GW1-2022-05140_Well Construction - GW1_20220531

WELL CONSTRUCTION RE-CORD " I For lnscrtlW use 0N1 i':
This form can be useAriir..singlc or m ultipk n•cps
1.Well:ContraetorItif6rittation: _
la:WATER ZONES
Robert Miller FRO31: TO. Dy_SCBtPT10N
4Vc1tt nrAraf;arltalttc, ft. n. i
2675
NC,.Wcll iCoMmetorCclliltentiooNti rlicr IS:OUTER CASiiiG(fnrntnlli=ciiwdWetls)OR LINER{if.a i Ticabk)
FR031 .To -DTASvrTlitt TA1Gt*NF - ALATERT\L
SAEDACCO Inc 0 ft._ 58 ft. 6" ;o, Sch40 Pvc
Cnflvany Mono; Id.IN.1tER CASING OR 7'LTBING 'eotturm a cEascd toii 1
-MORS1 ITO DI6.MUrErt Tilk-. ES3 ATATa U#t
2,*Ii ll Constlliet[on T'ernlit. ft. It; ht
lintrllnpp,lirahleuellpemtits.(i:r..Carnhr;S1,i:e Yariarccr.Tr%edena:r.:j — m
ft.. ft. ;i1.
3.4Vclll�sc(Ct[CCi:.{Y`C11 D5Cj: tl.SCRE.EN.
Water Sitppl\`Well:" FROM 1 70 1•D1:111rE?TF,rt SLOTSIM T111CKN1`j$ I ATATRRFAT:.
Clrtgltetllthral l"JlvluniciplllT'tililic 58' ft: 68' A. 6° int 0 .02 Sch4o Stainless
06eoihcmtal(Heatingtt oalibg Supply): bResidential Z'later Supply(single) Ii (L int:
®htdustrial/Conm(eteiai ®ResidentialWaterSu IS.-GROUT
Supply.(shared) MOM 70. bTATERTAli I.EMPLACEITENT 3M711101).0I0UNT.
❑lrii ation 0 it.' 52' R. Portland �trimi
Nan:Water Supply Well: ft ft.
1714fanitotin MRcgovcry r4 rt
Tajccti(nt Wctt:;.
CSPinn'ifcr Recfi irge' Dodro ndS:ltcr Rcuict[iati0n 19.SAND1GILWELI'ACK(ir a t babble)
' TROM 110 1"-MATMM, ENIPIAC'I:LENT AI1:Tn017
❑Ai)TtifcrSiortl_^ca lid kccorrly Mdliniiyl3;iriicf 55' tt.. 73' ft. Silica Sand 20/40
[]AtiuifcrTcst- ❑5domtss ttce Disiid9gc ft." ft.
❑V.Nperimcntal T xhnologv 0Snb5ii$el C Cardrol
20;DRILLING LOG(allach addilional sheds if iwcessaryI
❑Geothenttal(Chisel{Loop) OTraccr FROAr T[} D�scRfeTtO� by .± .t'ntclztrk ti�rc,dGt,l
❑Geotlientcil(Ileadup-Cooling Retum) ft. ftIq'cam F
ft. ft.
'AjJteWel! 3/28/22 %Yc11II1{rEW-8
fr. ft
S;T;Wt.•II Location: ft. f,
+foi wg?i_-n Pre C�-T"r
ft. rL _l o Q1.2.2,30G
Fsaoilil}+�iiinrrNanc" F�gililr iM ti€appiicable} ft, ft.
1248 Bill Hall Rd, White Oak, NC, 28399 ft fL
Plt)SPcid Adldrem Cily.,and Zip 2 r.RI:aLAR1iS
Cumberland Three feet bentonite Seal from 521to 55'
CtINu(x I?arc411tJcnlrtcttironNo,(PIN)
:Sb.I ttit6l. and l.tino'iudc•In t epmeslm nutrs(secnnds Or ticcimal de recF. 22:(crtif�titrir•:
Or4lell riot wta;1,100tli to sufiiG�C rd)
N W 2/17/2022
Sdemturcaf': 3..r �! �F;:;!•�! -- Dale
6:Is(art-) MPermianetit or .I7Ttnil orary. Uy;srg»i�rg.thit fri,m;I hereby ecrfify thrf,die sells)waff.{wen!j eonstrutted irr.meegfdM!re
15A NCAC O2C.0100 or.iSd NCAC-OZC;OI0011 ell Coirrtrr,rdar Srarulaids and flNrra
a.A this rejiair to an testing,Nvell: oYtm Or MNo e!fiy"ajrFufrecnirf, rtr&-roll pTvfik,d tit i in livti reviler;
(#This�r,<zluTlr,frlT,emkl xttwle�TK�,arslnrcdot,F,rlranrrtfitulm,flluplahrfhcrtrrr.nc.ofdia
npn rlrrPer 911 m;ilikrSrrikrr t,r ars A!&2 il nI rTt1s prft, 23.Sitedia;trarlY'Or additl6nal hell deta113:
You may use.i[se bbcl;of tliis page.to_pfoi de additions[icell site,details.or i411
8.Number'of WA,constructed: 1 cousttuctiait deiuils:"You.inav aiso altachadditionM pages,if necessary:
1Forafrritdpfe 4,cr.4 i ONLY irirh rJie_same cdirarurdon,e%a-ctin
sawiran,fo r.% SCTBAi1TTAL MST617,h&S.
2:totalselldepth below land stufoi e. 7324it. For Alt Wells: Suhritit dus fdnu%iithiu SO days of complcticili of u'"el[
,or*MlditTI'Vdfri'isr47114dOpIkY '�0rraii(examNe-st@.a09"(1nd2@100)" c6n56-artiaiitn'ihcfgttoesian;'
Ill.Static ivater level helosv top of casiupt (ff j DIN-kian of Water Rmourcev,Information Pruiemin�t,Unit,
lflwiterlgel h,eluue casPr ,use"'+" 1617 Alail.St:rvieeCcnier,R 1[e[pir!Y�'2?G9J-IG17
11.Borchote diameter;10 (in.) 241J.Fnr 6 bolt We1b ONLY: Tn addition to sending the form to(lie address In
24a aboie,also submit a.copy of this forte Within30D dmis'of completion.of trill
MWell coustruction netbod: sonic construction 10 du;folloibillg_'
&C.Sri-r.ruti2q.'cabi6 diTrrt pasli etc.) - -
:Division of Water Resources,Uildcrground inJec'don Control Program'
FOR WATER SUPPLY"WELLS ONLY: T636 hlaEl Sere ici Ccntcr.R ile[gh,YC-2ib19�163G
13a 1'idd(>pm) 13ctlind of test 24c.For Water Supply&Inj"ti4u Netts:
Also�sn5n,it one-copy of is fond within 3t1:days of completion of
13h;Dislnfecttun.typer Amount: weli constnrction to the co»nW health department of the"connheivhcre
constrtk(cd.
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