GW1-2021-02407_Well Construction - GW1_20210615

WELL CONSTRUCTION RECORD for Ift mlUseONLY:
This form cam be and for sirgk or maltipk%++ells
1.�til Crtntrnctoriniortnatian:
td.1►rA. 1t:
Will Reyes V.R M TO IDPSCRtPtYCfR
Well Costmdor Nartle R. R.
4220 A
NC Well Con=ctorCWflrcation Ntunbcr Li.OUTERCWASFMNG nral(Nl xsed l tAs OR Ni.R r "trash
FROM T) DTAIM TRR Trtt'luCaM I 1IMMAL
SAEDACCO Inc
Compaq-Nam Tk l" , 1tGOR 9tBING' f►e+r►iltl lssedaan
FROM TO DIA1iF.T6R I Tt1t'i.NFM I MAT;RIAL
2.Well Conoracdon Permit 8 fL to. '
list all owirume wrflpermttz(ir.Counn:Suer,Varimere.Itgstiorl etr.)
h. h.
3.Well l sc(chock v%ell mic}: j SOMN .Water Supply Well: VRON 'ro VIDIANKYRR I SrAT IV,, 1 7111t"KNt55 MATFRI-AL
OAgaiculhlMl Cllyonicipall tl�liC 6 R. 16 h. 2° in 10 schedule 40pnc
OGootbetliml(ileatittglCooting Supptp) 01tesidental Water Supply(single) R R'
0indlistiiaUConimemai 011esidential Water Supply(sbaMd) t&'CR
FROM. —
TO MAT11RL11. 1?AIPLAI'F1l1EWMEritOD&AMOTSIvi'
Oftfigation 0 h. 3 h. Portland poured
Hon-Water Supply Well:
Mivlonitorin O o> R. ft.
1-tijection Weil: n. tL
QAquiferRcchvp 00oundwaterRemediation 79.5 1)
❑A1111ifcrStorngc and Rccof�efS C1Satitri()Battier lATFetAi, R1ii ,A.,
5 R: 16 fL sand 2a
DAquilerTcsl oStorMNMterDteimgc f6 ft.
❑EWr►mental T=hnolagy OSt"dcncc Con1ml
r11Rt1A.lii -Wt3 thillrtti�d8ldona't 33t1Acctssa
oGeothwiml(Closed Loop) D en= IRON T} DF$CRTMO;;NOWAVOW6s00'Wk lypt,090 ORM ere.
OGeodwi mai OtegfinziCoofloe Remm) 00thea in under 421 Remaits 1 a 1t. 161 1L tan silty sand
R. rL
4.Date Well(a)Completed: 5-11-2021 WdjyD#MW-70,MW-71,MW-35R
ft. tt.
5st.Well IAMAlon;
Dupont
Faclily0wWrNtum Facility iDN(inapplicable) R. R.
3500 Daniels Road Leland, NC Brunswick County, Leland, h. f. eosinq Unit
NC, 28451 Fr10simlAddsss.Cih•.endZip fir.- i
Cattily tyn:d Ift-fla ieation No.(PIN)
Sh,to tudr and Ungitude in dc9rMslmimitC$1scc6nds or decimal d egrecF. 21 Certification:
0twell Geld,ow t;st/tatj is sidnekid)
34.316943 1e -78.034190 R' te5 5/16/2021
sigmWit of Cet(i5riWcD cent= t Date
f►.IB(are}tliC REII(S): :�Ftrtllt0nettt or oTemporary Ity sfgrmiy,Ab form,l hereby eeWy tfir)I tke wvIlf.q mtdt+ttre)owntrmend fn arror[f»ar
u-1th 15A NCAC O2C.Ol1kl or 1 FA NCAC 03C.P2M well Corrstrwy1wr StaWards mid that a
7.Is tb2.s a repair to an Ldsting well: OVes or N No rap%c jrhir regard hies bran pmi irJrat m tier aril rntvrer.
If rills is a rep0r.fill oar w well coamtratofs ilommrkm areal rrptai"the nnrxre of fhe
reptirvmdor021 remfnkxser*t dorgindirbarkpfthusfame. 23.Site diagram or additional well deWls:
You may use ft bare of this page jo.0mide additional well site details or well
S.Number of wciis consimeted: 3 construction details. You may also atlaeb additional pages if necessary.
F �chrm le lnfeetk o w'non-tt ouv sWplr ws7Js ONLY ii lrh die sen4e eogstrnrrltotr,}lap r so RNMj r INSTtICTIONS
9.Total will depth below land surface: 16, 24a. Por Aft Wells: Submit WSIOnn Within So days of complietion of roll
For mtsliiplewellsllsr all Arpllasitdy(ermileraw,Plr 1@200`w4d,?+p+W) constnctionto the following;
10.Static water le%tl below top of¢asinz 8' (R,l Division of Water Resourtes,Information Pmftssing unit,
If hater level h abupe edithp.use"+" 1617 Marl Service CCnier.Raiczh.NNC 27699.1617
11.l3archotc diameter 61 (in.) 29b.For IoWWon 3W1c ONLY: In addition to sending the form to the addl>:ss in
24a above:also taibmit a copy of this fame within 30 days of completion of neJl
IZ.Well COnStroeftn method: sonic cVtisme iDn to the toUowitgs
1'i.e:anger.mmry,�bl�dil�tpaslttec.)
Division of Water Resoorm iUnderviooad Injection Control P"Wam.
FOR WATER SUPPLY WELLSONLY- 1636 Melt Service C nten Raleigh,NC 276991636
13*Udd(gran) Method of tat For Water Sat►nir!Yc Iryitu:tGln Wells:
Also submit one copy of tutus fofitl +*bin 3A ftsofconVe ion of
13b.:0hin etfnn,txpc Amount well constniction to the colmty bc'gahh drpnrtl inn of the count)ui=
c�►nstrlaaed
Fenn G1X'-t NDnb Cmali s DqwtxmW of EnOmmi N and Natural Rewwws-Dh slon of 11 sW R(5o M R vlwd Ate 2013