GW1-2022-10416_Well Construction - GW1_20221116

IELL CONSTRUCT IO'a.RCGORD Fie1t��,�rtU�alai
Tbh form du t!C-"w l-Firr Sfur,1 or tnalkiola neEls;
1'.Well 6iitr.•fctorInformation:
I4.WATER ZONE:S�
Brian Ewing FRONI: to i►F_5f rtti*ft(?N
1t'cll.£oiiita�Iartvairir; fT, fL
4240
]iTC.We13 ContiacforCciiifucaticnNunlrc 15-OUTER GASUNG irn�'mutii extived�aet]s1 RR LiNF i{if g"Picahk)
FROM TO � PTAIRETER,. TUTGF:RES'i RT111AL-
SAEDACCO Inc h' 1°
�f'prt�r,'tft}`C+lant(: td.INWR:CASING ORTt1B1NG", itierntalcdttsi:d-loon)
FRONT 0 [OWMETER.. THIChNFS& AtA7
2.Weth,Cotrstr stioUPcr[itt 3 TOM. 15 ft. 1" IL SCH-40 PVC
l ist erldr.}ryilictihlr.rretlpermatE fr:e:'Gbull%,S v,vat-farce.Fi Lrual fm-j
rt. fL m. _
3.'V�elt.iisa(chrcir,crclluse�: I'1.!(R�F'N __ _ __
Water S"okv 1VO4 FRONI: VTO nrtutTFU _scorsrza: TH1CXNt'ti5 MATKRTAT..
bAgdci`6m,t. L7lviuriicipalrl'tililic is R: 25 ft.- 1" In. .old SCH-46 rvc
mcoftmial aieidngt'Cooling Supply) �gResidential Water Supjy(single) ft. ft;,
0 bidustiial/Conuiiercial OResidential Water Supply'(sixtmd) �o OUT ,To. nrATs[iw,. i ater�c NT�v'r Nrr OT)& MOUNT
t7lrii"iltian .r_t.' fL
Non.-'GVater 5upp1�WciE:
�hlpiiifi4rin�- C]Tit�trti-rly �•, fi+
Injection well: ft, tL
E Al'urfer'll CChar a gGrouridSS~i(crllelucdiatian 19 SANWGILWEL PACK(it a plitabte),
- ' "Y).. r1WrFR1A1: 1 KiS`f't.r�t}fir �iT 31t_Trit}n
gAillrrf�r Stori�C alb lxfie44"£ty gfi�fpri>3 irric� 13 �f ft.. 25 ri. FILTER SAND # 2
gAelurfc�Test q�ivtiim�atcr f}rteii.36c
�ft•. rt.
13j�. cliwcnb1TmAnOOgy p$tt}tsiit rtceC"Wrol
20."DRILLING LOG6iuch additional sheets if r►eces"ryl
i] oiit nluil(Chdsetf"Loop) dTracer FRONT° 'FO bFzGRt4T10�A»br.is"nlricc�s id'nrek tca in o- ,i9st
OGeothennal ftatit g{Cobltu_g.Rewm) 130ther(explamtinier 921 Remadis) 0 JL 5 rt, FILL SAND SILT
5 -R., 10 fL SAND SILTY MOIST TO WET
4.1)atc,'Velt(s)CatatpOted 10-5-22 ell ID#A4TW-S-OS 10 ti. 25 tL SANDY SILT WET
Ae NVt-'ll 1AlC:ttu1n:
ft. rt. G. •t.
..�
Seymour Johnson AFB rt, is O7 L
FcililgYCr�rNaituc, Facil[t�7I7ntiCUri rabJc) ft. ft,- N�U 1 �V22
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft, ft,
Plt}siealAddit gCit} and�ip 2C.REdLtlti��ro' lihuial3 T
Wayne BENTONITE SEAL 11-13'
Ct'tr-v k1amC1 WartiCct:.illipti No,(PIN)
:56.I.i 61d,c and I, d n ittc in'de
( i�CC,3 TItilttrtC5l3C6ndS or LIeSIM71I il4'�`t'CCS: 22.C:crtitilYt11►n:.
(ii txctttN
tdE wrL itineus �srtft;citl)
W.
Br.u4l Ew p 10/13/2022
si�ateit�arCc!atEl-tciltia�eneonirr;.wr 13�tc
C!.i5(are)the{Yell(S)t 1=1PenrlSlnertt or 7SITtitLpOr01`i'. Ut..r,`01t9 ihir firrm..l hereby iertifv rhitlshe nrfl{v)way f irem)cunftrycred lu accordance
rrlrhISANGACO2C•W00.or,15, kCk02C;4.701Vi!!RnararrrrctiorrSrawarrlean4U1 rsr
7.)s this a repair to an czi4ting Srclli E]Ytw .6r E'Nq s o3rhir r�crr rl hirb brrn'li rr;rfc rr it r crrdr{nr;rrr.
,�ax}is u,�re,�tlr fiir o-vr kmt+itvt is�ellttiaw•tnnvtzm Ett,�arrmtrr.�urarrrr!rt�p�ahr rfac.ru�r:+rc of t�rc � ,
rr`tarr.�arns1'.er ln^in rR.rSrrcmr curth�hrx3tfdhdsfnrAt. ,23.Sitediagramor additional well tletaiN.- .
Yan nla} Use ti%Back of this paw,to pro[idc additir�nah Snell site details of well
Il,h'umbeiofWellsco�trttctetl: 1 constnictiarld�(ails: You.mayalsoo-at(achadditiouaIpdg:sifnecessary.
F`r?r,mait,�l,�l�1'�iir4�i e�rani�kt��r�rlrr�i•rt�i:iT�C1i4L}'»•ith rhrr.anrria rviirstriatiwr�,er>ar.c�rn
suk,var axar fmim SL1BN1i1fAL iN-STETCn0NS
Tots l yell do td'fteto)F,land st44,1 oi 25 (ft.) 24a Fir All Wills 'Sabtitit this kiiii nithin 30 dzuvs of comptciion`'of v`ett
For#rWr,'{*!cu•cilr7ia?+iivt nifro-eerart owii@tl1! fDn5tniCtianta'rltcfOtlavbing;'
1O.Sts tie neater level Wow top of eosin(;: (lY) h)ivWun of Water Re4u`ti kc-%Infnrinafidn Pr.kming unit,:
tf)'M-amrkveih4 are r'ditm,,ose�4 16117 htaii Sen•icc 6titer}RAlri,h,,.XC l75994417
tl`Burchotc diitmctcr;2.zs" Can) 241b.For,[ •l] 6 WI 114 QNLY:;'bt.addition to sending(lie fomT to.thie address in
246abate A6 6btait a copy of this fetfti i itbitf,30 daYs'of completion,of WA
12;Welt eoustruetian method: DRIVEN CoilStili0Ci011[o ChK.fO11btV iitg_
t66.mitger.rodur} cable dirrtii push etc:}
D, ivision,of NVat�r ResaurressUudeigi�onnd ttijectloii Crutr6l Pi•agiiam,
FOR WATEIR SUPPLY WELLS ONLY' -163614iait Seffice Denier,Raleigh,NC:27691-.16 6
13a 1'leld m 11c#lit d of lest 2dc,Fdr�Yatcr;utip iy&fnlecdt6a Yells:
Also stibmit bne copy of this fini,Withiu 30:65'sofconlpldtion:bf
13U.i)i3inf�xtiufl•tvvptit• ,�mnuot well,construction rto the caunIT Gith department of'the Counts:u•h=
ctansfiiictrti,
Form G\V-t Non0 Carolina Ctepmawnt.of Emirotintcrrt and N taral Rew u€es—Divi;Ian of ltIhtcr RmLrom Revised AC>gu5t2t"P13,