GW1-2022-05223_Well Construction - GW1_20220531

WELL CONSTRUMON RECORD
This form can bc,uwd ff�,iifvgteai mWiipk wcUs- Tar Irtcrud uso,614)�Y:
1.611:6ntraetor liformatio.n:
`M HATER ZONES,
Chris Ruffer FROM. TO ONSCRIMON
V4'01 EoiStrattar ltame. ft. ft.
4223 A
NC-Well NatractorCerfificationNitirEer AS.OUTER CASFNG(Mi maIti ci it metlsA OR LINTR fif.4
FR031. I To DL4ZTETBR, -1 THICKNEn 11.17,11.11
SAEDACCO Inc
colv;oly Name OR I
FROM To DMAIETER.- THICKNESS' ATATERML
0 R. 17 ft. 6 in sch 40 PVC
'in.
rt,
ft
itd(cwiwdl Use),-,
Water Supply Well:,, FROM 1110 1 13rvarcTEot, I E THMCNIINS• I 'MAURIAL
0 A&Ti I i�".Itural Mitinicipalftbl-Ic ;i! ft. 17 11-1 6 in '.026 ss
-OGeolitetmal(Heating/Cooling Supply) OResidentialAK'atcr Supply(singe) ft. R. I
01ndusfittKontutercial ®Residential WaterSupply(slared) IS.-GROUT
FROAT - To. MATERIAL ENTPLACENTENTAFMOD&AMOUNT
0 ft,.' 11 W Portland Tremie
lean-NiIatir Supply Well:
Injectiml Weil:;
Oft0cr-9 c c.h arg 0" MdrqujiN-ater R61cdiatlon 19.SAND,1GPMTL PACK fir applileaTAY
- - I
'QSjlinii t1 irH4'
y 1. cr 32 ft., 1*4 ft, Sand 3
QAquiiCr-fcst IOSI'06mvat.ce firli'qagp
btxpMwcobl Tcchnolpa, M�obsidcnce Cowpol
"VI.DRILLING LOG 614ach addiliorml shedslOwcesvilry)
04jeothermal(Closed Loop) otracer
FROM' TO PFSCRn`T10,%(o1or.hordtic".sq-111owk fy En�i?v.de.)
EIG&-iffiennal(FleatinglGooling R tum) E10ther(explain udder 921 Retuaiks)
2-11-2022 wal M#EW-46
See pap a noteSL
5a;NN1,01 1,ocation
V J_jr I
Che mours
Pdclflilyji I OivTr Nume Facility iDR(iNFO abjc)
MAY .1 1
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft, ft
White Oak, NC, 28399 -21.REMARKS -------
�2.-�k-
Cumberland 32-27 is a 6 in SS sump
CowlLy llamcl ldejijifie,�lfipn No,(F1*4)
56.Lititude'anil TAingitudc in
N W I Chris,-, Ruffer, 2/11/2022
Dale
6.Is(at o the MiPertuatient or oTemporaty, By-si"gnins jhIsfarim I hereby certify Mar Me ireflfs)wain(imere.)wruinicied iu.uceordcncr
ivith 15A AICACO2C.0100 or 15A NCAC-02C.0200 lVelf Cotwthicrlmr Standards crud fisWra
7.Uth6a rejojifto,an 0xistinjivellf ElYts or MNo Coy_bfrfjjf record hOS j,,71 p,,j.jded;;jjj,y:j�rjl oViler,
(,IWJ*47 k?cut o" twul(�,xpfab;Mierow.r1re of the
re aran the 23.Site diAgram"or additional well details-
- I'You-to ay use back of this additional well site AkJfls,or[yell
8.Numberefwelli constructed: 1 consttuctioit'de - Youirlay also altach-additio'jlal pages if necessary.
1W�t�ixkqe ivevX1441 C�rux-1-u Wier ptpAy ivc7b,QVLV.midi rfie.sattir constnrctlan,volt mi 0
'19a(Mai w,f,F",- -SURNITTIrAL FNSTt TIONS
9.1Ytihl tiell depth below land surftk 32
24a. Foe All Wdls .,Subndt this fifinh%vithin 30 days of coutpletioti of well
A,r ,�ir, fipfr tdl 4,1j61fdo,refi2(exampAr-M 200'and 2@M91 .6risthictimi to tha Motouing;
10.Static water levethelow top ofcasiuWt A) Division afWater R000keg,Information Procming,Unit,
If)Mi?e i ;�+,, 167'hlail' -Scrvicr Center,RAlvi 99
Leval h Virove edifox tue h,INC 274 -1411
I I.Borchole'diatucteri 10 in 24b.En_r Yk.ifeeflo We Rs In addition to sending the f6mi to the'ad-drm in
24daliove.also s0iait a copy of lhis:fbnu within 30 days of
CoulplPtibu of hill
12AVielfconstnictlon metl0d.• Sonic consituctiall to[100110%ving.
ji e.L r.rma .aibkAiTcdjasXr1cj
Division of Water Resource's,Undetgrouud Injection Control Vroiram,
FOR WATER SUPPLY NVELLS ONLY- .1636 Mail Service Center.Raleigh,XC 276994636
Vc..For Water &Injection4ells:
13,1 Vidd(eptu) Alctliad of test:
Also submit one Copy of this f6f,ift within 30'days of completion of
Disin(Minu type— Amount: NvOl copsiniction.to the county health department of tha'colimN.W11CM
commuctcd,
NonhCaiolina D,-patta=.ofErAiron=iL1and t4arwW Resources—Division ofAlater Re-tau Revised Augur]20 13