GW1-2022-10418_Well Construction - GW1_20221116

WELL CONSTRUCTION RECORD Far Ins,moil Use ONLY:
This form can be used fo-r#ttgle m tnlaltip'4 wells
Well Contractor Information:
I.I.AVATERZONKS
Brian Ewing FROM 7U DRiCRIPTION
16101 6MmdVTx1Md fl. .1 .
4240-B ft, re.
NCV611 Contmddi Ccrtiiicatl6a Niiiiiief 15.OUTER CASING *C"'0 L1iYFR
"'0
FROST TO PT,,%2%TFTEiF T_R1ffi__9i_ T11_4TE11T,1L
SAEDACCO Inc (L (L
Cavvmiy Nano; M-INNER CASING OR,1
FROM TO DLUMETER. I 711ICKNESS I ATATERTAL
Well Construttion Pellalt 0 ft. a Ft; 2- 11L SCH-40- PVC
list all aJoHrable x. Iryereqn r1r.)
ft. ft, irr
3.W_cll.U5e(C'hrCkN*ClI ase): 17.SCREEN
Water Sappkv Well:; FROM I Dr,%%tFTFR 51VT817-W. I THWWNFSti I MATERtAl.
0A gricultural' riMunicipa VNb,I.ic, fi,� 18 ft, '.'0 3.6 SCH-46 PVC
OGeo(beftnal(Heating/Cooling Supply') ®Residential Water Supply(single) H. rL. irk
13 tudus(iial/Conintcrcial Mesidcn(Jial Water Suppy,,(shared) 18;GROUT
FROM .70 NIATERML E%TPLAC3 N1LNT-1%WnioD&AIMOUNT
❑lrii anon 0 ft. 4 f!. PORTLAND POURED
Non-Water Supply Well:
MRccaVciy
Injection Well:,; n. rt:
El Aquifcf Recharge" 06rouTift'atu Rcmcdiaden 19.SANDIGPMFI,PACK fir applicibli.-)
FRI W TO MATFELfAL
QA4uifcr Sto!jgc`and Recovely nsilinity Rlyiici ft FILTER SAND # 2
IJAqu ifcr Test EISPOM nvat ce Drd,a'C
C1V,Vc1?mqn(iI T=Wtogy I 15ob51dcncC:Comvl
2(1.'DRII.UNLG t0G(,i`ujch addifionalibeds-if Fbecc.%canl
llqmthennal(Clased Lapp) 1jTrjcLr FRONT '70 DESCRIPTION fcolor.
DGeothennal(Heatiajg�,C.opting Muni) 110dLef(L.,pl6in w0er#2 1 Remacks) 0 ft.. is FILL SAND/SILT MOIST TO WET
15 ft., 18 rL MOIST SILTY SAND
4.'Do tc.WeH Con' 1�jed., 10-10-22 Wfll]j)#46MW-BG-S-0 1
L
ft. ft.
Seymour Johnson AFB ft. ft.
V C U
Fici1ity,KhvnqrNan1C Facility IDIV alwiJez.,W) ft. it. Zs ZZ
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft, k
City,and Zip `21-REMARKS NOV 1 6 2022
Wayne BENTONITE 4-61 jrgnrM2ti-:)1, PrCCW4�,-A UM
County Nrix]I&II0116C.1lipa Ncl,'(PIN) W10MOG
9 221 Cei-fification-,
N W rijanEw 10/4/2022
-n
Sigmium arCeitIrrad Wdl Conrictar Ditie
6.1s(are)the'well(0)t MPermatkent or oTemporary Ltysigijbig ji'*fiarw�i Ire-by ev�fify t�jf4 the irefl�s)was f�-ere)qjwqTejred hr-acevrdanre
with 15-A XCAC 02C.0100 oj'ITt KCAC 0k,Xzoo*elf ev;Fit�icaon a
7.hs-thbs a rielisir in an'i�ii-,tingillefif OYes or ®Nu
bVqrvian1wi and explabi the otarare of the
rq,nVr umk,921 M0'b.,k of then farm. 23.Site dWrant or additional well delails-
You ntay u Sie,Jlle back of this pagepageid provide additional well site,jdeM w ils-or ell
8.Number of wells constructed: 1 constniction detalis.
Od q iviqls,ONLY)tIrh the samr rtinstrudion,yt-vf offo
xuj�udf wto fpmp� SUBMITTALINSTUCTIONS
9joial hell4 e p I It bet*:1-*4 surface. la 24a. Fai-All Wills:-Subfidt this furni Mthin 36 days pf:Compteflon of 1►•611
For')",440'pie,i ah"hw"t vfhfepdaifdWerefit 3@20Waejf12@ W constniciip R'to the Otoviltg:
r n
M'Static water level below tag.o ftamilow. IDfiirmsttiitin Pnic A g Unit,
tf)PONF kt'01 h it 0Vtll Ldikx am;.+ 1617 Mail Ser vice CI lvi
11.Borehole diatactek-8.25" 246.Fnr tit Lggflog WON ONLY: 'in addition to sending(fie forni to ilia address in
246 ab&e.also subrhit a.copy of this,fonn witlihi 30 day4_of completion of w0l
12.Well corstnictiowinethod: BORED Lons(ructidii mtlw f0flowille:
(i.e.auger.n3tM%eabjeAixd posk etc.)
Division of Water Resdu rees.Underground Injqedon Control Program,
FOR WATER SUPPLY WELLS ONLY- 1636 Alail Service Center,Raleigh;NC 27699-1636
Nicthod'oftot:
13;L Yield ip)
24c.For Water Stipule&Ipjcctlon Wells:
(gp
Also stibifift ona:'Cpj�- of'Jhis f6ilh wiftbill 30 65;sdcotuftle!iqR of
13h.Disinfiect.idn#pet Amount: welt camoniction to the county hcalth dc'Pariment 6ribe county�wficw.
cowwTuctcd,
FonaldAW-1 C eviscd A%ut 301.3.