GW1-2022-05150_Well Construction - GW1_20220531

WELL CONSTRUCTION.- E-GORD FncTr rmlETsti l?NL1:.
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1:'tYctE:Gititractrtr Iritarutatiott:
Robert Miller FROM To I Ot3I RtPatOY
lkill£nr nutarT�rnc. tt. ft.
2675 ft. fL
NC',Wcllcbntr l rccrtifrcatiisnt"i"ci 25.0[fTEItGASt�1G`(the:illulfieescrt3ti`cFlx1'OR[lihfR iia 'pcaEkl
FROM I TO. DLVNT TER, TUiCKNER5 h1.17EN7.4L
SAEDACCO Inc O Yt. 1 25' fl 6" iu. Sch40 Pvc
I in tuts'T 1 lcnC, Id.`iN�.ER[ASS1 iMT(,OR'TllH1NG° eodiermat clafe 4oa i
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DWMETER- Tt11CkNFSS, hf,RTERLiL
2.Well lvonstructian 1'€1M* (t;.
1 ist pliaFytfiabTe vrrlT pxirrzi fr t.'Gwrnhv SltiM;UarTarerr.7!)'Erdtri,rlr.;)'
ft. in.
3.Wctl Use(chlxl..ivdl asc). r7:SCrtE_�N
'VaterSupply 11 FRONT. 1'Trl 1 UUMM,TRtx SLO-TSIZ: THtcxNFNs h WRKTAr:
CiA rclllttical Llr4fUt8j l[JaVP4tb19C 25' ft:9 35' ft;- 6" 'in. 0' .62 Sch40 Stainless
c,oDthcraiat-IE7catineC-ooling Supply_ Mesi&ntial'Whter Supply(siDnglc) ft f f is
OludustiialfConuttercial OResidentiai Water:5iippl�,{sl=d) :18:GROUT
FRos) ',10. MATERIAL. FATPLiCKNWNT 3rkTr101L&A3TOUNr
�lrri' tiara 0 ft., 19, ft: Portland trimi
2'on-water stj pp l''V dl: tt f4
G7lrfantiArin CDRecoNrry
Injection Well:; ft. tc
O F4gttrfer R€charge l droundtsntcr 3tetrtcrti t ait 19,SANDICRA IEL•PACK[if r!tliezhigti
17E1rtluF(Cr-S107d taadR€C6y �` P$ItipitykahiCf 22' 'ft.: 40, ft. Silica Sand 20/40
❑:qukfcrT6t [JStvrtnnttcrl3riini c ft. ff.
G1Es�aFtiments117�1rt1ttic��� pStthsid4r�ec t~ojuml' 20;[tRIi.I.I1G LOG fsiNaeh aif#tifi��nal'alierfi if rccecssnrvt=
[7G 11u�tnwl(;Apsett Looial t7 Tracec FROM .TOE DFscRtFTwx cobr,lhar4ac!a"W—jck1 3. ,i 0 v, t�
Ei llfennal(Iieatit ttCooliitg.Retutn)' ElOther(explain under 921 Reutnil sl fy t4
fL. tG c f�
.DateaVell{sCoi�ilrlcteih 4/22/22 �VEie11ID#Ew-2z ..
ft. tG �dta.+ fs..e5
S t \Nall Iaicutipu: ft. ft.
MAY 3 1 2022
it. it;:
FTtcilitt'aQss'acrlTmtic FiciT y!p#6tngplioahlc), ft.; ft. n v+r-"---
1248 Bill Hall Rd, White Oak, NC, 28399 ft, fL
Plgsacul At6dr s Ci4} sRldZip °31
.Ii!11L1 RIi4'
Cumberland Three feet bentonite Seal from 191to 22,
C(rtrratp! l?lrr e7 lyt riiiCiC tttnu Na.(PIN)
fib.I�rtihrttc anti I do itrtdc,iD tl ceslanilnut€s�sccond cir tltxiii al ila riff s 2L Certifimtio6-
(irc��il f�r�,�r�ft�7�>�iF FrclT;ilciri)
N v4 -,J� 2/17/2022
Dale
6.Is(*I the x>tttttllltiF'ni or .TJTI lilitOtYtt Y. ra rlirr l�taT-'ernm-.1"here certi rh al.t1ar rrrlr r w v{yer� ern firucttd irr;ml'6'tra�fnnrr
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ivi&15A.NCAC 02C-1000 or.IS,t NCitt-02C;f/ZOt7 t4ef1{tiirsfrrietloar Staralttn3fa.rrr+f tlarrY4
7.Lr this g ft8tt ttt 8n cct5tin 'el1i; i=Yes or 'EN i, cqix at ili r rfcrrirf hqs wca prnt ri tt r,sirtt(r<vitrr.
,(t'rief r is a n�tdr,fitter`�.e��w ttrTT;tw,lwTnnvi�o TlrJ'ar�rr:�ur�r.'r�j4laTtr 1]�F ruanrr€at-tii,r
rr�srzrrt�di;911. arizxitlie.br,�'r�ft,�is,harUc 23.Site dijigran or additional well detais-
You may usetli,back of this page to prdi6 additional\\ell site aetails:or well.
S.3Nnother of wells cti trnetcd: 1 coftstttrctioitdet$ifsr You ie }'.tl r;atlaclt titlivotutt pajes if ttt cessery:"
F+ar.maPdi�rdl�irla�t��'nlrra-)r�r'�r lr�tt�'tAi4'I:Ynut,�rhr'�maru�rsirrrclFott.;'tnl.c�.la
cui4areirm�r r RUBbiITTaItL INST[T TIONS".
9.`Iotat ell depth bet*land surface: 401 (ft:) 24a,06i -ltlt *ellsz Sainidt Ws iaeat within 31 bays of ccftttptcii0a of ss'ell
For,toiln'pyci=rtY 'rsP+aTJrtsTusfl consihctid.ntotliCfoltov.igg,
10.Static water lael.liclow top of casinW. 4) Dl*kir3n of Water Re.4.00ftei,Infortnutian pmcessin;Unit;
f titeild dated lt'abdtt 'Si,"'Sing" " 11517 A1ait.Seffice Ceriter,,lt:dci-,h,NC-2'i693-1617
11.liot€hole diameter:10, [ia) 24b.For THlaflan We.IIs ONLY: In addition to sending the fonu 3o fhe'addrm in
24a266i1i�A6 subtuit a co�y'of this.fami iri'thid 3tf diys,of-cotnpjetion,of.kvil .
12.'Wellcouctructionmethod. sonic c2+ttsi111ctit7iit6iil! .follotviii�=
(Le: dawtpusln etc.)
'nivL%ion of N'Vater itmurecs,Undergrodtid lkih:iioti Coii"l,I'rogt�alit;
FOR NVATER SUPPLY N%TLLS ONLY 1636 hiaE1 Service Ceitter.Raleigli,Ne27699463(t
13 i€ld tglim) °ictiiad of test• �24r,For Water Sii lP&In€et16a iVetls:
'Also mbtiiit o�copy of this foini within 30'days of cotn{lietion of
13b.Disinfection tvpi t Amount: wgll-canstntct16n to the county H caltli dcliamncttt of the county whom
copstntct€d.
FontGl414 Noah Carolina E7pwmemofEm�irennxift,a�dNatutal Resources,-d€vhlaniaf%MaterSteSatrt Revised A 2Y►13