GW1-2022-08778_Well Construction - GW1_20220909

WELL CONSTRUCTION RECORD For ltftnul Use QNlti
a 'this form car be"soil for sUTX. or Muff ri le nttls
i,Welt Contractor information:
14 UTAMRZ0140
Robert Miller MOM rtm tlt ticRtltllnV
n. n.
Well Conericint!rune
2675 l5 OlTtt?RCA$119 irentiiHAcaard"ascB. ORi
NC Well ColasntarCenifem"Nuot v mom lA I or I TirtfMSS MATF•RIA1.
0 tL 7 R. 2" is. SCB-40 PVC
3AEDACCO Inc Fnt)y E8CASINGORTUR Gi [hrrmatetesrAanri
t:an• rm Naiad R Tmck'N•ESs HAIERIAL
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2.Well Constr a"i"n Perrn A.
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lrrt ertl a1)p.+linrAtr wrlrpctmfFr fi.r.(blrnn.Saatr.turfniz<+r,1,�',etti®1 rn-.) � fi tot
3.Welt V-9(OMCk well n!tel: 0 S N
wall]" iA 1 MAURTM SUIT sm: 'ntll"Kivt:�'S MATEitirAt..
Water Supply Wrll: 7 fl. 17 ft. 2^ 010 SCH-40 PVC
D Agticulhnal t:001unicipal,"hiblic
fi. f6 m•
DGeothemutt Supply) Ditesidetitial Water SttppR-lsiirglel
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alidustllatfConlntercial riResidertia! l�er St h tsictedt
PR01f To3fATEREiL ElIPLetC7ML�T H�ItIHtr+Q►h1011%T
❑1ni tion 0 it. 3 f. Portland/ to
Non-Water Supply Well: n, ft.
almonitoring DRrcatie
njeet on :
QAgnifCr RCch:tt�t;'c OGunundwilu Retnsdiation t9.5AN 1t \BLPACK'fif aprAMIM0,
ynpy TO \i•vTFtrral, PSI r".1cir m1: 011
oAgoircr St"c turd Recovery' DSalinity°Binicr 5 R. 17 ft, Silica Sand 20/30
❑AgnFfer*Test O.Stormworcr ihnimape ft, ft.
❑E,xpennici tal Techootog ❑Subeid€nce Control 24.DRIT'U ti 1.AG attach additteaidsheels'K:acecs
Meothenual(Claud Loopt ❑Tracer FROM it► at+�cttrPnO�fus�r.saNaacr+�fur+icr;n �ctc.i
❑C>eothennal(Heatitttt Coalit*Retumi Dthbrl t..,' 1,'nn under#21 Reuraadw 1 0 fL 17 f. Tan silty sand
ft. tt
4.Date Wett(s)Completed: 8-16-22 Well tD#MW-2 "
R. rt.
ft.Well Lavabo@: IL f►.
Former ayaade Transmission
n. rl
Farililp•'Chvrcr rcrNa>,ac FactlitylAk!'if�pliafilc5 ("...•.rt. A.
Grpr;L­�CRt9
Lima-
544 Bragg Blvd., Fayetteville, NC, 28301 n ft. D%A Q/'r30G
PMsral Addass Cin_arfd ZIP 21.RF1l11ARPM
T" foot bentonit:e seal from 3-5.
Cumberland
Coat) t)arcei 1derAifit:,Uluu tJq fPi\lr
Sb.Latitude and Lorrr[tude in degrees/mirmtc*keconds or decimal dcoves: 21.certirbrtivu:
4ifveltrretd,oweLza7m Ixudliticiut
8/19/2022
Sigaatustof•'•�...�r w �•�4:�•� �•�-- Use
6.Is(art)the w'eRM'. zF rmltitUt or MTempor ary Br.+ining rhir Il rm•f 4erehr a rrre(+fhm the 11'rMs!kvf 1%n rrj cv r_nrue-taf in,arse,nhtwu
u lour 1 54.4vrrtC 0C,01M ur 154 AiCAC fi;(,',+),N)nitif Cvnirtrat ri.n1 srno{writs anrf rlxnr n
7.Is thts a repair to an existing well: O Ves or MNo ,or•q 4diti r:oml haS Arun tva:e;tr t o lftr• WI own-
fflh+c ie a rilz+Ir.fill riot$trtn+7t riot(:�fx+Nr}t'rie)ta)tf€!.rFJ$rrfirJi.17J11 e(tfwn rhr itwarr of the 23.Site diagram or additional w'rtt detaiL4:
re,wir tinder A_'!rrmakv seviim or-the lh"-(l-true form. �'
Yon noav tlse the back of this page to provide atidilional%veil site details it well
8.Number of welts constructed: 1 construction details. You way also attach additional pabvs if im:eSsaq.
f'rrr @)%fulls!'injev rhmi{N apn 1-41nrrt)ltt70s u'rffr ONIX woli dn•samermerstnreriarr sv:n)•e)rr QI IBMITTAL INCTL '1'1QN5
sxirJaire.nr fern.
9.Total well depth below land sritiace: 17 (fiL 24a. For A@ WdLv Submit this funs tcithm 3u days of comptetiou of well
F:N!tt311r1,dr t.rtts:gat trfl utrtn$•.c i€di�f",rrrnl reiar,�,pfr-7(d�GiMA'nJur Ptu•'10-rt constrixtion to the foltowing:
to.Stafk water level beldw tap of using (n,► divbkm at Water Resources,information Prumssing unit.
!tort 1.iJtnser.@situ,n+ + t617 Riait Service C:Cnta.Raleigh,NC 27699•-1617
1Jm+trr
f 1.tinrel+ttfe diameter.8.25" vial 24b.Fur Itliretfat►Wettc ONLY- to addition to sendio: It IL fi)mr to the address in
24a abuve. also ntbtuit a cap%-cif this faun %ithin 10 days of completion of Well
12.Well(ott tmction method:SSA cowstnirurnu to Cite li+Iiow'ilsL.
ti c.au;rr.reran-.cable direct Push eves Division or Water Resources.Underground Injettion Control Progr-aor,
FOR WATER SIiPPLY WftLtS ONLY: 1636 Mail Serv'lve Center:[e-mail] 276"4636
t3a y'idd
1 tic.For Water:�aEWY A 1!9V thin Wells:
i
twin Method of test Also submit orre COPY of this firtm within zu da­"softanrplclionof
%veil construction to the cormlC health department of the canal'where
13h.ObdureLlinn f_r .pr ,. _ Amount. _._ :_..._.a conotticted I
Faun G11-1
knnb Cainlum Lkpannein of£ucnotuixul and:+hunrW Rcwtsrccs-Division of water Reoui'Umn Ro ised August.Ntl3
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