GW1--02737_Well Construction - GW1_20240506

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• WELL CONSTRUCTION RECORD .: •o F #: iUetNLl
'Fux(90 gutba.t0d fa0.kv(gtonp� cs-. . , . . -
•i w n Cntttractorii.... . tlou
Stefan-.Smith ... • ' F 4t)4 qn• .V tI $CtttPYtt)N7
14'c!t Cpraitaitiyt rShW.
4 ' fG': :13 ..ft.:•Sand; .
3576A If.,, lt::. '
NCWccICciur�ietorCcnifOISS:Knmb'cr •
i-VO tTPIC sASINC(foCaiiiii iiillifOl 1,llaittifan triable) _ �.
... !IRON 70 : DL IETER .•TInQttiESS .:•.ATAit:RIAL,
SAEDACCO. 0 tt, 3 Ii 2" 1n. SCR-4 0 PVC
Cbnst!rt4**Z
IG lt°1BTt1 hill* Rfi 18*it'<r? -611ietmat cbea.:d„l±Olt}Y `.
• PROM .?O D1AR R ?IIIC'tuvES3: - 'MATERIAL- •.
2.W€t Constilaerion Penn# tt• , :. : ft .• • • • n•• ... .. ._. ... .
4fi(itt�tppplickbfr will p nsiIi (r r Countd Sttt(i;Vi nww. JI iti.:4 ir,J
ft.:. 14.•: ! rn •
3 St,cit ilsc(itierl.ncIl use) t✓FSGRi. N ` ,, s
1t'stf i Supph'.W�1t • •VR()M 7O'. .DIAMETER StRT�SII� TSICESESt, 9 M4TRRTAI
• C:,A,Bti uitrilal 0bttmtcipaV0i.li is •3 `•••t 13 ft. 2" , In. O10 SCH 40 PVC-
'tiOVotlietmal'(tleliti40oottng Supply) i1ILesidenttal�Yitcr Stpp1 .(stogie)` - /��p t
l�hidtltttaltCollililcrc al' • • :®Iiraidrittit4117ater•S**4'($111 L . -.pxoaT :.'To , 3tA7'RRIAli l•.VMPIACEMLNTarsrnaD c.lrtouvc<:,
ilftiigntlgtt:`:. .. :._:... ... . . ...: 0.5 It'.: 1 It:: Portland Pour.. '
liI.O. 4kilappt «*cii • .'
• • • • {ter
0Monttenir '.i ltecotiriy • ft. fG'
Injection 1te11: I
L9Agiitfer)techirr,,e I7Groutiilii'ater Itenieduihdti 019&41. p1GRAV—l+b P,Ckliifut)pLer6t►�) n .: 1 _; r j
6ROM "tt1 TTATPRIA RNIFI-A1tr\tYi,3110D .i.;
C EtliirfrrStatiigt :tttd iiccairt}. ii561nth Hamer _
2 ft 19 fl.. Sand. .- 2.
' JAgutfer T0 IJStormwater Diatlnage: .
ft pi.
p rinicntai":Ttrhnolori,,': t7Snbstitclict:Cor4irut t
at:DRIELING';1,0011R:icnaadtti`iiiiii it eitnttiis'Y,r1 # igh •<.
IIG.aottiett11a1`(ClosesdLGop) 'QTracerr . .• most . . :io j-:DESCRIPnON(6.*,birdnol.aa'sid t}P n s i.dal'
0' ft r .,9 _ Sand:
[7�te0tliertpal'(I•teauti��'Caloliilg Retuutl''• . i]Otltet:(z�tpL�Iitllit)tler.#2lC:�tn�s3 • .. . . . .L
4-18 24 . MW-3R• L,.•
n weti(sj Cofn�jeted welt;rnlr .
and
5J.Weil Location 1f. t4: ; ..
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Martin.County ABC ...• .•. - ''. . :.•• • . tt- ft a r..jf
l ct1ri}iT1►tn r�tu F,.".. • Fell..1tP#(ifa pit¢ablo):: it,. tt , .. .' ....1
. MAya
301.,E ::Academy.-St ; Robersonville:, NC,:27071 .. (t; • tf;!. 1 •
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. Pliiiicttlkddtesi.,;'( ,andZtp ,Ii� irti iRii i,• .._,s1 -" : 4. 1 s :a ,c- . _ .,
Mairtiii. . . . . . •Bentonite seal fro:DM'1-2: `*•,•_`..
Cotiri(�s.: i'aree11d itIfic Lf•antlo:(t'UVI: .
$tr Laittude and T on ittutte!n ilctcr ctlltittiot&sccopds or dcct tnal degz cs,: . 21 Ccr'aiicatt n j
(It efl ltet4,.D1 6ttfJona l''s u 4flc ot)'•!.
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35:625616 atiY 77:251798' �V. ��, 4122f2024
SFgpit ofCc•itttd�4clFContc)ctat.;° = :Date
6 Is(aixi)'the't%dU(s)::- Perniauenr,:'or-: tTermporet7 s ,r» t+Yir
lfi 1 hrrrb�itrrr fait tlar),rllfsl ts4.f(i.t!trt cVn vinrrJxd lit crczrrknice
u ill IMMCAG`0?C 41tki yr ISA NCitC IBC 4?OA DdI C.+ trticrion S410.ttidc;Etnd thin i' .
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ar . •a • ••• * hirrrinlltabezn n•rito:tt ontflsm• tf. angrtn iYctl QYe or P1T►: r '- rax e .
iftfrh i, ,'J11cxttbiiiiX!t #tmittrnol rratI al apfoobt•ik11.. r ofhr• •' ldi
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rinj-wafrrd :iiii.AsrFa oi rrralthi1 ,(71sfaint:: 23 Site diagramoraddttlopa !t elletas
•Youi.l nie iiilofthis pag proieadrlttonatell stedeails ef..
•• Cti tals _. �also itiacatoalpages lei . '
8t'ditibr oi Us cow neted 1 ;00 .Uue . . • , h ,•
Farmrilllprlt-rikki foir ot-rrun xrtrr,tb iPfi r' fr;Qa4'LYciIdr i0c raaireatistrucriar k`�tccirt: • '
;*.iftcn fo`?rt:: ....,1rfA :IN.... ..C"f'TOTVS';. . . .
' 13 ( ) 24a la MI tiltif Subnut Hts fool!' ithin3Udas of ctnpettoil ofwll9 'Gotalvfeltdcttibtoi ladhrfr . r :Foniirlpa> 1t14.i.oi1phsd8etfoiepe ?O24Aio 2000) ConstnICltonto:de tbloiin.a* LI
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li-.1.- faili.ivitter,level bettust top ofiiithig ;4 .- (ft). bs%Lston of Water Ro3porees,.Infirrm ttioa Praccsctng Unit
1J�r 0iikii**0-.0;i ini,r '" 1611MaiSerit reenter,Raletih NV21690 1617
11;lrirchote diiametcri•e.25" ,. (in.) 24b 4pr lntecttt tt�V�ifc ONLY. In addition to sentttag the form to tht:addtrass in:
24a aba� a t py f dad•"of eootpletton of well,
e lst).snGnil 4,this faTiu ttittttw;til
12,Well Construction method MSA nstn CtlOI tO:t follow`i)gn ;
(Le . tar,!);eublc duact iias cfc.t: .. . .. .. . .
Dhlsian of 11'atrrltctouiors,Uudei rou>rd fti)ergon Control Pto ant,
FOI WA7'LR51wPPLYWELiSONLY 1634MallSamict{.loiter Ralelgh, 1C1i6991636
13a field( ►nty Method ttt aes:. Al2°1c.For Watci Sanply:&intettion'0clic
• so s ubmit otie copy of tins form walun'ttl doss ofromplettou of.
13 15i3lnfidon hpr, Amonnt :'
*It;construction to-lhc counter tiealtit dej:utment•of U)a col nty.1%,4o a :
.• •„.—-tip i.. 1'
FimiOW t itmt'hCam hutDepetini off cOkoisient autra]itcwtuccs t)n-aioa.01AsIer.ft . _ Rcsfscd17,4 )f Ot1
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