GW1-2022-05226_Well Construction - GW1_20220531

WELL CONSTIdUCTION.RECORD For ltgcrnalutiNi�:
This form can be uwd Col single ci multiple wells'
1.trVciLContiaetnr•Itttormatlon:
1 _%VATERZONI..N
Robert Miller FROM• rU DFSCRIP110Y
}VcllCgra[acro7NamC, R. R, '
2675
NC Well CantmLiarCcnifvcationNuirbei 45.OUTER CASING(For mnttl4astd wells)OR LINER(if a'►icabk)
FRO31 To nTA�tVrElt THICKNEIM b1ATERT.aL
SAEDACCO Inc 0 fl.. 88• fG 6" I In Sch40 Pvc
001tv,01y.tiauw 1d.IN.I R CASING OR,TL78ING 1,,w1heranal dured-loo i
FRONT TO DLLtiIETER TriC"Es5 ATATMAL
2, Wal'Constrtiatiiin permit
lisi Lull appYicrrhle tscll prrmlt;li:e.Comity;S!d!r!,.lrnria"cr.IrI'eLUOt eic.j
n.. rr, i>w
3.IftMIJ5 c(chccicWdl use): t7:SCREK
Water SnplTly_Wd1:
FROM TO UTANIF.TF,R $LOT Sty}: T111MNFS$ i NTATERTA1.
❑Agrienittlral OMunicipal ttbk 88'1 (t: 98' it. 6i1 id 0 .62 Sch40 Stainless
®Genthcrnral(HeatingtCooling Supply) 13.Residential Water Supply(single) ft, (L. in;
C�IndustrialJConuttcrcial. ❑Residcutial Water Supply,(sbarcd) IN-GROUT TO. NrATERw E,arPLAccNf6\TN117rIiOD a tuotrvr.
❑lrii'ation 0 ft.' 82' ft. Portland trimi
Noll-NM_iter SupplyAVeR:
❑hlanitoring. ®Rttati'cry n• ft.
injection Well: iG rt.
❑'AquifcrRccharge' t06ro11M1W1icFRciilcdialtan 19:SANb,GRAVELPACh fill a plimblvr
'F'R0141 "1'Q' I 1TATF,RtAI, F.h1PIAC:M NT\II:T1101I
❑AituiferStora�e,ai>�lrccar;•rzT' [15alinityl3ai'iicr 85' ft, 1031 rt. silica Sand 20/40
[]Aquitcr7e6{ ❑Stomliaatci bhinaoc
ARxp;rimcntalTochnolgp! �1Cuhsidcl eColdtul
36r DRILLING LOG(nitach additional ibeds i(ticcessin
oCkotftennal,(Clused Loop) []Tracer -FRONT; TO 11M IUFFION routvr.6arthiuxi wit'nrek1 id byre,ck:)
❑GI-olhennaI(ReatinWCoollogRetuns) ❑Odier(explaur urirler Al l Retuad s) tt. tG
ft., fG
4.DateWell(s)Couipleted: 3/2/22 6VellID#EW-63
ft. ft.
&a;Well LtrcatiIIM fG ft. MAY 3 1
2022
ti. fG
oitii),bii.rxrNnm. Facility iD".(yCapplicatgc) ft,: it. nft' vie-Flrc m-m
r.ae
1248 Bill Hall Rd, White Oak, NC, 28399 ft, fG
l'h}'soul Aifdibss Cat}.:tild Zip _;_I.REMARKS
Cumberland Three feet bentonite Seal from 821to 85'
Cotrnik Parca!l0o0rw4t6pnNp,(FIN)
5b.1�ttitade'and"ngittlde in Acgmesfminutcsascconds isr dtcitiful tl rccsi 22.Ccrtifieatiog•
(if steal!'�ht,r tsrn:Icib'lall4�>arsl7i�:iCtd) •
N * 2/17/2022
Sienawm'af•: „d�%rF s :;:Y• --- Dale
C is(ar)the wello): m- Nnu rnetit or .OTeniltonry
ftr rignbrg chit furmr,l'hereby ecrtify 11 at.rhr irrll{s)xxcr r •cnj cunrtryezed in;iwr eXd mce
rvXV I3A NCAC-02C,0100 or I sA NCACOk,0209*elf L o ritrrialon S1na4dr41s and limn a
7.L5 thk a reliair to an existing Nullf mm .pr ENo eali�olrhis reerii d l i>s buea l ra»rrb�l rrr i�r sivll{nvnrr;
1J rt is tx is mp}ii,tile iw s`izuuw ruad'exp bi Me nu rune of the
ae'rirrir ezmst€r�3P ritiwrards dr�z)ema ar cvt ldm.br;c'$c�'•tJds faruc .23.Site diagr•8rn or additional Hell details:
You niay,itse•the,back of this page to provide additional Hell site.clrtails,or 1"yell
8.Numberof�r!•e lls constructed: 1 constmedoii deiairs Yati.imy als&atlach additional pages if necessary.
For aitarlllple b�e�iliui tv, fl w-Tt firer sW*Lyivrrrh ONLY w1rh rile same etinstru&1pu,ya t,c(w
ra3k,iirtrJrlj:rra SC BMIT EAt,iKSTUCT70NS
9.Total tfell depth betoii land surface: 1031 qp 24aL Fur All Wells: 'Suhntit this fomi NOthin 30 days'of'cornplction of ri'ell
For AItaW fr Irehis'liar 17td'44,Was'tlt*,ra0(e'wur 1pk,3@:0P"aexil2 I O'y C0115tnrciiah'to tluc foltouitig
10.Static water level below top of casing: (D) lrivisiau of W2tc"r Resu ii,k6 Information Processing Unit,
If none Irvrl Is above Cdsft arm"+„ 1617 hlait Service Center.,Raleigh,NC 2769.9-1617
11.borehole diameter.10" (in.) 24b.For inilrtlott Wcllc ONLY: in addition to sending the form to the address in
-2;4 abga.also submit a copy of this font within 34 days'of completion of He'll
12.Well constriction method: sonic constntetiou to lire folloii"hig:
(i .urtgcr ioAar): able,diiecr FnItctc.)
Division of«'ater Resou rces,Uudetgrountl Injerdon.Control Program,
FOR W.&TERSUPPLY WELLS ONLY: 1636 Mall Service Center.RnleighiNC 27699-1636
13st,Yield(g(im) \fetlrad bf test 21c•For Water 5_upnly&Injection Wells:
Also silbnlit one copyof this funn cgithili 30 da�'SdfCOntp18i14rt6f
13b.Disinfix ian,6pe:, Amount: well consinica to the count♦`health department of the couni l<—ficro
constructed,
Faint GW-1 Minh Carolina Dcpanment o6Endronn,cia and Naraml Resources-.Divislbn of NN'ater Reuirces Revised August201.1