GW1-2022-05240_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD For lutzpW Use ON.LY:
ThEs form air be used fin.single or rmi9flok wells,
w 611-16utritaor Inforolatiou:
I J.AVATE R-ZO N V S
Robert Miller FR01111
V6101 C00radorName ft. ft.
ft. r ft.
2675
Nc,wcll Cdrdmorar CcIlifrAtioo Nuj&c'r I&OUTER CASING(f#)r'mnM-ci%4'wcM.4 OR-LiNER ak?Nible)
,
FROM I TO IDTAIMETER TH T MAIMM
SAEDACCO Inc 0 ft. 50, ft. 611
c4lop-toy N;3ulo Id.1NNER CAaINGOR-1
FROM TO DIAMFTEW. TIMICNE MATERML
,rj,f rL
Water Snpply Welh. F14 MAT 70 DIAMETE'R I ST.OTSIZZ T1jfCxNF_-',S 1-MATERTAT—
OAgTicultilmll 5 0 fi: 70- fi.. 61, 8n 0 .62 Sch40 Sta:inleiss
Mmilicitual(HcmingfCooiing Supply), bResidmi a]Water Suppjy(single) ft. I ft.
131ndustrialfconimcicini OResidential Water Supply,.(sbamd) TA: ROUT
Mrrioatian Fttosr ., , 701 MATERIAL
0 ft. 441 (L Portland trimi
Non-Water Supply NVpll,
rL
Injection Well: ft. ft.
bAqui(cr'9ccfiarge bddro'llyidis'licr Rcin6di5t'iob 19.SAN1n1GP,%VEL PACK(it appliwbN)
TROAl- 10 MATM%11
ccoveq RInicir­
MA fkcr cis I 46nni, 471 ft.-F751 rt, Silica Sand 20/40
qu Test watcr PTItriiivc
V N I h ft?_
,p�riwcnta To,- nology bsnb5idcnc�674MI
-20.
MCheothennal(Clukd Loop) ElTracer
EiGmitenual(lleatinglCooling Mum) 00ther(explank under 921 Rewa&)
ft., (L
4.Do te Well(s)Coulpl eted: 2/20/22 W ll JDp EW-61
f1t. I V r L)
50,Well 1AICationi
ft.. (L
MAY 3 1
Pacinity'lowpqr N-111W F acility IM"(ifa;pjJcabl4
R. ft, Infoi-imati:n Pro=5"w-:9 Unh
1248 Bill Hall Rd, White Oak, NC, 28399 15"N
Pj6i5edr tidrC§sXj[y.jlnd Zip =21.REMARKS,
Cumberland Three feet bentonite Seal from 441to 471 Five
Coo* Porre]ldoflific;Aion No,(PIN) f
siti.Iloke"21iii itin ftudc iti'dc I
grm41rninutcSh�'ndi n I i'al
9 - I . 0 . ot'ledw fti 22.Certification:
(Itupli fictil,OIL 1.10ong Is'sun,
N 2/17/2022
-0 1 Dale
6.Is(afe)the ivell(s)- xiPernianent or oTenkporaty
fty sisidng.ikitfiarw,.I Ircreby rerfify tha!4hr ivel)�.q%-ay(titre)
w0 15A ArCW,02C,01aX or,JfANCACQC.02©DRitJConatrticrlarStarrlarrJsaiirlrJasrra
7.TN"thbs'a repairfopin ribitjpt*,O'cll: Me�� or ENo
P %V11 Mow,
23.Site diagrant oraddit.ion,al well OWN-
You R14y_uie die,b5ck-of dils page ib'01&ide additional well site-deug or well
S.Nottiberof wells co,ustructed: cousttuWenl'dei�irs.'You,1114V Aso afinelvaddifi6imi page's if necessary.
sufmiif me form. SURNIIIIALtMETMONS
9.'Totalivell dep Surflie 1
' th 6etowland X. 75 Ard
(ft.) 24a. Par All- l.s..'Subial't dtis ft�nn%%ithin.3b'days of-contp6ion ofitiell
For"MaMple Com5tritciiiIiito did fbilovOng;
10.Static water level below top of 6qinw, (ft.) Di.vis I inii a.f Water RLsource-ijnffirinu66n Pro'cemin",Unit;
if»vwet level is abo"'L."Ifyg,IM Center,"eigh,'NC 27699-1617
I L Borehole diabirtek:10 (in.) 24b.For bifeefloif We.].NONLLY- In addition to sending(lj0rfdMj to(he address in
24a abbka. aIs6 submil a cow'd this fann within iQ days"Of-complMoin of tw-11
12.Well wnstruction Inethod: Sonic
(1'q,iu;pet.ru4*,'cnbf&diw6t V'Ush,etc.)
Division ofRl-.tterResources,Uudcrg"iend lujedlon Control Vioglrknl.
FOR WATER SUPPLY WELL-90NILV.- i636 MA Service Center,Raleigh,NC 276994636
13a,V'tdd(gppi) Mcthod of test. 24e.For Water Supply&Injection Wclls:
Also stibfitit one copy of thi&fdrni wiffiliti 30 fts of conioletion of
ljb.bisintpeti'an'type: Amount: AVC11 construction,tG'the county health deparimcrit of the coi'jWvvkrc
constructed.
NortItCatolinaDepaninciaofE",itonnicima.nd Natural Resoumes-Division of\AralcrRMLrO� Revised Aqgust_Y)13