GW1-2022-05163_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD
This form can bc-uyA- f&ihi&-w niultipk.wclls,
14.IVATER ZONES
Robert Miller FRONT -to I ovsCRIMON,
N%10f.or4md,DrNamd,. ft. ft.
2675 1 - fC
NCVcI]CommewrCcrtilicationNiurba 15.OUTER CASING(r.)r-intilikiwilwellsi OR-LINTR '8ij1gbk1
FRONT I TO, I P1,01ETER' 'I Tulcmmm MATERIAL
SAEDACCO Inc 0 !�,1 42. (L 1 6-1 -go. 1 Sch40 Pvc
CaitVauy 11;3mc, i63NNER-CASING OR-MING figeodwri a)ck wd-l-m
FRONT 110 "VOM R 'METE Ic ss, SL47ERLLL
-I
2.Wcl I COMql-13ctiou 0ejwlit fti
3.Well,_U.5,a(chM,CNM.1 use),:
Water FRONT I To Drxmimit: I SLOTS17.E I T1i1CkNFS$' I-NIATFRrAl.
0.Agdcu.finml ONfunicipa I IftbJ.1 1 42- ft. 52- fi, 3. 0.10 Sch40 , PVC
136w(hennal(Reatingtooiing Supply) ORtsidential'INIdler Supply(single) rt. R. in.
131ndustrialfConintmial Mcsidcntial Water Supply'(shared) 181-GROUT
FRONT TO. MATERIAL I EMPLACENTENTATMOD&AUMOUNT
13 0 it.' 4 61 IL Portland trimi
NotiAllater Supjily WA
Inject[,on Well:
IjA4:i i fc rR c"c fia"rgi 19.SAND1
.FROM 10 kslplAcrm NTWIT1101)
nd''g�-1 Rccovcty nsil nity lb lci '2 49 R.. s R. Silica Sand /jo
❑Alitiifcrlest osloftni6tce bTalnj,
lif~Np;rinicittal TIN-hnolog-y I7Sabsiiictr I C614TOI
DGeotilennal(Qused Loop) OTrtter FRONT 1.1ru DESCRIPT10'%(c*br.1iqN1qv.,A,wit'rick 1yjx,'wxiA sivudt.)
OCr6othennal(F1eatiqLJPCoo1iiig Mum) ®Outer(emplain antler 921 Recalls)
ft., ft.
4 aD,te%1f-4 1(4) n kled. 4/12/22 Will JD#OW-2 9
11
ft.
MAY 3 1 2077
Fam1hy IDN(itappikob-1c)
R.-
1248 Bill Hall Rd, White Oak, NC, 28399
-21.REMARK:
Cumberland Three feet bentonite Seal from 461to 491
parcel 1LknIir*j1Jon No.(P114)
61dc in'41c,56,Listifiidc'aiI'd Liiiij pvciftninut4f�ccioinds Iir Ociuinl"Ctrec':- 2L Ccrtirteation.1,
N 2/17/2022
Dile
xPenuaticut or. OTesupom ty
mirk15A XCAC 02C.0100 or ISA JVCAC 011C.4_100 hell r,,'0;;jt>ic'r1o4 S­ma4ardis and fW I ra
7.11s this a-repair to an,6-
misting-well. [AIN, .tin
1p ms�
d)r r.'tq the �23 She A#rantor additional w&I details,
t,mA
the bacl;of this page 6'0rovidz'qd(,1i,d6"a1 well site details•or sell8.Nuttilieref iVells co nitritued: I------ constmetiondeia'L You:-may alwia,ttachadditional pages if
SUBMITTAL[N-STLICTIONS
9joial w0l.dcpth below`land surface: 5 21
(ft,) 2Ia For All ArMs Sobfidt This fbah tviWin.30 il;tys of completion of iy'el
Frxrtraaflnt constniciiaii to th�follovdfii-
wolls Un 4?ffder*y'ffdj�,iPe)q 4examok-_7@4
10.Static water level.lifdow top of casing: Di*'Lsia-naf Winter RLs oureC4,lnfiirniiitii3nPr6cessi gUnit,
1617 Mail Service Cenier,"ci- !)-1617
'11,Ne V69
M Borehole dianicter.6 (in.) 24b,air.taftfilld Wells ONLY: In addition to sending the fomi to(lie address in
246 above.also submit-a copy of this fonn witbili das;s'of Completion of we'll
12.'Mit collstniction method' Sonic constntclioi&Co t1w fallc4in
(I-C.31ic-=ii4wy.cmbicAhM rusik etc.)
Division afNVaterR i6urce's,Uiidergri).uiidlktjectioiiContrtilgroor4ikk;
FOR WATER R SUPPLY WELLS ONLY-' 1636 Afall Service Center,Ra-leigh,NC:2769-1636
13a,A'icld-(g 24c.-For Watce Supply&Inject' Wells.
pM) Method of Also sobinit one e6p), of ibis
f6inr i wilbiii 30 days of completion of
Imsinfecti n typc� Well COMMICtitHi Co the,Coonly iWa'ith&pqrjjnCM of the COURW when:
0 Amount: conmictc.d,
FonnIGNNI-1 Noilb Caiol'uta DeNamin ofEnvirojuncittaud unraml Resources-Division*Mlalcr Reswutm hcyLod AuSust-201.1