GW1-2022-05169_Well Construction - GW1_20220531

WELL CONS'I UCITON RECORD Fdr.irrcrnall�s�DNIb:
ThisRTfilc n be owd faR-smtTaaa•nta1603a4 lis•
1, Wd1:6ntra06i,1nforn1atiou:
14.AVATBR'ZONVS,
Robert Miller PROM' 7o ntt±iCrttt*Ait}Y
%Iolt,+n sas4or9ame ft. tL
2675
R. ft
1+Te'.Well C6ntindor CcttifrcatirinNitr b6i -I&VUTER CAS lur snulti-rwWjI We 11! 0R IsiCiER`if a @eabk
FROM. TO DTAME,TER TMCtu'VF„C+3 ]ILAM AL.
SAEDACCO Inc 0 fL, 43' ft. 6" ;a. Sch40 Pvc
offfiptnj'.MocrrC. 26 fNNEH CASING OR-TUBING 4berabentjzil ehrsr:d4,)o
FAOAT Tti DIJAMETER_ I 7mct,'INEs9 hLKT€ ki.
2.Weil CAnstivctiiiR j'ei'ritt w: ft. ft v!
lrstdrldnjrficahlr..rsrdlprisrc ft.a,(.Ciurnhr;S1lr?c,Ynriarcr,14rkd
ft.
3.'Wclt.T3sc(chocl;:tvi li p5c; 17:SCRIIN.
WaIerSitliply W ll* "FROM 1'To= tstAMF.-TEK stOTMZx; I 1"01KC mss IhxarPRt4r,
bApicuit,und i hhtnicipalfiatit)lic. 43-1 ft: 63 M. 6" 11i 0 .02 Sch4o SEainiess
Mco(kintal(HeadoeCooiiag ipiy) Mesidenfiai iter Supply(single)
CJ1nduslr1,WCdnuilerc1a1 OResidential Watee'Su T8:GROff
ppf}:(stklretiig �FROSI. To NUTEREAL EXPLiMIENTatsrnon&MIGUvT
[7lcii ition 0 ft.. 37' ft. Portland trimi
Nou-Shafer Supply Will: '
ptytotsil©rn.�- I�zte,4,oiri}. ft.,. ft.
IhJceiiirTt Nett;;
"Atittrfcr$ech3r e' Hti+Gmttiuissifcri#etitcriiaiioaa tv.SANOtGtttlttl t+w[I (irs ifte,aat�y'
n
F'Rfi1f T€i +riv'rit{4r. rift 1f1itYt 15fi.infiti
A4titaef f lortge-andAe6vcl}' l�Sa9init}l3�tracr 401 it. 6e r fr:. silica sand zo/4b
❑l9tittif"I Test f7Stomm tt. I}i yioa c
• fl. ft.
(7 ^nmc1161`i),:ti@Cc� *. 4itiasidericc:t aidtFl
'2a21iR1I,LIitiCLOt;innaehaddittunnlsbceisifrcccessnri•i
E)eodtetn all(f;lused Loop) ❑Tracer RObr 1,70 DFae}ttetloxtcvi5r,tiardric iaiA°Harrel"r� -ri icir t
❑Gt titertrtnlfFFIeatit� ocalitt�.R5tum) ❑0Chertexalaiiiundet•.92tRemadss1 tc (t
fL, tL
4.Date Wett(s)CQttlpmcd 2/5/22 1INfiW-60
... ." .. WH ft. tL
ipf;i4"dtLocation: rt, rt
Uritt
tit}a`t3ir�acrNnntc F�ct�ii�IDrc iaf'a}ri+tisahlc) ft, ft, y ;
1248 Bill Hall Rd, White Oak, NC, 28399 ft rA
P114•sr irlAiG]rest C.it}_�ctd2ip 21.IZF`It1A1t1iSg
Cumberland Three feet bentonite Seal from 371to 40' Five
Gcailcli 1rc]1t>rrl3�cG9t1Go N'�..f&It�7) foo
l #ifirda and T ntil, li"iri.d grecsJrniitirtcsiscconds;or iecernal+legreci: 22,Ccrtifrcatirlii:
(tt`�ivti f�;.4t.`tst�J�t'tl7rria�i�,crsffis'�rd) •� -
K .� 2/17/2022
Siwrcat 3rwlc rs ti'�"- Uaic
6.1s(are)the well(s): MP6ri"aftetit or OTeti porary. H'y sr`grlirrb a}re�f.jorm:1'herrb}•ecrf%{p.fliw:tdrr n'rlf sj vats yt'eb}curavtrurttrl ui.;rrc`t'er�xlru�cr
iritli15ANCtC0.?Cffl lor15AMCetC- CNA79;tfeilCAirattric#airSrara&4u wid'Mar h
7.Lliti a l!ci8rr d aft kNt, �.
esfiy;t+i rlias rc�Qxrd hrarGr€ta prrnlrk�ra.ttae rr>yrl mr"r�r.
:fat*ar�axarrlerdrfadliaar,firrcxnwir�l't�tirarevia�ak�r°�rrr+i�t.aarararlcr�7aT?tt7rc�rararrarerft�trr :
..r^e'�narrrui r$ Imu�ek5.�xr d�ararli-cuttlrcd+ruk-aj;rJri.joFuc .23.Site diagranior additional wdltittait9: .
Yan tuay use tli Uack of this bags,to praiS7dk.addirional well$iCe;detaih$,or in 11
8.hintiber of stills constrRe d: 1 constriictiuii defaits You.inat'atxa attach additloiirt'Ogees of necessary.
l�xa�atrsidti�tc, rka�ra�tarvi-i+�ir�te3ir�a��u�P7�t?A'L}'utth rliMsrrre7a�uskeurJFirn,.e+�aac•icrra
r wriicnuc}teiri. SLIBI i PTAL1NM[K"t ONO
':Taticlldeptit:betorci.tuitsurfaeti 68 r {irk "2dsi lar Att.l,reftg "'quhritit f1►is fdmi itiithin 3f1'xlays Of eomp[efiriri of µeit
Far•,rrrai,'a�,n7riitttsdicomrPtt� ilyd �ritirxrrrr�tr=a'"e�00'caruS2�l '# CvnstitiCfiorek49hctoit9uina;
10.,Statit Wat&level Ulm tuffs of caisiitfr (R,) Ili'isiop.ufWater 110ou rce4 tnformaf'ion Processing Unit.
ff ai�aierder�Fu`rhar�t�i�int�-iris"�" Id1'fihlaitSer►•icc Cr'.iiitcr,lt:rlei��,tir 31iC'2"eGrJ�-1ti17-
I I.Borehole diamctii-.10° On.) 24b.Fh,Vniecition W019`01'tM in addition to sending t1L-forni to ilwaddrm in
24a abnce of snhfiiit a.copy of titis fenu within 3D da}•s ore6nypletinis of tali
12,NVell cnnstmetiou method• Sonic ronsi,udiod iatit folloii"iji'.
ti:c.auto.ruin} cnblr.dueci push ct�:k
'Division a If WaterResanrcei indergro ndInji ifouControll`ttiiftanl,
roIRWATER sit'ppLy NvEw oNLY:' 1636 blitil Se`ffiee Center.Ra1eig1i XC:27659-1636
MA S'ied(gpin) lictlend�oftest:
'i4c.For%Vatci�SiipiRlc d Injoe6n Fells:
Also submit ofti 6pil of this forth within 36 d4sofcotnpletion:of
1311 Dhsinfixxtiun ty a Aru4unt: vohi.cansfnrcdiin tis the cast}:ticOth deparimcnt of-thd corrntvat•hcc
coi�sm�cted,
FartnCi[61-1 vntdh C3rvIlna Ckpaaa cm of Errvironnrcta ai�i�arrtr�l Rcsaurecs-ISiialuR of`tra�r&terntro� Rettsed'Atlgusd nii13