GW1-2022-10430_Well Construction - GW1_20221116

WELL CONSTRUC-HON'RECORD
This form con be used firsingla ci multiple swits,
i i t ra t o r It I f'o rt H'..it i o
14.AVATER ZONV;
Brian Ewing FROM TO DESCRIPTION,
Nell I CP,OradorNamo,
4240-B
NC,Well Cordiaclortcrtificlit,i6nNujuli6i 15.OUTER CASING Rot mokmeji wens)0 LINER"i H ricable
FRO31 I TO KA-319TElt= 1- 11ICKNES4 11 At.%nHUL
SAEDACCO Inc (L.I in. I I I
Ouqimq-Nanlc. M INNER CASING OR71JIHIN0(geolherz at closed-loots) -
TO D1,01ETER.. I THICKNESS ArATERVII.
2,Well conaruction PC gill i t,14: 3 TOM. 15 Ft, I" PVC
3.Well like(C It cc li,'Wc I I vise):
17.SCREEN
Water Supply VV*11: -FROST 1 TO DrANTETFR 5T.0TS17X 711ICKNIN-5 I MATERIAL
is rt: 25 (1, .016 SdH-40 PVC
LjAgficuttuml
DGeotherrttal(Headji /Cooiing St4)pjy) Mesidential lVa(cr Suppj),(single) ft. rk
EJ hidus0ii1lComnicricial ©Residential Wator'Supp4-(slarcd) is.GROUT
FROM 70. NTATERFAL I EMPLACE1,MTHMOD&AMOUNT
ft.
n-Watiff SEE pill}'Well:,
ORccavvy ft.
Inj eel lott Weil: fL ft-
13Aqu!fcrRccWrge E]4jioiiMT$a(cr Rcnicdiatldni 19.SAND.GR k%eEL-I1ACX fir alijolleat)(c)
:PROAF TO I sivamtki. KNIPJA 1"T SITT111011
CIA: iikrSto .4 'ovcly' '[3salinity 13imi�kr
T 13 ft; 25 ft, FILTER SAND #
1JApIfer.fiest Dr,11TIRC
lir=�,qv inicnhl Tiechnot9gy 138 ubsidemi;Cor4rol
2C.'DR(LLINGLOG kumh ad(lilional sheets f riecessfiry)
EIG.xiltitennal(Plused Loop) !]Tracer .FROST To KSCREPY)ON(volqr.1hmrd1A--T4L i„11'nKk t_N tW'Prjod?&ft.dtll
.
DGeothennal ffleatingCboli up Remni)- 00ther(explain.under#21 Retnatks) 0 ft 15 iL FILL SAND/SILT MOIST TO WET
15 fL 25 (L MOIST SILTY SAND
4."Da I to NN i e1l(s)(NnilddIed:,l0-1l-22 W&iID#A6TW-S-03
ft. (L
ft. (L
Ei IV P
Seymour Johnson AFB ft. ft,
R. A. NCY
1050 Wright Brothers Ave., Goldsboro, NC, 27534 rt, ft.
Pliv&II AddOr55_Cjty.,;tnd Zip
'2 1.REMARKS Ai f
Wayne BENTONITE 11-131
covint), Nv,iPVq)
5b, &0d,c in qIc
22.Ccififiration:.
.N _--p-ria n Ewing 10/4/2022
Si-.n3W&,a Matifted Well Cociufla,'10 I T Dal e
or M. Temporary. By Aignilig M*fiTjW,J herebj-rerfifv di I at Me ivell vmv cvnrinrcyed ur,acconlancr
mirk15A XCAC'02c,0foo­or 1.Tt"K,Ce1C­a2 C-,,0,20 11'elf Conomcdoir Srija4aufs and ifwiia
7.16"thL-s a re I mir,t.a ati mi.5tigg Nvelk oyes or 'MNO
dir
repair aii6r,021 or O'n die back vf this furnt. 23.Site diagranfor additional well duails:
You niay use,t1,k back'of this ojja to provide additional well site detaM,or%iell
�o atfach addiiti6naf ipagcs if mcessary.
&Number or!tells constructed: cons(tuctioli delai6 You iota.als
Fornuddt*Injtwhwi ONLY)Kris
xutwle L t ivie form. SUBMITTAL INSITUMONS
9.7oial iF 11,depill Nlow-laild SUrfac 25 (rEj ;aa� Pot All Willp. 'Subndl lids fame w'i(hin 36AYS,of 06tup'lelion of 1�611
For'nv4?fi,,qe irviff 1.s7is t v ff dep ks ffdWerefii e.yavjpie�3@20'evid 2@ lvo)i 'Cons(niciiPh it)lk follovo
10.Static Water IeVel below top of ja4ittg- (ft.) ng-Unit,
Ifitwer IeL-el 13,i6ow ifox:hm 1617 Alait Service Cenier,Raleigh,NC 17699-1617
It.BorchoEL diamclek.2.25 (ia.)
tab.F_nr1n[gg6ort3yelIqQNLLY: Tn addition to sending flie forni to[lie address in
24a above.also submit a copy'of this form Within A dav of completion of ud
12.Well coustructiou method: DRIVEN Lons"Clido!®"Elie:followin
i.e.aver.rotary.c6le;AiTCar'-k etc.)
Division of Water Resources,Dadirground tnjcc-lion Co'n'trijil VrogrArn,
FOR WATER SUPPLY WELLS ONLY. 1636 Mail
fail Service Cenger.Raleigh,NC 27699 1-166,
13.L Yield(gpinj Method oficst: 14c.For.Watcr Supply&tnjcctl(in Wells:
7'Also submit one,Copy ofJhj1&f6rillt'%ilithm 310'da)"s.of C611101el ion of
13b.Disinfection. :h-p.e: Ainnunk !yell 11 cansinictid-Into the countyk'aftif&Partment-of jhc' CG1utv'-,LvWri;
111 comtructcd.