GW1-2021-07804_Well Construction - GW1_20211102

WELL CONS" RUCTION RECORD Fortraccrnul ust ONLY:
n§sarru seal be owd fur siii*or mwtipk-Wcga
1.Well Cbntmetor hdarmation:
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tom. �. ti. .? f 7t 7 •k k+? .�i�'s. i .X ti.
Robert Miller , hb FROM pFSt'ttlVita>
wo!Corarudtw Name, �•�� �� R. - ft. i
A
2675
t 1S iv ` lllt', .aiMittt `21it ,, b
NC Well C«rurw«r CeciiRcstlan ltnsdret `0} O?4 I 71a 11?ADmaN 'fnit'R
SAEDACCO inc 0 ft. 20 f. 2" SCH-40 PVC
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t: arrn Nxn :' ttffsIll7fBIItt ;I thiielsltidtEda' t<,__:
FROM fr! DAMETER 4r1ICWWS3 MA'1FBIAt
2.Wttl Constrtretion Peratlt 4: ft, k h,
lrar arllaacafrte Ls-rli pvmeit:Re.Crnmm+,Srasr}fgrJara~e,l��ixt err.l
3.Well Use(ehtAl l;well me?,
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Weer Weill MOMra. a�nntgl�R t rs�riµ ins..,._VA.
DAgd=tttral �IMUniEapBUAgtbliC 20 ft: 30 rt. 2" in 010 SCH-40 PVC
DCVD#Wtrlyat(HeatingCooft Supply) OResidiential Water Supply(single) ft it; in '
C.IluditstrialfC.orulterciai DResickri ial Water 5u /�L�,,��,� '1
t9',�i�`r.YLt4"'1A) _..
a�aohr 7O IA�'EItRI. ENTMETHt?I# A. LTT
[3hrilptian 0 rG 16 rG Portland trimi
Non-Water Ater S*PPV Weil:
R.wtilon Well:
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11QMonitori C7Rccassrre
DAgtricrRcdiarge ClGrountirmterRerne"an
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MAquiferStmScarelttccosV, C�SalinrvPirricr t8�'!N ttia Ir + +tiar Linn
' 18 R. 30 rt, Silicaa Sand 20/30
O AOu.ifer'Tcst AStormawrter lhatietap
0EXKrin=Wl uchnotog OStdasiderxc Control
`3i11tI41aRCif tar3i�i U iraitsir
.,s•y
od l(Closed Loop) tlTraeet JM0't ' Dona *W,b.;auc�s�tv ec� O
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OGeothertal(Reatit n2' R-ettum) 130dwigElainubdu#21 R>awkS) 0 ft. 3 rG Tan Silt
3 rG 18 ft. Sandy Clay
4.Date WeHgj Completed: 9-15-21 Wdi 1D#PZ-42D 18 rt, 30 tG Tan Sand
5*4 Well Location: R, rG
Tuscarora Landfill rt. rG
Fm6t7ibVaMrNfl= Fwilft•-r a(-ifawtimbi6) rt.
7400 Old OS Hwy 70 West, New Bern, NC, 28562
Fk s oal AtBiess.Cite.Wd Zip >it6A s777
Craven Two foot bentonite seal from 161to 18'
Catruatx Potto Iftifor4afloo No,(PN)
ft.1',.gtitude and Longitade to de fitlnatealwconds of dec ml 4egrec5 23.Certification:
Gravel finkt eft WMrg is xtrl rd)
11r 10/6/2021
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6.Is(urel the wefl(n): UPMnuneat or ZTemporary
err*ning arrig,_fiurm,!Qereka rtI7YJy lhat thr xr!!{3!isr {wtemt ceenarnnered�t aae imre
074 f.5,t NCAC 4QY.01W er>'FA NC4C 01C,i 200 Well Comrriurlem Smaduas arMf dW ar
7.Is this.a repair to an oisth*well: OYcs or 1;'No rr�rr e!Frtitti rrrmnl hrr�frssw lia»crdevl rn Xfiw wwtti+wm�r,
if dr1,s&a rvpdr,f it out 1 witw well cMaLYrart:M a htformwkw awad raplabi rho mrare of the
&r r wa ter0-I remarks epraran ew rm the barl uPA6 farm. 23.Site diagram or additional well details:
You may we tip bwk of this paw f4 panift additional well site detail or well
$.tlnnlbCY`4 wells oottstrocted: 1 cool ai*n details. You may all teach additiittial%as if=essety.
fbr mderple iftkrrwn ur rams-hater 5VqqP!sells ONLI`n•!th rhr Wme cou3trnrtt rn,y"can Bh1t A!tNSTEJC B IQNS
9.Totsdwell depth beb land sutfaw. 30 (tl,) 24a. for AU Wells: Submit this fart within 30 dav6 of compWon of well
Form triple welltHe erlfdrpft Tda'rrew 4exanN;h-1@.'lam`mxt 2@[Owk C=tnK ftR to dV-fo11tlstin27
let.Static vatte r level below top of,asinZ (k) Division of Water Rewdrees,Information Parcelling Unit,
fj ruler 14Ffft tj Ob-OVe f a&M,*,ON""+" 1617 AlAit Service C1`l1w.Raleo,NC 27699-1617
i r.Bflrdu►tr diatootet,S.25" (in.) 24b.En InrrtttM Nells ONLY, in addition to sending the form to the address,in
24a d ove. also submit a cope of this fomi nitbin ?0 lots of completion of tcei)
11,Well c+ottAMCtivn ttit bed, 4,25" BSA cotisanartionto the folloNvirges°
(Le..anger.raftry.cubic,dimd gusts.etc.)
Division of Water Resourem Under9mund injection.Control Progratu,
FOR WATER SUPPLY WELLS ONLY:
Mail Service Center.Raleigh.YC 276".1636
i
138,vidd(VM) Method of test.• 24r.For Water Su 1 A 1PjKtE in%'etas:
Also sttbik one coln,of this fl ute w4thul 30 days of eouipietiton of
19b.lUixrnfailxan AmuuM: ,k cll construction to the county health depatarntut of the counly�a•hc�
.`w''°"'•'""" — sOntbtrttetetl.
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