GW1-2021-07814_Well Construction - GW1_20211102

WELU CONSTRUCTION RECORD FarIrtearilUWONLY:
'lobs rot m can be uw4 Eat silgls or multi mauls
1.Wen Contractor lulonnatttorn
141 N» _
._
Robert Miller noyt nt tttPttc;1
Welk Car4ntciat Nam % R.
2675 �� �` It.
k
1+:,)' r Ol\ i aaRaQ l JCliiIBlj, �iY4iYb NCB'.. •.J' s` ` -.., 1e n
NC Well Comuucter Certification on t wooer y b c�
1 1 FAOh1 TO PLAMTER MATERtAt.
SAF.DACCO inc 0 tL 5 tL 2" in, SCR-40 PVC
NO� .�� __
Ctrrtrartne
=ft� rrtt.-
DL1UE'rER IMCKNESS MATERIAL.2.loved C'ondmodon P017.ait v-Sa' c'1lfeList xTfl+S�tie state urtP pt+*"itr i€c.C otruev.Sd�dr.t ariprrer.7r*601fir-0
in.
3.Well l sc(chock well rise:'
Water Supply Vll: � ro a` ssrr6s 5b"Mwr , lnnrxcSI Sea >vrwsYanM"*
P�fA rissLltettal C51M1anicipall ttblie 5 IL10 It 2' in .016 SCR-40 PVC
f� kothermal iltealin ooti ty"1 MesW ntial Water Si tr. ft 1n
!tom �Stf� >pp�•tsinglel
13h1dustrial/Commercial Mcsid nfial Water Supply-(s1ared)
FROM 170` MATERLAL. XMPL D. AMOUNr
MdLstiou 0 It. 3 f. Portland pour
Non-Water SuPPV well: ft,
Mhfonitol 1311#:Cm
IR well,
ie4Tt€ai
C7Atlniferi;cchargr CiGroutadvrateriEotrocdislioaL
AAgtiiFcr St gil ar ltecav ry' ASalinii<Barricr "ON X lttAY rant w+rf�4 �vr �nttn
4 M 10 It- Silica Sand 20/30
[Aqua Test 05tommator Dtaiaagc
DE\?cnu cntal Tcchnotopy ❑Sabsideace Control
�r4;15 'li:` I�iiicltitl`t1d1i �tNeitslE - "�-
t7Geiothenn-il(Clamd Low Mirai= noM To nESC.amrlaN 00br.tfagu - WAWA otm VAM Att,sic.
OGeoq iad(Restif SfCocali Mum) ❑Cld►er LtxAin underA21 Reim ft- 0 1L 3 IL Tan Silt
3 tL 10 R Sandy Clay
4.Date Wen(&)Completed. 9-16-21 fjlp' ID#PZ-51S
tR It,
Su,Well Location, tL tt.
_ _ _
Tuscarora Landfill ft. It,
Facility+MnerNam FaclrhtDff(if applimblo a
7400 Old US Rwy 70 West, New Bern, NC, 28562
Plvsical-Adlrrss City.and,Zip t
Craven One foot bentonite seal from 3'to 4'
Ceuk* ftW Mdrily ition No,MM
Sb.Latinfidc and it rn ghu4c in dcgrectIminuteelseconds or decbmnl dt 22.Cerdf Watiun:
oirncltr1cw 0M tolore isssmeiero)
IY W 10/6/2021
6.is(dare,)the wells), i)Per•mauew or oTempurury !i ehis Np ,yWn g h farrttr,i Irerrfrf cerrrjv%rhel the n,efN,•sf uwx ftsereJ cti7nruurted In acxxxritsnre
it!*114_KCAC Ob'C.0100 or ISA NCAC M,0.201 Well G nrratree'dan Smndrrrars and a
7.Ls this a repair to an czi*ag well: s7Ytx or ENo ear c!frhis reroni our;.been rlfmir!''ed tothr rett 047u r,
;'f dais is a Few?,fin ow traMW uv it eo wnwdorr btfi mmnion mW eapfraht the maw of rhr
repsgir raster 021 remarts.ver an or rm dm hrerf r f fl&farML 23.Site diWVam or additional w l details.
You may tine the back of this page to piovide additional ttitll site doWls or a.'�ell
S.Nurnbe rof wells conAruded: i eattmurtiandelads. You mW also aftch addittomuti Rages if necessary..
Fear nndt itr irfct=rho+nr non-rrarer Akop r wrib ONLY with rth saateeoustramftarr,�xir cxi+a � �i 3�IIV"S�[1C Yfd)IV
smaha itme form.
9.Total trill dgah below land surfart 10 (ft,l 24a. tr Alt WOW Submit this form wilhin 30 days of coarplerlrtn of quell
!err mAYAief a-dif 11sredl et•Po3 t1 Ails rr�ia/crmwTrh f�2f1f►'vrteJ l�rlsl<+1 Ccur,ouoian to tW 1roltoWirs;
10,Static water Invi below top of easing (M) Division of Stater Resourees.lufor matiof.Processlnp,l lnit,
Ifrra.r?frryJ As dkiVe r uahil+. "+" 1617 Mail Sen-im,CV11ter,SlaleW INC 27409•1617
L 1.Borehole dtanicter:S.25" tin) 24b.fpr lnlrrttan VtXW ONLY.- 1m addition to sending the form to the address in
24a abem also subunit a eopc of this feat!within 30 days of ccolupletion of gel!
12 Welleonstrnction method. 4.25" RSA cotutruttion to the fduortdtw
(i c.mtpr.rftM-.cable,iffind push cre.l
Dt<islum of Water Resonrccii.tlndergrnLrnd injection Control Frogttiun,
FOR WATER SUPPLY WELLS ONLY' 1636 hinS Sen ice'Center,Ral fth.NC 276"-1636
l3a.Yidtl(RPm) MOM of test* 24c.For Watcr Saliplr&trticotian!Yells:
also submit one oM of this forin within 10 days of completion of
tab.11lzlufer to wt:ll construction to the countyIhealth dgmd mcW of ibc connh whero
Amount:
cxtr►stututu:d.
Fern Gew-1 tromp Carolina MpaitsoM- of£nc rarumd and Nn=W Itewor -s-i wWon of Witer;t"CAMU S Revised AgDM:Wi3
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