GW1-2021-07809_Well Construction - GW1_20211102

WELL CONSTRUCTION RECORD For Imml Use ONLY:
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1.Well Contmetertntormation:
Robert Miller �' ,Vs 1 FROM Pgh(!RIPITAY
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NC Well CormarrnrCScniCx ticnNv>diea ,• �- ' FROM fro PTAIMMIt THIMMS MATIMAL
SAEDACCO Inc 10M 0 fL 24 fL 2++ ia, SCE-40 PVC
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Water suppiy- TO VIANIFTER. cr �!� rTiTc Tt�tiAr..
Oft"MI 24 it. 34 M 2" im .010 SCE-40 PVC
f3C,eotherm at tHetttinglCoolira,Stgrptyl 01 tesideutial Water Slipph'fsingle3 rr,: n In
®lndustrfobrCol fatal Reslelatiai Water U (ssba(d) ;4 ;RtSEE!'? ..'.. ..r.
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pill}- YRObI 7q dTA7E L{I EMPLAC©MM MUM CM AMOAil V;
ticln 0 fr. 20 iL Portland trimi
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0kitfiferRcsh:trge EXroundwatcrRcnrediatiall f w l+ti►' � "a- Y' - :<
QAgttikr 5tomge aW Rewwiy Milinity Punier 34 2 2 ( at±rc. eMt � r�r�nr tttsnIL34 fi, Silica Sand 20/30
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t7Crooiliemtal(Closed Loop) Mracer FROM I TO $ ir*rtOc br rr4eeii mn+ram rtre ac.
OC,eoiwmWflLegd E22fi Retttm OQtlier6 cturaleTrl2lt2ernarksl 0 it. 3 (L Tan Silt
3 M 20 It. Sandy Clay
4.Date Weit(s)Completed. 9-17-21 WCOMMw-10D
20 ti, 34 (_„ Tan Sand
Sa.jM4rell Lileatitln: IL It._
Tuscarora Landfill
Facilfty- wmrNur,ae Fast7aptt}r liEam,ticab)c) fi. k
7400 Old US Hwy 70 West, New Bern, NC, 28562
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Craven Two foot bentonite seal from 201to 22'
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Stl.lAa titdc aftd Longitude de in dcgrecsAninttttst ads or decimal degrecs: 22..CeetU'rcatioe:
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ui*ISM NICAC.02C.0100 ar IJA NCAC MCA tTf►Well Calmmetlrul Srdawfards and that a
7.Is this a:i+ellait to an eslsting wells -Mcs or &-No rgpr of MA moral haA been r.rl..*4(o stm+iMl owmrr.
if aials is a re¢nulr.elf rxvr,taaruwa tiacld craararrmrrn drrja+,x�rrrlt+a,asd ra7+lrzi.r rlti't>rrrarr nl"rlrr
retarir MdL-rdSf remayis nwEm arm rhr bart aftAb farm. 23.Stte diWiim or addWottal i dl d€tallx:
You Mt aw tlw bock of-ft page to pmride addltiotral Vivil site details or well
8.littml of srcilsa►,nstnleted: 1 ttttedita �. 1',iu rummy also attaebu9ditionalpaes if ua esssuiy.
For auadr4de 4*erkw ear rum-wavy sjlp welts M LY atilt rk+mmr comb rs1m,p-a Mo
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9.Total well depth below-land suriam 34 (ft;) 24u. Fat•.All )V?ellm Submit this form%ithin 30 days of completion or"U.
For mal4pi'r*rc+eldF llsrulltle rNs�J A/fj4 re artla'.Ytrrt+ra - "2t1+�° $@1FJ±T 6 iTlJtStlTtCtTOn tkl tbC fStllgYWt171y;
10.Stafle water Iml Delatr•top of radar: (ft.) M'ision of Water Reg rtrir+ce3,Infwination Procea+iug[tuft,
ff%svorr level lsabnue ratan?.:oaw."" 1417 MAH Shrive Otter,ltulekb,sc 276"-w17
11,Rtlrgligic diameter.S.25" (in:l 24b-For lniertion We11s U NLV in addition to soling Utz form to die addrm in
24g abo e. also subtmit a eupv of this forth wititin 330 days of conapletiatt of%rjI
12.Well eoitstrit¢iint+Mcillod, 4.25" ESA camsinictiou to the follot g!
(i.e.auger.taausg.e,bte.direxrpilsFi cec.)
Division of Water Resources,MktVVIInd injection ContraliProgmut.
FOR WATER Sla'PiPLYWELLS ONLY: 1636 Mail Service Center,Raleb h,NC 276994636
13,a.YEdd(gtmt) Method of testa 24e.1'or WaterSaiy&&jlnjcqkt n MLelb
Also submit ont copy of this fohn -wltwn 30 days of completion of
13b.Disiinfection$TWZ,_ __- _. __. Amount: welt consimction to the cwmrty hcnkh deimmnmt of them otudg a it m.
- constructed.
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October 28, 2021
Information Management
Division of Water Quality
1617 Mail Service Center
Raleigh,NC 27699-161.7
Subject: Well Construction/Abandonment Records
Dear Information Management:
Enclosed are well.construction/abandonment records for the following locations:,
Location Job# Date
175 Yadkin Road; Southern Pines, NC 13797 10%24/2021
2375 Lewisville Clemmons Road; Clemmons,NC 137,75 09/28/2021
4500.Old Holly Springs Apex Road; Holly Springs, NC 13780`, '.10/08/2021.
656 Laurel Hill Drive;,Rutherfordton,NC 13769 10/04/2021
7400 Old US Highway 70 West; New Bern;NC 13770 10/06/2021:
Sincerely,
Karen Byer
SAEDACCO,Inc.
Enclosure(s)
t
9088 Northfield Dr. ♦ Fort Mill;SC29707 ♦ www.saedacco.com ♦ [phone] * Phone [phone] Fax '[phone]
South Atlantic Environmental Drilling and Construction) Co.
4