GW1-2022-10426_Well Construction - GW1_20221116

WELL CONSTRUCTION RECORD For ll1matusl6NLY:
This form can be usad foi sHglc or rnultipk icdls:
1.WcII:Colttractorhif(rrnwitni:
74.A1'ATER IONE.S
Brian Ewing FROM TO nP�CRIP710\
1vr]t Cnntaactnr Nama Q, N.
4240 ft. ((:
14C.Wcl1 CoirllaCtorCemirwrationNlur,Ucr 15.OUTER CASfNG(N?multkaurit rvctis)OR GiIYER(tf a cahlc
FROM TO .Dr, IETER: 7rrIC[CNEq MATERTAL
SAEDACCO Inc
CanspmryWam; UANNERCASINGOR7'L'BING cothrarnatcki Ldaoei
FROM r .TO DLA\IE'rER. THICKNESS \tATERLM1L
2,Wcit Construction Pcroilt#: 3 TOCR, 15 ft. 1" SCH-40 PVC
I isf rrll vlYaiicahle x ell(IPimltx 0,x.Couah•.Batik:11ridarrre.l(1'ec6X eir.) m®•
3.'�Vcll.Iisc(Checl,.a-c11 PSC): 17.SCREEN
Water$o111r1ti'ti►
acil:,. FROM TO ntINTF. .t I yWTSIZE I Tn1"-Nf 5 AL{TFRIAL
0AgdcuIturaI Clhiunicipit ttblic is ft., 25 ft. 1^ ins 010 sex-40 +� PVC
OCeothctnta1(HeatinglCoaling Supply)' OResidential Water Supply(single] ft. fL
®industriaUCvnutiercial. ®Residential Water Supply(shared) Fn0 ROUT
TO 1TAT6RtAI:- @�tP[ACL rILVT hiSrElr]D R',\M00NT
�ltii artier, it. rL
Non-Water Supply Welt:
®Omonatorinr bRccavcry
Injection Well: f4 rL
bAnuifcrRcc,6arge f]Cioundri:llcr Rcm141tion 19.SAN DIGiUVEL PACK(lr a r tlie.WALI
' 'FROM 70 arAYFRIM1L Cthn'1�{C{tiU:\T\n:TnOn
l7 yfiiier Slort�c aisd Txecoy'cry' 17Salinily&Imct 13 ft. 25 ft, FILTER SAND # 2
QRflikerTcst ❑Sl6rmwat&15imnage ft, if,
❑TxTat'rimcnf:il T�hnoCragy l7Snhsidcnce CordTpl •
20;DRILLING LOG(attach addifional sheds if necomry)
t7Geodi:Inlal(ClgstdLoop) ❑Tracer FR0�1' TO D15CR[PT10\(cnbnhardim".wit'nickt% nwtA%dG1
OGeotlten nII(Hexinf++Coolies Return) ❑O(ller(explain.under P21 Retuari s) 0 (y 5 fl. FILL SAND SILT
5 ft. 10 (L SAND SILTY MOIST TO WET
.D'teW'L'll(9)Coulpk(cd: 10-5-22 ,%YillINA4TW-S-04 1p ft, 25 (L SANDY SILT WET
;a �lrcll Lpcatiam: ft. fL
Seymour Johnson AFB ft. fL ' f --
FaCiliiya'QTvncrNanic Facility ID,:(if appl6cablc) O N.
1050 Wright Brothers Ave., Goldsboro, NC, 27534 ft, ft,
Pltyilci l Address City.and Zip =21.REMARIi.S
Wayne BENTONITE SEAL 11-13
� '
(cauup' Nrucl ltto0r:�,•ilim No,(111N)
.5b,I a{itudc and I ftititfic in.dcgrecslminutd1scconds air"decimal dcgrec : 22.4crtificltioa:-
(ifvtr;14 f�lrl;rvr�1;i17tat�is:stdlicknt}
N ti� Brd-;a.n_Ew nre 10/13/2022
Sigruwrc afCcrtificd W.cIl Caiitrn.tar Date
liPernianen! or .BITemporar}' 1rp.sdgnrng thir farm,,]lrrrrb}rerrifc rbaf-riar nrli{r/vzr mere.)cunrrruclerl in-arc'aarl®acr
mirk 15A NCAC 02C.0106 or 15A NOW 02C;0200 Well Comtrrtcrion Stiarxlarda dnd Harr a
.h�thisareirairfuanmiitippVcll: a7Ycc or '1KNu ccpTof6A.rev,irt&,vberelprovitk4l rnvitrr,
1f�"Psar 0 fill 4ait(kro4w oml cxplabt rlie,rurr.,re of rlic
ipffir or cm dac bra'.(cf adds form. 23.Site dial;ram'or additional wdl details.-
You may use the bacl of this page to'luovide addidotiat well site details,or{-''ell
R.Nirmbcr of tielLw constructed: 1 constmction details: You inay also nUaclradditionai pages if nccessaly.
For mairif4e ir;tcvr!m tv uwt,-Sauer sarpl.Jr trill-ONLY aridi dar.mmir roarstruerim,ymu C(w
caf utt'�iuir{:rrr. ,_RUIMITTAL iNSTUCTIONS
9.74fa wF lldepth below land surface: 25 .34a. For All V1'e11s: Subndt this faun within 36 days:of compaction-of sell
For mairid+lriirlix'r'rcrrVlIepAvIfdt e+reail(eartrrvpk 2C':(k7'ar412@1P9y cons(nrctiontotltcroatoTains:
10.Static water level Maw top of casino 010 bivlduti of Water Resources,IfifOrmatibn PruccsMneg Unit,
if uld,ier level,i-abare came g,use•"+" 160'hlail Str{•icc Center,R•rleiwh,INC 2 76 99-1 6 17
14Borebole diameter,2.25° "(ia) 24b,For Inicctlnrrt Wells ONLY: In addition to sending lhz folnl to the address in
246above,.also submit a Copye'of Cltis,f0m1 within 30 diiys'of completion of tMl
12.Mcilcoustructioa irlethod: DRIVEN catucnfctlatl 16 t tc.follming:
(Le.;uper.rotary:cable Ijij,w pusk c(C.)
DiviAou of Water Rcsou rocs,Underground Injeedon Control Frog atn',
FOR WATER SUPPLY WELLS ONLY: 4636 Alai]Ser vice Ccncer,Raleigh;NC 2709.1636
13a Yield(gpm) 24c.For Water Supply&Injection Wells-
. test:
Also submit one'copy of.this form,tsitlliu 30.daysofc6mpletion of
136.bisinfoetitin h"pa:; Amuunt: {�za1 constnicti" its the cui' health dc' ment of thc.Counh.{riscre
coWrul;Icd,
Fprni G\F-1 cNonli Catalina Mpmmtt of Eavirannrlo a,Rd Vgrurd Resources-Division of Water Reautm Rievised Augta i(r13