vater Supply(slkird) IS.-GROUT
%FRO51 % To ATATERUL rNIPLAMIENTMMIODAkANTOUNT
❑Stiff anon 0 ft. 391 14 Portland trimi
Nara-111ater Supply Well:
Injection Well:
MAquf(er'R.cqbarg& Md6uDdii.lcr Rcuictliotion 19.SALN D.1MUMEL PACK fit alijil ic;Ofc)
FROM 'I") ivfA:rrRr,%r, RS1PI,AMIF.NTAIETnolf
MAqvlifcr SWrIg'&1W Rccovdt3.• JDSqlirtity 6�':jH
I -F 42- R. 701 ft. Silica sand 20/40
DArlinkrTcst 13 St6rmll-alcf l5haloa
ft- ft.
[j8-,p;riwcn0l Tcelinotpgy
10.DRILLINGTOG61tach addilioriol
0 Geothen"(Closed Loop) OTracer FRONT
0G.othennal Retum) 110dwr(explain iftijer 92 1 Reloads)
4.Daie"We"(S)C61ppleted: 4/20/22 We'111D#EW-23
ft. ri
LD
-114.�14241 ft. ft
MAY 3
ft, ft. n rin;Uon Pr.c-T,*q,�,rg Urh
1248 Bill Hall Rd, White Oak, NC, 28399 ft, ft,
Tip Ad&Cs&aly.and Zib 21.'REM ARKS
Cumberland Three feet 1;ent-onite Seal from 391to 421
nutc�,s�brt&Or dcci!p I ifilt
Ultitil de ad acidLijut;hudc yl Ives:
(1ruell CDC14; 22.Certification:-
2/17/2022
or oTemporary.
Aj ygnifig jhirfin!r4%1 lreiEby certify that the ivel)fs)'as f"re)caminrcmd hvaceonlance
7.LOhLs a rvpAr to an Ex4tini ivell. Mcs- or MNo 'rCVY of rx,-nrcvrd kfu K-al j;r0ridu raar wrel wifer.
1(dllis'is a mxrO"fili twit,CratonyA iv ell cmwnicvtatr hrfv rowel ot and cw p?ah i x1je.narzirt of the
tiros Me&wk cjt(hixfbrjJL 23.Site ditigranfor additional wcll details:
You fliay:uS6.&_ba&-of this 0.g I a-to pTovidee additiong well site.deans,or Ivell
R.Nutuberof Wells c6fistructed:-1 C0tIs(rucfio,1:deiai&;-Youitiny aLsortlach addifiotW I pages if necessary_-
For Ar iqAvje 10miol EV'.rt&j-itw;e'r Wply ivle?b ONLY w1rh r1j.e.urme yva tym
SUBMITAL[NSTUCTIONS
701 24% Pot All Willn' Sobfidt dds Jbirri within 10' 'd d6tt ofcll'�hays compte
10.Static water level below top of casing., (fL) wn 6tv "ii o,f,Water R6 ourci s InAirma.t'idn'ProkemiTIL,Unit,
SdTice ernfer'
11.Borehole dianIctek;10 (in.) tab.nrFph�ajj Welly ONLY:. In addition to sending tlw.f6mitotlic-address;in
24daUove. also submil a copy of,this forte within.30 days'ofcouipletioii of*01
12.Well coulstmetion Inethod: sonic Lonstnictimi to thelblloMfig-:
(Le.sttgcF.rotW,cabl.6Aitccf posix dc.)
'Division of Water Resources.Undergmund fiajleelloil Control Program,
FOR WATER SUPPLY-NITLILS'ONLY: 04 Mail St-Tvice Center.Raleigh,NC27699-1.636
13.3,Yield(gpm) Nlefl.tod of test: 24c.For Water'Supply Injectlo'n Wells:
Also submit one.0603' of this falrol'with ill 30'day5ofcotupletion of
13b1,'D1siftfL1Cfi.0n#P'e.- Amount: well comitructibil'to the county I alth department of the cminiv.whem
IC
consmictcd,
FanuldW-1 North Carolina Mpartaxnupf Envirounica ard'Mintral R'esourcrs-Didslbo of Water I Rmurms Revised Augost 2013