GW1-2022-10407_Well Construction - GW1_20221116

WELL CONSTRUCTION RECORD Far Frdcrnaius<t3ril :.
This fbrr4can be uscd,fdt:aingie 4,nurltipk mlis
1.Well Coiiira(etorIFiforination:
Brian Ewing FtirTrl: TR DkSt RtpTlt]\
+VVettcvrsirrstarNatrns ft. ft. i
4240-B
NC,WcucontiactorCcriife6tianNwribe &OUTER CASINGftaim�rFllea�c71"viclls Qit<[iCIERftfd'FIc"abk]
F7tOAI. TO ' OMMETER t 7tItCEu€Cti 7VIATLRIAL.
SAEDACCO Inc
�bntp,ut}ai�t4. ;6 IN33ERCASING`OR_TL'BING �tmcrinttcEn�eddj+r" 'r:"
FRa'%1 TO DLASfETGR.. TFftttiNR55 htLTt R.L�i
2. C113RSti1tCtit7Al lei ntt ': 0 ft. 15 ft: 2" SCH-40 PVC
Ia tKtrr.�iriaihdcx�rd imritx(i-r Cnunrv%Slrt Tari"-e.l(3`exti[�r10,
3. Well Ldse(ckocl: ell aye} 27 SCREt '
«'atcr$itltltli S1'c11: 'Fn(1N1. TO otAXFTFR, 51cOTstri. TfitCKNtSS MATER(At..
15' ft. 25 ff., 2" .R .010 sdr-4O PVC..._,
l�rAgricYtltntal [�14i�iiiictpszVP�YtUGi:,
Ceotlrertttai catin aoir 5 I l ), bResidential Vatersu ��• fr, in,
3 >nP.Y Ppl3`{siu�le)
®ltidustiialdConttitcieial E3Rcsidcn6al'4i'iter5uPp1};(sfrtted) ,FRO RO[Jl'`"To, liATEiFIE: t;to'LACfNMNTaiunioDSAIVIOUNT
F7lrii ation. 0 ft. ii ft:. PORTLAND TREMI
loon WiterSupply,Well:,
l�lafo,torin, % :[711'; nirr3, •.= ft;
Inj clitr�tvc[t: (4 fu
E)Agtitfcr*dWrge C(Grouxidtmit i fic,*dint on 191,9.1. D1CR AVV 1'ACfi fit a r ilkatotol
'M)Aj % - 1VfATf,1FtfAt. KSEPf:A(Z%1
laAtltlrfCr$fOiJ�C ATpdeCOFCt3` GiS itjnn>3nrne r
13 fY.: 25 ft. FILTER SAND # 2
CIAt)tiifCrTCSt ❑J�tOrnlii7tfCCl}PtiY4'CoC ft. CC111I mcntnl'l�hq*gg iJSalasid�stccCorGm1
�.. �20.bffiGll�iG�I:OGr(nNaebad�tifon"�sheetsitnrressarti
OGeotttenfutl lose!I uop) 17Trar eY VROAI. TO DESCRtrrno"S cubr.na01icry"ia'n>rr sot.WA
l7Geothenual(HeatinglCoolfn -Relum) OOdter(explain un&r#2IRemaiks) 0 ft, 15 ft; FILL SAND/SILT MOIST TO WET
15 ft., 25 R; MOIST SILTY SAND
4.`Dite,�l:lt(s)CciniplWtctl: 10-5-22 ii,]I]p#A2MW-BG-S-01
ft. k
54,11rcll Loc:ttuio E M. �.
Seymour Johnson AFB ft ff
P'aoilit}•,kDvcmrNunn dtgplical O, fl. fti
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft, IL
If>fr�sa3a3aa] Pr t lry;l
110S}cu9 rttldress Cate 4nd Zip 2t fzlni,lRfiS
Wayne BENTONITE 11-13'
CtrtrtYi]• lrart�e9 l�kn�liriuiliun N•a,.(FIN)
31i.,I ftihfdc`and I frngttutle in ticgrccstmittt tcslsccDnds tnt dccirr►tl tl_"Yccs 22,C'citificOioil:
(ittcil t`coil;W>L�1fli�7t�ri��ti wich,Ck:�1? .
R' � . ,W.n 10/4/2022
Sig€t�tnr�afCertFlavdPrcil'Cgntcrctar_ [late
G.'I3(arca the\\'Cll(s}: �IPI'ttnAlierif :irY .L]TtltljlOrll}', Hr rirnin lrrif:errrr I lreeiby CCr16,1hi1r,f1w urlrs nux wem cpursfnrcird in-rteeojedance
xltak"jS.t NCAC-O�"C�l(Xt or 15r1 NCr&67,.4,1.40*elf{gna#rricrlair Starxrrards Knd tree�
7.Lv this rr rcpnii to ptri fit st et;\t'cll: Mj!'i .fir ENo� sr ri nrirrr,
d/r#rs[c,a r��tu�llP�t.C�it,nw x�at{�»sstnrcvturr�arfturiatrrlinr mrrr�ap7ra3a�r4�ru�rrr�of t7ic � ,
ilCeicrt riridt�,r#2}rsanrAr:ti tr,�r acexn fhc YfiA of then f6rur. 23.Site drngrancoradditional well details:
Ybu'nra}use 41k hack of this paI'v';ta.pfoiiide additional well site jditails go ti'elt
.I pm t_�rt►f\i'eits ct nstrtti ed: 1 constiiictian`detaiCs You mac A6 iiliach-additionAl jiages,if necesIsaty
Fear•mi,ifir♦lc 1tjk rkan cr.re, r-it�t�'r sa d+(r Deb*t UNL}'ivltd�rhesnrpz tv�irstructdat,yixr.r a
ntv�;4-�"rird
fi TI3t4f[fT',t :Ift'S111 't'7ONS
s'K+tu+ � ..
9.Tatalic€It ileptL aelttir hind:surf�c 25 ( ) „24a. Fdu Alt Wrllk 'Snhridt dais fdtnt within 3(I days uf''compldion of well
For rrtafrtd+dc r�crdr lxsi r Pith 'i�rif�i€cnt fcx7rrr�P<.i�'2i}tTawr��:ftkTF ctinstmetion ttro five fg6lUVF,.n�..
l0.Static\\°after level,lr+elow top of easinw- (i�� n'of Water Regoai r��wy[nfurmattpn lstnicrtiin�13nitr
ifiititat1.°s{�rls,vdnrc, sPt r " i617'Alait Service Cctiter},Rflci 6,xi 2764J-I617
11,Borsltotc tlianrcter:8.25° (#n.) 24b.Dr filla,iti�ONLY:,;lift addition to sending the foriu to the'address in
24a`aiiore also sitl tiiif a:copy_�of this farm ir�ithiii jti da}s`of-critnisletion•bf isell
12.kcitconstructiou inethod: BORED cotuttuCCluiY to the d'olltiwi ig_.
(i�c.aucr.,rutaq cablc_diirctguslt.etc:)
Division of Water itesttutrres,`Ucrdergrutind Injeciiou Coutivi)t rbgro!n,
FOR�1r`ATERSU'PPLS WELT 5 ONLY: W6 MA Scrcice Center,Raieli;h;YC�27b"-6UU
13:i,11cld(gpm) A3etUnil nf`tcst:
24c.Tor WatcrSur ply&'fnicetfori Wells:
Also subnnt one,eon'wifiis f0ittt iSithin 30 days 4f.Conri}letlon of
121i Uis3tifYhun,tvp Ai uuni: -iecll eomfilictibi,to the coring*hCA6 4.lrt u 4,o1 ihc,callw-where
• `- ct�nstnictcd.
Bunn,Gt�?l Norl�CwoIIrtaD4udna:ntof'&wifonnicntsf{tdVirmallGwtnecs-D_, �tIonofRrntcrR riux PerisedAuguA:�itl3