GW1-2022-05168_Well Construction - GW1_20220531

WELL CONSTRUC ITON::RECO D Fair lrganwliTsc,0140:
nis forth cunbc used raT.singla or midtipk nclls
1.We1101itiaewrInformation:
14.AVATER ZONIS
Robert Miller FRONT: TO nFiCRn'fION
\1`ettCurAgixtart*tarny fG ft. ,
2675 R. ft.
INC.Wcll Contractor CcilifichtionNia ici 15.OUTER CASING tfnr meth-ciscd v!10 OR LINER tit a 'ticabkl
FRONT I TO, DRA;t/BTF R. ITI ICKNEC", hhATERIAI
SAEDACCO Inc 0 ft..1. 55' fL 6" ill. Sch40 Pvc
(cts�go m}t t tnw U.INNER CASING OR TUBING t'eothermal cku"A.xi 1;
FRONT TO DU.UETml.. I TtnCKINM I NIATERUL
2:1V�t1 Constivrtinn l'ctmiit�: R. ft. °n�
— F—E�--
LirTltll nppilicuhle tsrtll prisraitY(i_a.Comir'a:Stntr,.t�nrinrrcr,ltlrcitr'rxy eu..J tt. fL in.
3.V4`c1LTTso(chock rti ell us* V.SCRCEN'
Water Supplti�Vcl1:., FRONT, l TO Ot.AAtF;TF:R Sf.OT5t7F Tlt1(-kNFjS I h1ATRRIAL
Clr9dli€ulnnal CJ14ittnicipalll'ttt?Iic 55' ft: 75' ff. 6 im: 0 .02 Sch40 I Stainless
CiGeothcmtai(HeadneCooling Supply) 011tsidential Witer Supply(sinlg c) ft fur
MudustriallConmtercial DResidential Water Supply(shared) .Feo ROUT TO lTATSR[AII EdIPLACEhtT?Thit r110D S AhfOIINf
❑lcii";ttion 0 it. 49' fL Portland trimi
Non NVater Supply We11:
likionitoring R. fL.
Irticctlon Wc►t: fL fL
13Agnifer Recharge' tid.droundIV11cr Rcincdiation I9.:SANDIGRM1L PACK fir apjillejbl )
PROM '10 n1.►rl Rrnr. F;hlYl 1t FIIF:NT d11711O1I
❑AgnifcrStorag"caisdTrecovr1}• QS1,11inity131mcf 52-' It, 80 ft. Silica Sand 20/4b
0A4u fcr Tcs4 ❑Sdarrte tcc f)rtin►�c ft.. ff.
❑lvsponmcnhtl T�hnaialc��c I7Stthsidcn€e Catfml
20.DRILLING LOG tallach additionulshccts if neccsmryl
❑(l orkel aW({Clasen Loop) ❑Tracer FRONT: VTO DF.5CRFPTtON(cubr.t,:tr,Faic,�
06 othennai(13eatilk&Coati09.11etunt) ❑Outer(explain under 921 Rett atks) ft. fL
DateVell9 CAnI le-ted• 4/11/22 EW-55 tL, fL
4.
( ' . iYc1l IDp ?t. fL ..R
Sa:Well L#tcatiow fL ft. �n22
ft. fl.
FliGilii}aClnncrNnnrc Facl7itN7lDRtifapplia7b]e1 (t. fL
1248 Hill hall Rd, White Oak, NC, 28399 7t.,I ft.
Pltrsical Aitdies�city..and Zip 21.REMARKS
Cumberland Three feet bentonite Seal from 491to 52'
CA#Intl' I'ArE'6t tc►eranl`c�:iliprr Np,,tEIIN)
fib.I iNh1de aril l on(;ifitic in tl ltc5?minutcs?seconds decitnAI dejpiers: 22.Ccrt cation:
C)tnilt taw;Wry�alnai+Src(Itckad)
2/17/2022
sigzuttrrc`af�:-�;3,"fn:r "� -- Dale
6.Is(are)the-\1cl1(y): ttirl lDent or. oTempor91 Y I1p.szgilln�ihdY firmm,flrereb}'terrify dutr.rlu irel4s)vvr f were}cuarintered fi utY'ol hwre
with UA NCdC OZC,0106 or.15A NCAC=,0300 U'ell Coitsfa salon S(aaa4drds aald rlanr a
7.U1111bsareliairto an,c*iating'welk 0Vcc .or ENo crriso}`rhiT record 6rasfntraanrorldediq)IM.iirllmmor,
I,(at�ls"Tx a a>•,mT?r��I oar�rr•Itw#sr!!��xsnmvt�xaa rrrframtr,Tliur anal exlalrafat Il+c rmtaarc of rlre
a�la^.ra�trrrltrhZP i wlim rs araR nc im tJirIn,, of r3.k faruc 23.Site dit;rato'or-additional well detail is
You tua�use tl�Back of this pdge.tb.provide additional well site:dtrLtils,ar*'ell
8.Number of tiiti119 to,tutructed: 1 Construction daluits.'You.inay also.attach addtional pates if necessary.
for ere rir�r-�gar'er sa{pgs w<;?1Y 0iVLY wlrla r.4e.scrma t�nstrarerlar,}ter rnn
cxtt yiirawe j rra: SI1BdiITTA1 INSTUCTiONS.
9.Total iseil.deptb Wtoir Iona surface: 801 (ft a .24L For All Wells:.'Subtitit this?firm within.36 days iof'Completioti of Fell
1�oettrailrlPJorel#ll3oaafla st d(zrrertiex a{elr d 3UlTerratlb 7lk7 con'5tntctiontodtc�fgtlo%iu";.
10.Static water level below too of casing. ((1,) D10sidu of Water.Rmuries,Information kio erring Unit.
if irvrFar level JS cbave ctiaov au"+" 1617.Mail Service Ce.ter,,ltalcipilr NC 27699-1617
11.Borehole diameter;10' (in) 24b.For)_i►iMliop Wells ONLY: in addition to sending the fonu to the address in
24dabgo,e..also stilalitit a copy of this fonu within0 days of Completion of%01
12.WClf cotufrngtiott method: Sonic c'onstntctiou to iite db.116%ving:
ti.c.mar.mini}.table.direct pask Ctc:)
Division of Witter Res6urces,Underground iojedlon Control Progratu,
FOR WATE R SUPPLY WELLS ONLY: 1636 Mail Service Cotter,Raleiali,Ne 276994636
13:t,1'ield(gym) Method oftcst: 24c.,For Watcr'Snpplc&locction Wells:
Also submit one'copy of this fume,within 30 days of completion of
13h.Dlsinfection,t°pe: Amount: well constiroctidn tD the county health department oi'.the.coimtv.where
constructed.
Farn>G\F-L North Catalina W- anniem of Emirorumm and Natural Resources-DiiiiIon of\Water,ReSou Revised August2D1.1