GW1-2022-10423_Well Construction - GW1_20221116

WELL CONSTRUCTION.I CORD,
Far,inrwntal FTs�OA71®Y:.
This farin cusi bo ascd-frri.3ingic a%rnultipk uxps:- .
1:4'�etl"C;otr#r.tctrr7itBorlttatiarts
1-1.WATEIt;ZONF:S
Brian Ewing FROM 10 0F'-SCR9M0QX
4240 � f1
NC-1VellCantiaclort crtift�iitiirrrNiuilicr I&OUTERCASIAlGfro"rmultI=emailwells ORGiNErtit9:a ficabkl
FRONT TO PrtiIrFTER•. 7illCfSVR55 h1ATERT,i1
SAEDACCO Inc 4
Ctm rtrrf.tf eu 16tINNER CASING ORTT`IISING` ,wlbernaleliused4otj __-
FRONT TO rlUMETER.: TMCKNESS MATERL1t.
2,Welt'611stilrstii06'ecrillit k: 3 T0C(l. 15 ft; 1" '� SCE-40 PVC
Irxf drPlr.}TiliixilvPca rll pumrf s(i c:Gnunh� S:r.C;Vnrianer,7{YecYreb eac;J rt., tt, Fn,
3 vFe11 Usc(chetl i►cN wise),: 17 SCRt_EN:
tirRterSnpltlxR?cll FR[iN1 TO nrlvereR StOr$irF: TntctcnT��s` MATFRIAL.
C1t ocultural 6mtlnicip tTaILbi.ic. is ft.125 ft. i" h• .b10 s61-46 PVc
13Gcoflt unaI(Heal iu oolin3 S ltr) 011tsideutial Water Su Rr
�1? PPh'{single)'
❑iudustrial/Coniniercial lVater`Suppiy(slaw l) is.,GROUT
FRONT T[1. MATERUL 1,EINTE LACENILNTME`HOD&AMOUNT
❑Irii}itipll it.' �{.
Non-WAfer Supjily,Well: � t�
�l4toriitpring ElRccovvy
in�;ctlon 4Vi;lt: ft: ri:
FlARurfc0ccharnge, EiGwll xdvi ifcrR6lcdiafion tv:SANbIGit1` LhACKtit i lliistitcY ��
PROhf" 'tio I htATFEd%L I RNi'pi,Att"%Il.�TNit:-ruon
l7Agillfer Storage ati�ltccpc'Ci}` ❑$alinll}13 Irl7 I 13 11.. 25 p, FILTER SAND # 2
i�rtgsl6cr7cst f]5t'prinn�tcrlyitint�c ft:_ ft.
G�y?cRmcnitr17�1tnfaCo�T. f7�ttbsidencetru�dml
I9 DR.ILLENG LOG,tauach additional sheets if rrrccessaryl
❑Grothenml(Clustrt Loop) ❑Tracer Ffaoht LTO aFscRrrnarN'rmwr.t sra,icm.witAwk1`iiv iii a etc t
❑ fltennaf('1reatilg+' oliue.Retonill ❑other(ex l6ift m0er.921 Retaotlt5) 0 ft, 5 ri FILL SAND SILT
5 ft:, ' 10 rG SAND SILTY MOIST TO WET
-t.l}ateWell(i)Ctlliplelcd: 10-4-22 WilllD#A2TW-S-03 10 ft,' 25 r4 SANDY SILT WET
a;1'Erl Ltleatitloe
ft. ft.. Vie. -• �' :.Z 1•-
Seymour Johnson AFB ft, ft, + .`E o e v
>Sicellt}Rt+ncrNuntc Fact7it?lIifi{SCaplic�hle)
rt. ft.
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft" ft,
Phys`reid•ltlii ss Cat} uiid ip 41.R1n11RF: `ir:Ft;>wF! r: .'w'^rig UNA
Wayne BENTONITE SEAL 11-131 ;!�f°rj
Ce,a 1 tcCi:ltkrrt CrCltjuri No,(&1N)
Sh.l atlhldc anal Llingit is in llgglvi w 1p't cstsc' nds"or�ekbillil i2gI 22.'Cci tifecvtilrii:
(lf seltfeetd tbel�liltiotiii,S1tkill) + {��
IF; W -Bartam �EWif_"11 10/13/2022
51n.71i iPCchifkd Well cuntrrtar' - _ ale
6.IS(lrC)the NSelt(c): I31'rtv►auenl Or .�Tcuipot ar}'. #f sipjnrg j44 farm i herrhy cerrifv rlju!,M4u n•rP.{7kl v;av k¢rtJ euminrered h["e",rd mee
teu(r 15A NCAC QC,0Ta9.6j•.1SA NCA�C-0C,9209 Well C9ieatlaicNivr Stara fmrfaQrrd rlanx d
7.U`thtr•ii rcpafrt0 aft tclstin Nsel1' 01rs,r safd or �Nli rsliias'r�rorrll rrs hsrn frrrnidrit rry th dl ow;ier•
lw
�r�ic it r���iir;tn'P t�ir�'nr�rw turld nxurrrrevt�ia r�r�iarrrur%'rvr eu�ilrep7rat�i aria ru�rrrc+rf riYa . .
i� rrrardei#21 irmv iAraticln6rz a ao t6c hrit'k cftYir+ uru,. 23.Site dii gran or additional Well details:
You Tony use Ilk'6Ck bf this 00,to Urocid addiGoiiat Avell site,detAi,,of siclt
it.Number of Nivlh i'on trnetW: 1 consftuctiolt details: Y6u ltia also atlacit addition it jsa eS if 1=essaly.
Far,araitrl�Ta<iRtc�rl��i ept rtr�i-l+�raer'urirp,(i,ii7tL r7ewZl'm1r?1 rlr,�_saaNr rv7iistrucri�ir,}•�:w.axxr{
.rs w,eraayc,j(:rrr7. .. SUBMITT"AtLlXSTLTC.TIONN,4
0.Taia Fell depth befo*111lid surfam' 25 (fp .24a: Prii All.Y'1rilk.-. Subndt Ibis fueiii-within 36 days n(:taimptsli6a of µ'"ell
Fv�#P lfipk l leth licr rril,*auks tl { srrri£texamu It 3@209-and 2@ 1m) Co'ns@mctioit to the fpika-0110":
1tj,Stair water level below tup'of easln t ( ,) llivitifIia of�V>.ter Ite i4nries,Informaiinii llttuesil6g Unit,
lfwhiir level&fiboie iislrilr:lim 1617 Mail Sers•ice'Cerite'rr Ralc0ii,tli`2T69a=1G17
11.41or4oh.diameter:2.25" (in.) tab.For 1l W,an Wrflv ONLY':'.1n addition to sending ifie fomi to the'address in
24a a60�c,Aso submit a_capy.'bf.ihis fonu within 36 02L s"of Completion,of tsall
12,Well eQttsh9tCtiolf ine.thOd• DRIVEN c`otistriicifan t®:[lit StillUiVitlg:'
(%e. ncr.rater} �atil�din�i gusfa etc.) ..
Divliiou of Water Resources,Uiidcrgr000d iojerilon control Pragtaui;
FOR}4TATER S.[rPPL l��f LGS ONLY 163E Niaii S�'ice Center,Ralett li;N 276�19�-1636
13:k 1°lcld(gl►n?) A3etlit�d pf:tcst: Uc.Fo Wafer Supply&lnlcctltm WON:
Also Subalit onei copy ofihis foriii,'Mthiff.30 d#s-gfcotbi lelionof
13b.6isinfLetinn i' Amount:, wdl com,5lnrctina to tlic conntg ftc'alih dcpartnient-ot tlre,eciimh:tinc�ri.
. �'p'. constmctcd.
FarmGW-t haith Carolina Up�nmrirt of Eruitoiniieaf vanunl Rewurecs-Dii iYlon aPSL'ater rt Siit Revkcd Augirstipl3
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