GW1-2021-07805_Well Construction - GW1_20211102

WELL C-ONSTRUC 10N RECORD Ferhimial Use OWN:
nis faun can W tried for s_mgk of nualiipi aclls
1.Wen Contractor ittl'ormatiorr
Robert Miller FROM rota D tptt 11
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2675 \� �• r�}
N '� ��.=. ��i�Otrx�r.,� �� �°�► .... �i��t)1Z . - lab ,
NC Well CommaorCeafficcaafonMunhcr ,;fr ti M TO D1AMl7TCR THiiTtNFlZrs:' MA i tAl.
{ gyp+
SAEDACCO Inc
,- '�,: t.�G�`• 0 ft. 24 fL 2" in. SCE-40 PVC
CoeaimlyNams �'' 1V1 lt. 1lK • . ._, g .
FROM TO DL+►VMR I Ttf MISS MATESIAL .,-
2.WdI Contitrttetion FSr'rnit tr', M n' M
Plat urf aFr rnwe urll femur(if a;ruwn=,swe.Uariarrrr'L'okem elw:)
ft. tt.
3.Wdl U,w(eheMwelluse}
74FID
TO 1,%W r.aR StM Mom; UIC-Et MATiTtlelI.,
1. 34 (t. 2" In. .016 SC8-40 PVC
LjCj illl6vwj(Head `Cool' ppb'( 4} t#Iig t1tg, >3') t�ResiRlcnleaCVValer Su[JRi'5i tkE281�6'a1lQf 5i7 )1 SblkiFd'YI%IkW D&AMOUNT 20 M Portland pour
N[ati-wgrer sop*well. �
�hdotiitpTiitG Q�r�P!F'e '
QAqu)fcrRecharge 00munda9tcrRcinediaticm
FR M faiA,T t,�i �ltT.,a�1F;7'a'7nk`ltn(a
QAgtiiferStargseand ecov€t}" l7Satlinilyil3rtcr 122 ft. 34 ft, Silica Sand 20/30
flAgii)farycst L9Sformnatcil3[aina ft ft
❑E�cimcn�l'ft'sltnaEagy C15abs9te Co[atmt
• :.:D1tltlaF�>18T►i�t1a>��ddltivatiT� ` s`3faese3sF°`< <,;� �r.rv:.'+..
i7C*lhe1mal(Closed Loop) ❑l'raaet FROM TD onclttI mN tow.i+arduee.1a I#tn "dM ott
17Caattlettstkl(Reant Caro' Rctuml Dt3tlaet( ainurttler l Re nits) 0 ft. 3 fL Tan Silt
3 ft. 21 It, Sandy Clay
4.Date Wtll(i)+Cet iplated 9-22-21 WdI;DpMW-27D 21 ft. 34 fL Tan Sand
Sac.1A°ell taacatiou: k
Tuscarora Landfill ti. fti
F=fty YA,wr Name Facr'litr•W*(if appi"icablc)
7400 Old US Hwy 70 West, New Bern, NC, 2S562
PfisicSt Addre City,tara4 Zip :3fi Rl lit,�iLf.S. 777
77>
Craven Two foot bentonite seal from 201to 22'
cAndly No,(p1N)
5h.lAtitude pied La ng tvd.c in degivWmifiutcslwwods or decimal degrew 22.Certitkadow..
of«ellticla.oretable 1ss�dTsrka4}
W w 10/6/2021,.
6.1S(at*)the well(iys MIRet"t anetit or OTetnporary !tp aigning tt,6i ewm1nw&d tit 0:'eari9im"e
n3Ml I M NCAC 0.0.01M ar f 5A NCAC MIC.0209 Well CotesrrnMM Ssirdurtts mrd lim-F 0
7.h this a repair to an esii)ti"vell: ENts or MNla a�+pr�n,`rhis reru+rd h �rm��emk&v0 rnatas Wrlt au»�er,
tf this is a regttir,fiff Mr ltrrmaw well nWel mr faforr"wrtimt drA er@tain ON 01(nere of des
,mur owlrs l macuikr xeoetarm ur r thr l�srl vjilrtr jnrm. 23.She dfiWam or adi itional N ell detalis.
You trM ruse thi bwl of ibis p2ge t4 ptirtdde addilional Well site details 4f%VM
B.Nuafl cr at yells constrn ted. 1 e msltuet on detad& You fay also attach addiliottal pages if itewmly.
For mit 1*lojecrkvt oo om-wwret i4p , peals t:NLY MA the samle eonift Am.yafr rAm t#�tL,T L RgMUC M
sabmft nue hrrra.
4.Total well depth bed land surface; 34 (ttt.� 24a. For AD Welhp Stabndt this farm within 30 ibtys M c+oaWktion of well
Fornneh4gewelftMirafftrbifdifflirrntkampte•MATOrin2 ON) cons4nictionto the.ifiAlowing;
10.Stytle water level below tap of eming: tR•1 Diviaaion of Water Rmumer.,tafbrrnation Promslag U alt,
Ifuximelemlfsahomevadik id17 Mali senite:C�eter,RaleiBb,xii rws""m!
gorrlu►c dimmctsr:8.25 24b.Ear ONLY- In addition to sending the form to lute address in
24at abmv—also vaunt a coin, of this fotni within 30 days of completion of wall
IL Wdl tinostx'eclton Method: 4.25" BSA t:onstn[alton to tlae fail0W ng.
(i.e..uupr..mim cable di[ect pub.vc.l ftblon of Water Resources.Undenmund tojallon Contra)i Program,
FOR WATER SU'PPLYWELIL S ONLY
iti3fi Mali Strvlax Cemec Rateifh,l'�TC 37fi99-113C►
13;t.Yittd(gent) l►aelhQil of test; 24C.For Water, to cox Wells:
Also submil one copy of this fOtfii vilthin.30 days of eolupletion of
13b.Disiuf don type: tl ..,.e. ,-, Aatnuart :.. well consinrct on to ft Catnm-dearth dcpamneuf of the couadv when;
con�nictrsl..
Fenn GW-i Nonb.Camhm ftst mem of Emimiu mt and NautstSil mLwes r)Mion ofWat«ReMMM ticniscd Augaati 201