GW1-2022-05171_Well Construction - GW1_20220531

WELL CONSTRUCTION RECORD
This•fann can bc u-wd PiT single or multiji3q.wdisI.WdCCoutractorinEdrmaliou:
14.IVA'IER ZONIUS
Robert Miller FRONT TO DFSfRIPItrIY'
NVOI Com ritdor Nat W, ft. It.
2675 (1. ft.
NC well cdflfmcfor cellifi6tion Nlimber .15.OUTER CASINIG Mirpwillki-wd nsjO 1;ICIE (,I Fr,jiblel
FR r
ETE 'S
FRO37 I TO PLU F It ,I'tT"T'tL
SAEDACCO Inc 0 fIt'1. 5 0 6" .'jiti, 1 Sch40 I Pvc
�,fvipu' y'Name i6,INNER CASING ORI'UHINGff,-emothLrj alckj."4wo) t-
FRONT TO DBINIETElt I THICKNESS I ATATTRUL
2,Well Construction OCITtlitt ft, Ft,
ft. in
3,,Wa1LUsa(eliack well u";e).
Water Suplity FRONT I.-TO, DrAlVIETrEt I SLOTS17Y. 1"4[CJ0TS!i I MATERtAT.,
0 1 Agif.p Itural ONfunic.ipal/hibj.iic so' ft, 60- ft. 6 'o* .62 Sch4o Stainless
loGeothennal(Heating/Cooling Supply) DResidential Water Supply(s!Dgle) ft.
ClindustrialTditintercial OResiduitial Watcr'Supph-(sIxivatl) GROUT
FRONT TO, MATERIAL I EMPLACEINTENT3FMOD&AMOUNT
Ohtipation 0 ft.' 441 (L Portland trimi
Non-Witter supplywoff:-
it. ft.
lklRecol-qry
Injection Well:, ft. (14
13Aquifer,Rccfiargd" Wrountiv0tcr lIcnickition ig.SANWIGRAVEL!-AC
Klumli'FRONT I VNIPIACLMENT SHM101)
ElAquifcF,S'ioTa :.114 kccQVCIY Q' il ini IV mime,(
47- ft., 65 (1. Silica Sand 20/40
CIA44itter test 1356rimunter ba 1'r6go
I I I"kb5idCacc C014TO I ft.
20.1 DRILLING1OG(attach additional shcdsif necestary)
ElGeodiennal(!Iused Loop) oTracer FRONT I TO
[]Ch atltetmal(Heatiqi Mom) [10ther(explain wider 421 Rewaiks) ft I. (L I
fL. ft.
4/3/22
4.D1 Will ED#EW-16
A:44 W1141 ft. ft. --VA--Y3
Facility IDS(i1 appikaW) q,.n
ft.,
1248 Bill Hall Rd, White Oak, NC, 28399 ft, (14
'2L REMARKS
Cumberland Three feet bentonite Seal from 441to 47,
GotNty rotuCl ILI,-wjrLC4jiJpn No,(PHN)
22.C icati*-
2/17/2022
Ddle
n
6.Is(are)the well(s)- -xPermattent or OTLuiporary frereby rvrjrlf�r�ja�j�ir irg�14s)iswy(iu?re.)cmutrueied hr vceqrdcnce
ivi&15h NCAC 02C.0109 or.15A NCAC P-C.0209 Well Cjp4ifrwcdoor Stan4ards and-Aw a
I IN thin a rCilAir in 211 '"'Cli. OY&,-s- tir 'ENo rcoy.bf(filf
R-
'23.Site diagram or additional well detaits:
YOU[114 I!sp't4i Wel;of this Nbe t,o.p.tovide additional well site,jetaili Or tv'ell I
8.Wintiberof Weffi constructed: 1 ootis(mcdon details;-,YoLL ir4 alsoatiaell additional pagts if fiecessa*�
For i4jiWple I*ent4i v ot%-j'-ivarsr sj(pply wdly,ONLY vidi r1je.same
=kur,fnMEA'.rn. SUBMITEALMM-10TONS,
9.70iA htill depth.betawland surfacc,. 651 .24iL Iai All Wells Subfidl this i1iriii uithin 16-days:of'compIc1io1x of 1}cll
For#fRjfiX1 lrrljlljiir l�Jjjlpllas(ido,reo ft(e.Tarubie..1WCO,atu125sId7ITy consonictipit to dw folloning':'
Unit,
DiviNidi of Water Re-qati rci%, it I ssim,
10.Static water levethelow tog ofeasinw, A) Informt bn proi c . .
lf mover.level h,above casftq,rise M&Alan'seffiep Center,IlUcH,I,INC 27699-1617
It.Borehole(lizincter-.10 010 2411.For h i I ion Welly ONLY, In addition to sending(lie form to the address in
244above, also-submit a copy of thi§Jonn within jQ day�s'of completion Of 1%,61
12.1%refft,oftstniction ine-thod: Sonic Lonslatetioli to dbe I56110%vilig,
;czibl
LCI aq etc
.)
.) DMOtin of Water Resources.Underground Injection Control groggrinn,
FORMATERSUPPLYINFELB ONLY. 4636 NfitilService tenter.Raleigh,NC27499-1636
131.Vield(gpT) Mettlad'of te5t: 24c.For Water'Supply&:Injection Wells
Also submit one c6jpy of.this foinn,within 30'days ofcoftiplelion of
Dlt�41sinfection Amount: -we'll,constinction to the county Health depanment of the counh,wilcm
constniewd,
Nonh Catolina Dc7annicut,of Envimamem-wd Nbuttal Resouxes-Divii Ion ofNVaicr,Resouves Revised August 2013,
1