GW1-2022-05132_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD
Tbfs form can be used flifilligle airnaltiIikmcils,
14.IVAU,R ZON ES,
Robert Miller FROM TO MiCRNMOX
lt'cil Crii�ractnrT�talue. ft. ft.
2675
M.Well contradorCertirmationNumbey AS.OUTER CASING(f.w-ninlika-,iril wel'10 OR LINER(if s'p 11,10-1kI—
FRO31 I TO. I MUMETER -I THICE NTIM 11m.TEUTAU
SAEDACCO Inc 0 ft. 401 ft,] 6" ia. Sch40 Pvc
Compiny-Nmoo: iti.INNER CASING OR-TUBINGIk-ewbe j at closed-loop)
al C '�ti6n onlit 4. FRoar To DUMETER. THWO-ESS. IMiTERLALL
2,w onsti'll ft: In.
fjo 411amffraOlo wv4pomiffix.Cwnfy.,Shrto,l'arlawe.1r.Y8CdG4 01.7.) ft,, ft.
in
17.SCREEN
Water Supply Well-
. 'FROM,
I[.TO 'DrA%1F.TEE 5,0T817Y I
TVICKNESS 'MATEMAL.
0Agric lnnal ctfunhipalnthli� 40-!ft.T60- (., 6- .62 Sch40 Stainles s
Meofficrinal(HCaIjng1COOiir9'5bpply1 Mcsidmiai Water Supply(single) Ft.
Mlvdijs(riil/Gymfifcrcial MRiesidentialIffatef Suppf.(sbaicd) .18.-GROUT
'FROM ,To. MATERUL 1,EMPUCTSTENT]SUMOD&&MOUNT
0 ft. 341 (L Portland trimi
Non-Water Supply Weft:
Mllecovery
Injection Nett: rt, IL
bAqui,fer Rcchdrg& M4joir6d%"-kr Reinctliation 19.SAN M'GR,%VCL,I'AC
�FROhf TO, ILI,T '-I, �R2r PIACENIFN'TA1t.T11011
37 i ft, 65, ft. Isilica Sand 120/40
pAqmficiTcst -I5tbrnln-atce I)T,Imnmq ft.. ff.
Uchnotogy
U.'DRILLINGTOG(allach additional sheets if occeswvl
aqeOthempl(Clused Loop.) 13Tricer FttoSt .To OF-SCIUM-ON,(color.1-urdIA4.VA'"wk 1) late.dr.)
❑CrroIhennal(Heath kg/Cooling Return) 00ther(explain under 921 Rewa") ft. I it.
rL
3/20/22 ]DO EW-2
4.
MAY 3 1 2022
Facility IDn i k ppjjcabj.)
ft.: Ft.
1248 Bill Hall Rd, White Oak, NC, 28399
;cSr,-Cjt}.'qnd Zip `2 1.KENURK9
Cumberland I Three feet bentonite Seal from 341to 371
county Piri:0 ldojlifi A ion No,(PR4)
JaAtjtude and Longttvidc in`dqgMcStm1nu%tWkco_uds if'r d4"cimalAtt- ri-ei,
(Ifllpll furl,ona 1410�g tq%M(fl6ki 2L Certiffi:atiorO,
.)t JV 2117/2022
Dale
6.Is(ire)the ivel!(s)- or Methporary flie wddl(s)ww(yrrm)canyinicied br aaortfanre
with[Sit XCAC 02C.G.100,on 154 Ncic P.C.02tv well f oirstrrictfar Standards and iliai;a
1.IN this a ftpAiir to an rnxiNting,",cll: MIN,. or ENo CW ofrfwf iorv;id f rs7 tl&71 pnwwd 1-7'jim'1101
lfrkis Laic twule.%plabi r1je ojarary qfrlje
23.Site diagram or additional well details:
You m4 uso_ilia back bf bits o` ,to 01&idi additional wellsite,deWg-Of Ivell
Gage,
8.NumberoMelisconstructed: 1 constfucticKdelaik"'Youv4y also,atlaclvadditi6naf pages if necessary.
Fe r nlil iq*1 iollfill I.V.0 mhirer swp(i'lei3ls.0jvfY I 11r1i r i 0,wile CJj?.5trM4Vdf4 1,Yt*ClOn
91113MITiAl,INSTiTC416NS
9.76tal wiellAepih WoW land surface: 651 24m For All Wells. 'Subfidt (Ws inn -w n 'Ithin 36,days Di"couiple-fiod of i cll
CoMtrujctidn�to 411c''follol"111g:
10.Static water level below top ofeasinW., (ft.) bl'V-'Ahu of Water Resotift6,Influrmatibn cesginda.Unit,
lfwgw ievel'b,aba!o tv'sing;am 4"'. 167 27699-1617
11.19orchole diameter.2 01 (in.) 244.Far_1uWt Ind Wells .In addition to sending lite forin to the address in
-
246 ,ox,6. 6W subndt a copy of this fOrtli within 30 days'Of C6111plettoill of well
1%12. 1'elfcoustruction method: Sonic construction to ak following..
I ..
(Le.auger cabin,aims posk etc.)
Division of Water Resdurc&,Underground Injection Control Program,
FOR WATER SUPPLY"TLLS'ONLY- i636 Alail'Scfvice Center,Raleigh,WC 174994 634
24c.Tor Water Supply&Injection Wells:
13.%Vield k,#irn) 'Method of test:
Also subriiit one.'e6p), of this focift-witbin 30 days ofconioletion of
134.Disintmfilan.type..; Amount: WC11rcom9tructian to the connty�hcafth department or the countywhcn:
constructed.
Fonn,GkIr-1. Man],Carolina Department of Em irmunc-ift and Natural Resources-Divii Ion oMlater ROKG'Lrces'