HomeMy WebLinkAboutGW1-2022-05135_Well Construction - GW1_20220531 WELL CONSTRUCTION RECORD
This forth can bc'uscd for sNgldoi midtiok wcfls,
Robert Miller FROM .-to 1011
Well Corirwor-Nantc
2675
KC.WaUCanimciorCertific�ati6nNim6ei 15.OUTER CASING(for iiitillkiscil n'eN LIN! Ldpj�,±, kj
FR03T TO I PTMAIETE Tmc,.w S!
SAEDACCO Inc 0 JL, 551 (L 16" i 'im. 1 Sch40 Pvc
coliqlany. MINNER INIGOR H1NG.(geo1&rznd cla,,M-loop)
-6115t!`13�60k Pernik#. FRON R. To rt� 3 INS M.
Ila 4liaMillrable.-�-vftprhakx fir.C6unty.-Vwe.Varlaffre,Iryardan eir.)
J.,Well-us e(6cvlc.;V dl t isc):
'EN
Water Supply Well: F110%1- To I DTANIFTFR I Sr.0TS17%. I THICKNFS5 I-ITATFRIA1,
15 ft: 75- (1-]6�j�0 .tat Sch40 Staiinieiss
-®Geothermal(Hcafing/cooiing Supply): C311,eside-ndal Water Supply(single) ft.
Clindustiial/C6nuftcrcial 0111midcutial'Mater'Supply.(sbared) 18"GROUT' - A
FRONF , , 30, NTATERE&L I EMPLtCKMENTNIUMOD&AMOUNT
0 (L' 491 ft. Portland trimi
Non-1'1,.nerSupply WOR:
Q
Injection We'll:, ft, rt
M4jrmM%�-awrRcnicdi,ition 19.SAN WGPLILVEL PACK fit appikabr-e-)
FHO f METHOD
Qr1"Ifirsioog-6 nio iJirfi 4
521 ft.- 80, R. Silica Sand 20/46
MA(Iiiiie'r Tcst -Igg
Q].V-riTcnla Tcchn logy vlb5idcncCcoltrol
EXjw, ;hernwl.(qus,ed Loop) IlTracer FROM; -TD �PFSCFUFMN
(f-mplaiu w0er#2 1 Retnad'-s) ft. ft
3/3/22 W J]D#
d EW-38 Aj L-
it.
MAY
F6ctlhy lM"(jF#p1Jcii*)
Pi%C1248 Bill Hall Rd, White Oak, NC, 28399
Pl(ys"Eitl Aild kvs.,Cjty.and 2i 21-REMARKS
Cumberland Three feet bentonite Seal from 491to 52,
No,
Siij*jtildc'alid 1.onS.ttulc iniilcgticihlilnu*sAccund s or dedmal'ilcirre i"w. 22.Certificatiori:-
(Ir,woll nood"OIL,�taom g i%vdrj��111)"
2/17/2022
w1c
MPerinatictit or riTemponry
fty-signing jWt-po;I hereby certify 1baf,.1he w44.y)P,-ay{were)
4,co)vejayrnrefed!waeeqni r-,
with FSA XCACQC.0100 or.15A AVAC trc.o2oo ivea cojiitr;cao;t standards 4714 fijaia
I 1s'thNq repaifto an,k.xiwfjAng:Vvcl1: OVes- or MN(P, rfvynf fitir Fer(;,dkGN&-,A PM1*141 fqi&lirlii-vner,
re-ir trnddrdt7l imu fkiliwfinn 0r U'-1 Me Ilf"' 0�tddXfCMUL. .23.Site diajrani or additional well dWails:
Yon'rftak-use Use bwkw dils Ng'a to provide addid6nal well site details,or\6.11
C61isfiliction delails: Ybu:ifla'also attach adiliti6iiaip g&ijf 1 me'essafy.
I -ppJ witAffiVLY lrjrjl rl
SVBN1lT1ALl1V—V-TUV-h6NS
9.'Ijrotal,Wc11 depth bcjo�T Land sorfa&i 801 24.,L Parr Alt Wills: Submit this fu' %vi Ifin 30 dztv-s of completion of iscll
Fo r,)iFii�fipjV 17'jjje C o M n I C t i o;Ft A,1—No i t i-n-
10.Static water level below top of 6shia: A) lllvisifl'n 4%tcr R*S'ourei!s,In6miati6ni lirxtcessin�g Unit,
I/Mver level b,above vdiing"iarr 1G17°kailservic
H.Borebole'dianictw 3.0 In addition to sending(lie form to the address in
24;iabove also submit a-copy of this.forin willtin 30 days of completion of well
12.Nvelt k)DItstnictioll method: sonic eotutnretiou to;the follo"MOR:
Division of Water Resou tvzs4]JUdirgrptind Ipjcction Control Pm.kin;
FOR WATER SUPPLY WELLS ONLY-— 4636 Alait Se*rvice Center.Raleigh,XC 2169-1636
Maj.Yield 24e.For Water Sueply&TnjcrA!on Wells:
Mcthod'of.t6t: Also subunit one'copy' of this 661 within 30,days of completion of
13b.DisinfeLtiontypie; Amount: wcll cons(nictidn iu'thc county:health i1citartment of the coiiftWwhcn;
Fans'MA14 Nonli Carolina Depatintent-jof Envifon=nt and'Naumd Resources-Division of WalCr RMUtFCES Revised AqpA201.1