GW1-2022-10424_Well Construction - GW1_20221116

WELL CONSTRUCTION RECORD For'lucrull
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I'Well 6niraetor Information:
14.1VATERZIMS
Brian Ewing _FR_0`N1T_T_0 OF.$CIREPTION
welf'eqr4rivor Nam
4240
NC,.Wcl]ConthclorCerlif=tionNinii66i .15.OUTER 01ISSENG ffior'wullkawd vic1`10 OR LINER ffKa
FROM� I TO ' ' I 111,01IFTER, I THICKNESS lil-1111 MMRIAL
SAEDACCO Inc (L' ft.
INNER C 4ti1NG OR TUBING 41"m1hurt A cbu!wd400'0
FROM 1-10 t THICKNESS NMTERML
211WIiii ton-'stru&FIT"'Oersilit#: 3 TOCft. Is Ft, 1 'hL SCH-40 PVC
3.Well Uic(Chcck Well usc).
Water S"1111ky%1101: FRONT I TO WANIETFSt I 51.0TKUX TnICh"NFS'J- I NJ,,%TF.RT,%T.
Mgficulttiral i is ft, 25 ft, 1- iml .010 SCH-40 PVC
OCyco(hernial(Headng/Cooiing Sq)ply) OResidential Water Supply(sID*) R. ft. K
ClIndustrial(Cdnintercial DResidential lVater Suippb,(shared) 18.GROUT
FRONT J0 NIATERW. NTPLA�CTNIENIT AFMIOD R AMOUNT
Elidioanion 0 ft. 11 (L PORTLAND TREMI
Non-Watir Supply'-WOO:
mmanitodiig Elftccavcry 6. ft
111jection Wail:, ft. (L.
QAqiiifcr Rech6rge" 0droundis-aticr hcuicdWion 19.SANID,1(:1t,'ATL PACK(it applicaMe)
13 i�quifcr Storage.and Redove,ty 0.Sili.nity Roirdick 'FRONT -70 1.
13 ft,- 25 ft'. FILTER SAND # 2
ElAqii itcr Test f3r,kin6ge I I
ft.
MzI vprimcnlal I-echnology 11,90sid=c Comm I - It
-10.DRILLING LOG(attach sddi0091111 S11CC115-if OCCL3521tyl
OGeothennal(121used Loop) CTracer FROM" TO KWItIFTIOX(color.1hardtievo,willriwt,1ypc,'gr*in t&ic,dCJ
DGeothemia I(Heatijqrj'Caoling Retuin) 1:10fiter(explain biider#21 Rama") 0 ft.. 5 it, FILL SAND SILT
5 ft" lo ft SAND SILTY MOIST TO WET
4.'Ddte 47dippleted: 10-4-22 Wa"111D#A3TW-S-04
10 ft, 25 (L SANDY SILT WET
ft. Ift.
v t U
Seymour Johnson AFB TL IOL
Facilily,ChencrNantc Facility 1W(kappij, ul- -C LL
�a*) ft. ft,
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft, ft, jooirnia�i-zn Pirc-c45c-D�.-ug Unh
Pltyiicid Ail '-55-City.and Zip '21.REMARKS
Wayne BENTONITE SEAL 11-131
P=el hizu1irtc1lion No,(PIN)
5b.I 'and Lonjotinte in ni.d 4timde 22,Ceitifteatiori-,
(ifpCIO field.outy.1;1001j i'moon6kni)
mg10/13/2022
-
-Dale
6.Is(arej the ORenflaftlftt or ETcnilmrary 11y,sis6ig j4*.fanrt,-I frerebt-cL rrify diarI)ie irefifs)way fK,r;v)cmzvnicied ht acevrdanre
Iviliv 15,t NGtc 02C.0100,01,15.1 AICA&ok,o-,6o is,'wi ronit"irrivit Swalardsvid fixi(r
71.hi%thLs a rclizir to an exhiting vvell: Mes or ®No rerprrd 1iay,K'rll p"r4n0ew rajix NOW1 olviler,
If IW'11.0 rrjmlr,fifl k4ur Arvim ivell and explabi Me narare of rAt
arL'VI the beak of this form. 23.Site ditigrilm or additional well details:
You way use.tli.i back of this page to provide additional well site dei0s.or welt
cons(mcdow details. Youv)v also attach additional pages,if necessary.
For itudfige,ftUeefivn tv vNj-ucuer_n pj4y rr,rr3 ONLY ivirli r1je.satur cons%truc1!wi,yPaxao
AM(A"Ift one fl-riq. SUBMITTAL INSTLICTIONS
9joia I well depth betow laxid surfke. 25 (170 24a. Fnr,A I Wals. Subfidt 11.4.faIn w.i(bili A days of completion of well
10.Static water level below top of casing- blvisimir of Water Rv%'au riu.4,Informatio In Pr6ces-ing.Unit,
If wd',,et level L,rhove twtaxitetg,' 1617'NIAH'SeItTice' Crm''ter,RAlco,a,,*4C 27699-1617
11.Borehole diameter.2.25" (in.) 24b.Fair Ft.
ijMtioqL1ee1LqONLY: In addition to sending die f6mi to the address in
'14aabove.also submit a copy-of'this form witlihi 3q dm;s of completion of well
12.N%1c11 coustruction inethod.- DRIVEN ColMniCLiall to the followhig.
(i.e.auger.ruiary,cable diTeci push vcj
DiviAou of Water Remurcesi'Underground frijecilon Control Program,
FOR WATER SUPPLY WELLS ONLY: T636 Atail Service,Center.Raleigh.NC 27699-1636
113a Yield(gitra) Method of test: 24c.,Tor Water Supply&Injection WC11:5.
,
Also subtAt oare cdopy of this f6ini"within 30 da3�of comitletion of
13b.DisinfLition type., Amount: .vcli comIniction'to the cbij*nn,klith dcpartnimit or tfic cmIntywhCre
KoriliCaroliva Dcpvvixnt of Envirojuivin-and Nitand Resources-D_ivi.i ion of N*,Icr RMULroes Revised August 2013