GW1-2022-10415_Well Construction - GW1_20221116

WELL CONSTRUCTION:RECORb-
This-£ntiitcan bo"nscd-Fai,s pl ie ar tmrltiPL"u`ells.:
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Brian Ewing Fsl1,r1 a0 PtSRtRTrt?N
}clt+Cp"relrarJortinis�• ft. k.
4240
NC Well CantiacrorCadifrt i ion Nih&e AS.OUTER CAIS f*]G(16?muttl=ta®cdwllsi QR GiNER i1"s' Tlcahk)"
FRONT TO [7:
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3.Wcll Dsc(Cheelerscll use): I7af:KeEM. _
Water$tppt E4'ch: FROM. TO PUi,et:Trit st.nTswrx Tr#I"00—Ss MATERLST,
0AigT'ctdtural 0.M►uiicipald'itblie: is ft: 25 (t 1 .010 SC13-46" PVC
❑fscathetn al(HeatinglCaat ng Supply) ❑Resfdcutlal'atcr Supply(single)
❑lndustrial/Ctmwtcrcial Mesideutial-Water Suppb,(shared) FROM ,TO, hLAT6RrAI. 1,EMPLACEMENT LAC£4TEYT\ti f110D$'Ah1UTlN7
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IAMnnitoring. t7Ftccoac>5' tt.: tt,
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ocrevIhcmiul(ClusetlL-oop) ❑Tracer FR05T I To uFsetttTTtO�cttar.uera6Cxr,5ripridettt.,�>.. nor trt
❑Geoiltenuid(Heatirp hgMuni) ❑0deer(0-p1ain under 921 Retnatfis) 0 (4 5 ft FILL SAND SILT
5 fL, 10 ft' SAND SILTY MOIST TO WET
4.T)ate:FYell(S)Gunlplwfctl, 10-4-22 ylriillp�tA3TW-S-02 10 ft. 25 ft, SANDY SILT WET
S t:1 t 11,Ltieateriu -ft, fi "( La r 's V r '
Seymour Johnson AFB It ft.
Fac7iil Ox;ncsTlanc fkflay IDn(it -",We) ft. ft
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft,, ft. (friOFpi3adr1 i.Cwv g(lf{Z
Plt}sscal.Addrss C3t), itdZita =2T_RE.MAICi..q_r_
Wayne BENTONITE SEAL 11-13'
Cfltrl�t�' t?an�ei td,ml3�erlic u rJa,_(�itV)
b.I�tihrdeand 1�Tajetttrle rri'¢ggarCslmtnutcstseconds ar'ticctmal drecs
or*o Al fa K,eur41010 4,is mdricktd) Z Ccrlifit skiori:'
N V4` Br. rl WI'lr, 10/13/2022
Siac�3fiii�of Cc¢tificd W ell Cantrxtrdr Dale
6.Is(trYe�_tare-1Yp11(S}: I� ltllfltient or M- Rirtporal'i'. IJ .ri dftt d�ix:arm 1Irrrrfir f errtr s tliieJ rdu vr119 v7rx W'er, crneYdnrCted hr,weorrl ce
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With 15A XCAC 02C,01A7 or 15A NCAC 02C;020:KW C04;1aracdon SrrarOdrds an d r&r a
1 is thus a npirtr tit in eci:atinj rti'elh El'i'u or t31Iso cry7r_aft/�is�i iorrdhasL eeri pmrrrfrd ra_i a:�rrri irw;ucr.
{l tttPc ra adr dd3 i t 4 zotw wtiP e�uYraavtavr&tfyydrruttt wr of the '
IY'�Ui.t1'rLClltKr?31 aY'vW+aF,E.%5YYI6'3Fd t1F rA7 fldl,l�itC •re�t,lYS'/U Falr. 23.Site diagram or additional well details:
Yon m )tse•die back-of 119s pagr to pia}td�addrtisrtra!well site,d�ails„ar well
S.Nmtt erof W6Ils a ustructed: 1 c6itstnrctiart dei,�is Ir uirta}al oauach iuidi(i' i pages if> ccssaiy
Furst:ifiilaleYr�Ferk�ia,,rd,�iMuievrar�p�t�rr�1�;U,1��Yir•1rJrrlirsrrnea•riiirstrnrtFodr;,i'r:u.rrrfa .
rvP�vrii drys i�ri� SUBMITTAL INSTUCTIONS'
P.'Tlttblwalilepth-belowland surfa�e. 25 (ftl �?�,For All♦►re11K; Siibtidt this fanii vtitivn 36 clays af-coitipleli6ii'of iiiAl
1�r�ditrF��iEi��ctl�diart�S�ac�,td`�iir�dilta,Yrru�iPe=:.���t�Te�r��!;m�1�f1}' f9�5tniCtiOn"t4thcfaltptiin�;
1t1;Statie water Icr'ei below tarp of easing, (f4) 11i0siou of Water PruccsSing Unit,
if watet level1,i7h aw,exr(gX tar+ "}" 761714Iait Sea ice Ccafc"r,,lt iicin�;lr, V("27G9J-1617
It 1,I3nrehotc iliiTllletCt.2.25" ZOO 2 Ib.Far FoIC&Ijoll Wiliq ONM': .In addition to sending cite form to the address in
244 able-also sabinit a.caps of;this.l`anii W ithip 3(i da}•s of completion,bf iWil
12'Wcll cnn3tractiou method: DRIVEN Comtructiaii ta`tlee t6li0rihw.-. "
(i:c au�Acr.riatrr) cabledrreetpiislietc.l ,
DigisionofWaterResaumT#a Undergmundlrtj%ciiartc6mrolProgram,
FOR NVATER SUPPLY WELLS ON X 1636 Malt Service Center,Raleigh,NC 27b99-1636
ZIC.For Watcr'Sataply k Injection welli.
1,3a ticid(Wni) Method bf tcst: Alstr"subnrrt a eop}' of thta fuiiiT"tisith" 3(y da}'s of completion of
131�.UisinflYtian•tVpet Amunnt Ave11 comitnicuon to the cdunr,T he"allhi dclaartrticnt-at thd'ccnrnh,,wIrr ru;
corimuctcd.
Farut City-t Koh Carolina Dcpanntmu at F Revised August.26t3