GW1-2022-10425_Well Construction - GW1_20221116

WELL CONSTRUCTION RECORD Farftucr11a1UxoNTi':
This form can be used fm-single or multiple wills.
Welt.ContrActorLtfortuation:
14.f►'ATkR ZONIS
Brian Ewing FROM T[) DFw('Rlf t7O\
)VCII Cof iatdor Nana ft. R.
4240
ft. I.
NC Wcli CrirtiractoiCaniCrcntir3nNwriici 15.OUT8R CASING(Grr rnaltl ra;cil uetlsl OR GiNFR 1lf a 'livable)
FRO31- 70 Dt:41/ET6R �TtnCGNtiSS IiRTERTAL
SAEDACCO Inc fl.. fL
C01ITMty N;une Id:INNER CASING OR 7 L'BING' wihermal elused4 w
FROM TO DIAMETER THIMNESS I MATERIAL
2,Well Constrvctil►n 0.6tilt 3 TOC(t. 15 ft:. 1" SCH-40 PVC
Lire trNnpfilirnhle H'c!I pr."imitx(l:r.Crun,tv,•Stxrt, .irnriaacr,Irty"erb't:�rlc;)
n. I'L fir
3.Weil Use(cheer.ii c11 uscy: _. -
17.SCREEN
water Supple Well , FROM I TO I DIAMETER i 'SLOTWX ITnIC K1Tti5' MATERIAL
riAglicultural ic i5 'ft. 25 ft. 1" if,,. olo SCH-46 Pvc
06eothmal(lleadneCooling Supply) OResidential IViter Supply(sigjJ )
®htdustriallComntercital OResidentialWatceSuppfy(sbarcd) 81oRO� To. +trrERUI. I g1fpLACEhIEYTAiEii10DSASIOL12Vfi
131di'ation
Non-AV;iter Supply NVGR: ft. ft.
[Mklanitoring C111ccalriy
Injection Well: ft. ft.
C1rtqu'ifcrRccittirge 06iollmis11cr11entckiion 19.SANDiGIIsVEL PAC Kfifapheahtci
'FROM 10 mxrrmmi, P.MP1ACt rr:\T.NH.TnO0
QAgriifcr Storage surd ltccolrTy' CISRliniri H�rnCi 13 ft. 25 A" FILTER SAND # 2
❑A rlii'MrTcat C35CormSt rtcc6run:1?c
❑]V=rimcntal Technology E]Snbsidcnce Coraatol
20:DRILLING LOG fanach additional streets if accessar•l
i]Geothernial(Closed Loop) ❑Trace[ IDFtiCRiPTtO�irnbr.h�n[nc++,wil'nrekr " ,e.t1t.1
❑Geothennal(lleatir up+Cooliug Return) ❑Odu:r(a:.eploiumider 921 Remo&) 0 it. 5 fL FILL SAND SILT
5 ft., 10 fL SAND SILTY MOIST TO WET
4.Date-Vell(s)Ctinipleted: 10-5-22 Well ID#A3 TW-S-0 1
10 ft, 25 ft. SANDY SILT WET
Sa,IM1.41 Lo1!36111.
Seymour Johnson AFB f4 ft a i
Faat3tt}•,rt?tcnrrNnntc
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft, ft,
Phtisicui.Citd vs�Cit}'.,Ind Zip :21.REMARKS
Wayne BENTONITE SEAL 11-13'
Gpuu�i' PNrvd lrP.atirte,jflpo Np,(FIN)
ih.I ititudc aria I�irrgltrrtic in dGgarcalrn nutcsrsccrrnd`lay d+eirnal rlcgr ci s: 22.(certification:
(ii'tires+it,i'�1tJrrnr�lai47ot�isaicflic:r:il1) �tr' {�'
i —Brian _EwI� 10,13,2022
Sip:utur,ai-Certifrcd Well C6"-tor � � Date
6.Is(are)the well(s)t oPmnanent or MTen►porary By s;gn!„g Asir fun7,1 ke:rrLr eevrfifv char the n•r/!(.r)V'L•](werej consir"cled hr,accordance
ufrh 15A NCAC-02C.0100,or 15A NC+tiC fr,2C 0200 li'elf Coiisrrrtcrfwr Rawlarrlsand fWia
7.1.thisarelia(rtoan,esistingivell: ❑Vc-s or ®Na, cnlrbfrlitsrrcr:rrfhirsla�iilirm';d,�trgili+tirllrncn�r,
,�ar,lsTr s�l�rli'.,f+lf+ur�`ret�rrw l+rll c�aurnrclt�trl rardanw;�'nn+earl ccplrr�r thcvu:rnrr,;f the
w1vir widar#21 rrvm arch•a .Ai a or rvr die&WI.Qt;iti•forur. 23.Site diagrara'or additional well details:
You may use ilie back of this page tb provide additional well site details or ti'ell
R.Nuariberef iwils ionstructed- l construction details. You amy alsp'altaclt additiolail pages 1f tt`'cesSaty.
For whlfir4e l d1 V irwi aTi' uk,�4!v' d1s 0j%'LY u•lrXj rlie same corrsrrui•rlwr;yeas ala
•csl4addr"e f rin• ' - SUBIIiITTAL.INSTLTCTIONS.
9:'i wiA welt deIWt ket ,Iand surface: 25 (ft.) 24a. For All Wells: 'Suhndt fiefs fritui within'30,days`.of eomptetlon of Ts`ell
For fn,iltlplr icelh16i rd14TT&S'fd rlWerent(r.Trrrrri^;fe-j@:00•arul b @ 109'? C4nstnrcii0d to d c fplloui'n"z
10.Static water level below top of casing: (B,) Diricion of Water Resources,tnformation Processing Unit,
if),vrer level b 6ov.e rilsfR,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borebote diameter:2.25° (in.) tab.Fnr InMov 3YeTlq ONLY:.Tit addition to sending tits fomi to tic address in
244ab&e,also submit a copy of1his form withili,30 days of Completion,of e'all
17.Well mustnictiolf method: DRIVEN Coustrudiod to llt,e following:'
(i.c.att"er,roI3ry;e#6,diymt pusli etc:)
'Division of Water Resources,Underground Irtjectian Contttil Ptn;;rany
FOR WATER SUPPLY NVELLS ONLY I636 Mail Service Center.Raleigh,.NC 27699-1636
13a field ftm) Method of test: 24r—For Water Supply&Injection Wells-
Also subriiit ong copy' of.this furtii }titbit[30 days ofcomolet ion of
13h Disinfuition h'p : A'tnount: well constnn Lion to the cormty hc'lith department of the coiinh•.whctc
constructed,
Fonei d1F-t Nonh Cmalina M-Witstem of Envi omnent aad Natural Resources-Divi,lon of Rraleritmtroe-s Revised August Let 13
I