GW1-2021-07808_Well Construction - GW1_20211102

WELL CONSTRUCTION RECORD FartrtearudEfsc.ONLY:
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farm can be nscd r ttk or tmlttiglc ac11s 9
1.Will Caaleactar Intortnatiuu:
Robert Miller Q1� FROM To p. tttl?tat7rt
1�`e1tLiJrttattatlkatrt �� n v ft. ft. ,
.-tom i
2675 ;,✓'cam��C;� yy� R�..�yr ft.NC WC)4 Caa112G4ar CCRitIC`IlI1D)r tvrttuflcr rA31C'J -
�` � itR4lt t8 OLA1t&Thtt tt)Ittt1PF MMMAL
SAEDACCO Inc 0 ft. 17 k 211 in. SCE-40 PVC
fk 1N ll ' DV
(:druwanr fotc ilf>8J ` 4
B[aQM Tf) DtA THtCi6!7t;6g U TMAL}
3.Well Canetthta Penult#� tt ftr ia.
1-to trft er liraWe"U prrnrltx("#.;Crauah,3$TIV.lrnrirarce:7tysctiCrt car./
ft. ft, iq.
3.Well Use(ehuekwrcll Vise)'. :1A
Water Supply Wctl: tmu�a TO MAN eTtltt ,norsuw..A I
tOApticulttual tlMito ipai> tblic 17 Ft 22 k 2^ lu. old SCH-40 PVC
MOthetnUt(11026 9C 40bi Supply(siDSIe) ft ft ±a
�.Su�tty) �Residetltiat Waecr
rlitldti5ftlfComMts'lal CfRelsidentki W.4tttr SVVPly(shared)
PRt!!1 TO 1ttAT .w S9rFt.A T i1 EMOD&A. OtiSaT 4
flan 0 M 13 ft.: Portland pour
Non-Water S'uppty Weil:
�!'rlortito ❑Rena« �' ft"
wetion Well.
i3AquKcrRechMe QCroul►dsrticrRcaandixfiora
0Aquifer Sionge and Rtxo m, t7Salini lateieir to_+lta MIM- d IM i�'x000,
15 rt. 22 fi, Silica Sand 20/30
McplkrTat
❑ExF#mcMi Tochnotogy{ i73t tsirlenta 4 otttrol
' �f1t1l. G+1A� _sell�idiTifi�`nYt` t�•a ''. ..� -�-� .._.�} ,::
❑C,00dlettad(Closed Loop) 4Treer e m -M DWAWPON a.>ar;exrepeM ir„arratc 5�aVe7
13C><+otltetttlal(Ile-antgJ010Ii Retuml 00titer(gM!!!n utxkr#21 Aewatl,$) o ft, 3 ft. Tan Silt
3 ft. 15 ft, Sandy Clay
4.hate!Well(�l Completed 9-14-21 W ID#MW-23D ig (L 22 (t, Tan Sand
5a�Well Location:
Tuscarora Landfill
Fast'1r 4*%,mr Nnme ract1 t}Ili Of applimblol (#, ft.
7400 Old US Hwy 70 West, New Bern, NC, 28562 ft. fA
Flp-sics1 AtM ns.Cat.•.andZip 11] #
Craven Two foot bentonite seal from 131to 15,
Cont*- Part41lt'J siltt"6,t 9ti ONa,Its N)
.5h,Latitude and Longitude in a lcgrecs{mim. 4tcs/6econds or decimal des; 2L Certit'n=dr►n:
ftfmolt Add,,�1:2!•`1t74itstdfltd ell)
W 10/6/2021
SigkIILliw afl c:.t`�C h^�'""c•„ ... ji�+�� a,.�,,,, �_�_,..�.Ff,�,,�:,..�..�:,,.
6.15(xv.)&e wefl(s)t EPerukanetit or Effemporary lh<sagedng ttrrrEvan 1}rcrrhr arrtil rhau ttrP ttY}!{:v1 is fWrrrJ crtrsrtr3rcletl drr arer�rr/awt
1r4h I M NCAC OeC.Q/!!(t or 1 kt NCAC(VC.020 We Comrr�ardbn Stamdar,�s end±turf rr
7.Is this it nepile to exining well. Mrs or KNo r.virr�tluv rccorrl turn d+ren prmir�il ro tfar nxH s umrr.
('f drts:es a r�',a�rtr.Jilt aai krva�t nefLcc+al3trrrcttoa}allon�vc�rtsarranul r-_tPlrz►n t'�t urrrvtre vjrAr
rrpcir Mdrr,is"-}mnaffa x fiva or rm the hunk of tfdr fume. 2L Site diagram or addtiana'l wdl details:
Yut1 M,1 use the bael:of this page to prozidt additional aril site details of i1vil
8.Nato>Ier of mils contracted: 1 constrW ion deWls. You tray also unacit 2dflltio*A pl M ie itecenaly.
Fur aru drdif i QjMdP)t ar M(M-)truer-QtP&rMIS ONLY Irah flip MMr a wraMur}Fat,psi.cnrr
-W�sgd one form s unin A1..IN±i MCTTOIQ
9.Total wadi depth below land surraw 22 (f(.) 24& ft,r AU Weilx: Submit this';form lvifiun 30 days of cam1ptoitru of Well
For rrrutrttrl't vWts timt all 4*p&of Qtfl re9it lea.mAP?e•:i@.470'dMj 2@ jWrt Construction to Ow followiu,8.
to.Static water let-el below top of Minim 4 fL) Division ur w Ater Resaoreei,ofonntdon Procem n8 Unit,
1f»1010+10ft by obtivc want g,cue"t 1617 Atail service cotter,Roicigb,'*C Z'm".1617
1.1,Bgrrttolc 4j'M ne(Ct:6.25° (in.) 24b.)<nr G/kdon Ifth ONLY: in addition to settling the form to ilia address in
24a alrave. also$*Init a DOW of this form ►thin^10 days of completion of%V11
12.Wdl constrngtfwn ttrcihod:4.2511 BSA 0muliuction to the,fr .llowin6r.
(te.Mlar. ,-,cablo.direct pntx tic:!
Division of Water Remmes.Underground tnJectlon Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 tllail Smice Cetrter,Raleigh.NYC 3769'9-1636
13:t,Yield 24c.For'4lrttf °.Sa. rl,.1'Y��in�atiota.,u 'etls:
(QtAm) tlrRtltrrA of fcak
Also sdbtilI t one: t%!W of this farad 101diin 30 da)-s of completion of
13b.1ris1nfec3ion t)pr:--- ___._ .: A►mouet:_ - avert constructian to the county health department of the count wh=
con.�rueted. j
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Farm{i IA 'e�nhCamlinatfc"manlafEmimmuciaand\TttlutW of1Sraler'Resou tdevigadAtcustyto
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