GW1-2022-08781_Well Construction - GW1_20220909

WELL CONSTRUCTION RECORD F'jT Imenkil USC 0141,IV:
'11N rm"ank.owdral SOI&M undfirk isclis
I.Well Contractor Information.
Robert Miller FROM to DMIM"IN.
W01 CnIll"Cipt
2675
NC hell Cos.4mcwU-nikMion Nluntvr t "$.1A AS FROM IM MAW F 4 TIMMS,% MxTratAl.
SAEDACCO Inc 0 (L 7 (L 12" In. SCE-40 PVC
("awpul)Name i:16ANNER C"lNaORTVMMG*(&Mki%ai&��1
-
MO MM -M, I DFAAWMIt TIUMNEss HATMEAL
1.Well Comaraction Kra it M
(L
3.Well 1;%C(chv&well usiel: -47.-SCIRMW
watersupi&W& I FROM I To OTAUMM, I 51,00TWX
uAgRcultural ONfunicipaL-P-Afic 7 R. 17 k 2- in .010 SCH-40 PVC
supplyl 011asidential Water Suppkv(sinjgm (t. (L
DindusWatiCotnowmial ORcsidendal Water Stq)ph-tskired
pRO MI TO I kTMkkL FNT MMOD 11 AMOVINT
131thoutwn 0 tL 3 (L Portland/Be&Zoukte
Non-Alater Supply Well-, fL B.
ORMOvty
Inject we": ft. to
AC AC AC
Q Aquitcr ltcdm�qe 013youndwmcr RCOM446ion AC
OF in MAUKTAL
OAqottr Stomgc xd Rccovcm 08altnitv Birricr 5 R. 17 ft. Silica Sand 20/30
0 Aquifer Teo OSIOMMvcr Drainaw
DExpettracnal Technology OSubsidawc("oraral
13G.-athennal(Clued Loop) 13Tracet MON1 TO
Meadmunal ffiEatiRPjCAqqIiN Return! E30diet(eV. lain undet 0211 Remadsi 0 ft. 17 IL Tan silty sand
4.Date Wetifs)Completed: 8-16-22 Weil IDNM-1 IL ti NED
5a.Well I.AMMOOM M ft. Eu E I
Former Sunnyside Transmission fL SEP v 9-2022
Fxi]M IDNi faM
Pr-Z 'Rg UrIK 1
544 Bragg Blvd., Fayetteville, NC, 28301 (L it. W"Q/BOG
Ph-siml Addms-jL Citi.and Zip i[ct3lshtABA is
Cumberland Two foot bentonite seal from 3-51
Coolul 114tvd1dLwjf=1fi)t2N(,
5h.Latitude and Longlindc,In degivWminut"keonds or decimal dcgrvm-
22.Certification.
(it oell
11 W 8/19/2022
6.1s(are)[he wtlt1s1: MPermancat or OTemporaq th %'igning I&Y.form.I?rrrekr tvrii(.L-thus[Ow wetkt�wax i"erri omottreted jwr m-ev"fMirc
11.4rh ffA.NV'w OX AMO tw)JA WWI Coulf-m-1001 SMIU1405 erowl r)v.l,l
7.is this a repair to an miNting well: OVes or KNip r v OrW*wror.1 hv'%1w'"Pwvii4'4 ret ibe lo-11 fra-mer,
�f rely if a Pirpsir,fd(iar toomw WWI"iwt3q'qf.W'w1 mf(1rM7fhv1 E17i4 ecph'JO41 file
amdri,021 nvwrk-v.wrjhm or.m dw haul-art thiv.6 rsn. 23.Site diagram tw additional well details:
You ruay use tlx-back of this pap to provide additional well site details or well
B.Nuntber of%xib conartrote& 1 towtuoion details, You may also au'ach additional pages if nwehsaw
For waltipfe A Pv.that-v own-i,orwr ijq-#i a MY ONIAwnfe Me coat
SURAIMA .INS TUCTIONS
9.Total well depth k*hm land surface: 17 24a. For An WcU*- SAilunit this form willnu R, dais of coutpicim"of shell
For wllh�.pfe W.-IfOigieft 44"10*1440-4.,M)"Iml comstnictiou to ft folloning7
to.Statk vivw tMd below top d C"hw (ft.) Misimn ufWdter Rcsourem Information Processing Unit,
j1LjjVi:rj)rut)
is1617 AlM.Servicc Center,Raleigit.NC 27699-M7
Bnrdmk dualerer 8-25" tint 24h.Ea_IE 1VjVWqjLD4hONtLV. Inddition to sending the forni to the adtifess in
24aaNne. alsio salunit a cop.% of d I kis(otto within 3,0 d38s of cotupletion of well
12.%It"construction mjkod:BSA construction to the following.
4c.mga.rowry.caMr_dind wisk ac i Dhision of Water Ret"ra's,iludergrotind Injection Control Progrant,
FOR WATER SUWLY WELLS ONLY: t636 MAR Sen-kv Center.Raleigh.NC 276"4636
24r-For Water Suall&1p
132.Weld IXM) MrMw of test: jecLion Weld
Also subutit one cop%- of this fafltl�withio to d.ys ofcompletion of
tab.Disfulecthl"is ....... Amount: wLAI construction to the count%, hcallh dcpinnxnl of the county when:
Fonts Cult-1