GW1-2022-05149_Well Construction - GW1_20220531

WELL CONSIAUCTIONRECORD
For hitzintaI UscDNLY:
This form on be uwd kr.sfriglo tri,trialtiok wclls,
MWATER ZON�LS
Robert Miller FROM TO. DKiCHIP I 10X
W0 Ma 1 Cor4rwornw.
2675 fit
NC,WcllCarnmciorCcrtifbc,btiouNturber 15.OUTER CASING foe 11 siFil'tvcn-)OR LINER "k'
F1101%] I To ET E It- I
SAEDACCO Inc o fl..1 58, (L 11" -,a. Sch40 Pvc
C40*"My K'-wilo 16.INNER CASING OFkf' 'BING 0woffierinal ctirwil-looi))
FROM 10 DUMETER. I THICKNESS I MATERUL
2,Well CDUVilic6011100witlfr: .ft. Ft. 13t.
lift all cry;ar ibje teat Pi,.f:x ox-.Cairntv.,Shvv,-Ilariurwe.jryacdcn ell-1
-1 It.
in
17.SCREEN
Water Soliply Well: FROM 1.TO DIA'METFSt SF,0TSl7,X TujCKNF_'14q I ATATr%RtAl.
Mgricu,I.rural 0.Mull.i�,�]Pamiblii;, b1ft, 6 8 in. 0.10 Sch40 - PVC
ft' ii Ji,
0GCOMCM1111 MC161191C00iing StIVPIY) •bResidential Water SuPA,(sillsle)
131ndustrial/Comnicrci5l DResidential-11,1h ter Supply-(slizi red) 18.-GROUT
FROM TO MATERIAL E,%rPL*.crNroT.Nm-ruoD&,010UNT
0 ft. 5 2 ft. Portland trimi
Non-ANTater Supply.Well: it. rt
Irij ecil oil Weil: ft. (L
0 Aquillcr Recharge, 0 droundv'i'Mcr Rcn tcd il.M on 19.SAND.GPLMEL PACK fit aliplieal5le)
'VRONI 10 MV03tfAl.
ElAuiO S(o!j,-,c and Rc6vcl3' F-18alinity Ruder
QAq.u I ifer Test 55. ft. (S81 ft. Silica Sand 20/jO
Oq ft, ft.
bV-Verimcnial Tcchnolpgy Elsubsldcncc 6r4ral
20.DRILLING LOG(attach ad4lilic-nal sheets if wL,wry)
ElCreotitermal(flused Loan) oTracer
FRO',$T, TO
Meodiermal ffleatiiaWC-oolfnL,R turn)e ft. I I
ft. (L I N �-k—�,,r,--, V
4'Dat0.WeU(S)f6tqpjdCj: 4/22/22 1%yell JD#OW-17
MAY 2 1 2@22
4;INVI I.AlCilthln: to tt
n if;3 rw,G ljnj:
Faqflily IDIV ffapplj.ozbIc) ft.
1248 Bill Hall Rd, White Oak, NC, 28399
Phys'Xid Addii'ts City..and"Zip '21.REMARKS
Cumberland p Three feet bentonite Seal from 521to 551
114mO Iklqj1irLc4jlion No,(PIN)
�6.ustitu de and I-on qtitdla in ticgrvWnllnut6lsecnndi lirdecivinal dcgrecst 22.Certification:
2/17/2022
Dile
6.Is(are-)the ivell(�)- XPertuattent or 07ertillorary 1Jv.%ipdhy A&fqrm;i4rereby eirfify djar Mr uwfifs);,vas fiiven!)carolmered it aceordance
wi&15A KCAC 02C.01M Of,EM KCA&0k,0J160 Well Caiiathicrio'-,or 5'tarWards and dw.ra
7.U thbi a repai to an exts ti p-Nvelk DYLN- or kNo -cqPy of(if 4N!qvIl givner,
v record lias bern PM1,44"d r
23.Site diagrana;or additional well dletalts.
You may 6§e t1lie.back of this 0&,tb provide additional well site details or well
8.Number of wells mustriteted; 1 construction details.' Ybu tirav also attach additio'nal pages if necessary.
RDF
.m x iit an o A,n-j. SUBNI11fA L INSTUCT[ONS
qjoi.4lwcllAepth fietw*-land surface' 681 24a. Put-All MUls 'Subfidt Ods form wi(hin 30 days a completion of well
@
10.Static%vater level below top of casing, wi-Matt.ofWatLr Resoureek,Information Prkesilng Unit,
IL-drigh,NC 2769!91-107
rue �AIAU'Scn4i:�Center,
it.Borehole(lialucte,7 6
Olo 24b.For frifM&I naigNLY., In addition to sending tlw form to the address in
24dabbv4 also submit a Copy of this folul within k days'of completion of well
12.'%Vcll construction method: Sonic
(Le.mLgcr.rolaxy,obl&diw puck etc.)
Division of Water Resources,Underground Injection Control Firograin,
FOR WATER SUPPLY'%IELB 0NLV- 1636 Mall..Service
rvice Center,Raleigh,SIC 27691636
13iL Vield(z Alctliod of 24r-For Water SuLiply&injection loveM
. (glum)Pro) Also obrAt o*ne"c6py of thig-f6i,iu within 30'days of C611101el ion of
13b.Disinfection typer Annoutift, well,congtructibil to the county h6lill department of the county-when:
conMnictcd.
Noill!Carolina D-partment ofEmilortrivia and Nattual Resotirces-Divisioa of Wales Re souron RicvisM August 21113