GW1-2022-05187_Well Construction - GW1_20220531

WELL CONSTRUCT[ON RECORD For luznwl#so,,0NLY:
This form can bc;"T4T-single ar multiok wells
1.warantiriftor It do rmation:
Ij.AV.,%TER ZONES
Robert Miller FR01111 To MSCRIPTION
gl'p)ICvrdnrGvrl;(arau ft, ft. ;
2675 ft, fL
NC Wd)(7diduclarCerlifwntion Nuirbir -15.OUTER CASING OR LINTER(if a i flcahk-)
FROM. I Try DIAMETER, -1 THICKNESS MATYRTAL.
SAEDACCO Inc
0 ft.. 531 (L 6- Sch40 PVC
:11 1 1 1
I6ANNER'CAS1`NG ORI 8IMGA'wa6vnna1chjwd4oap1
FROM TO DUMETER 1 THICKNESS ATATERUL
2.Well
cajojfx'.""Vt4r!p,'V0r1"114V.ftylw6M 01C.-) ------
; ft.�
65c)
173CREEN
Water Supliky Well: FROM I TO D[,%',%TF.TrR I 5r.0TSIm THICkMS, MATERIAL
b A I gAcultutal riMinkipatTubi I ic w 631 ft. 6-' irk, 0* .62 Sch40 Stainless
06cothenmal(HeldneCooling SiTply). Mesidendal NV I a(cr Suppb,(sin&)
MIndustrial/Conintercial Mesidmial Watcr'Supply(stared) Is"CIROUT,
FROM TO NIATERIZ I E,'%IPLACY-NIENTAfMOI)&AIIOUNT-
__ _
El fitioption 0 '(L.: 471 (L Portland T t-imi
Non Water Supbly Wolf:
Injection}Yell: ft. IL
bAqlli f&'9Cqfi1'Kgi Mdrdundu-atu Reinctihifion 191-'S.VN DIGMVVEL PAC fit apph6blcl •
'PROM' � �TO I IkIxTimr.4t, RNIPIAC"IF.NTNUM101)
MA41d(cr Storage aixi 9c6vciy Malin 131iiic,f so- It, 68 ri. Silica Sand 20/40
'ily
056rnwmtce D,H" t6g'
!71�1 . c ft
13Y,cpriwcn1A Tlc�hn l9gy Coi4w I
-26.1 DRILLING LOG(affach aMiijoiiatifiecls'if wcosaryl
13C!eotbennal(C lased Loop) btracer FRONT To DFACRIPTION(mbr.haratico.qvivnpck n alai wv,dra
Elawfliennal(ffeatinomoting.lk 2 turn) 00flier(explain,nn&r#21 Retuaft) ft. 1l,
ft., (L
4/l/22 Will ED#EW-7
(L
ft. (L
MAY 3 2022
ft. ILl
FaqtMy iDN(itappikov-c)
ft, Infoly7ta2i-N)
1248 Bill Hall Rd, White Oak, NC, 28399 ft,, R.
'Zi -21.RK5L%RKS_
Cumberland Three feet bentonite Seal from 471to 501
01"MW Farrel IkJ-.;3ijjrLc_jfipti No,,(PJN)
.
- reci 1010t� M C icaltior'n.
N 2/17/2022
Dile
6.16,(are)the or Iffemporary
idift MA MCAC,02C.�)100 or 154 MC,(C 6-k-o-'09 ly'wl CVjfifrrk&#9644ara'S and rfmia
7." this arelmi E]'Yes� tir 'ENo
23.Site dhqratu�or additional well details:
You may IISP,1&back of this Oge.toi'lukiih additional well site details' or tell
S.NutubeirofAiells wmitruuM: 1 e6nStrudiondeiaits. Y0U!Iday also:iu'ach additio'nal,pages if necessary.
For i6hipre iqjt rhm tw'- _Wgpve'fh'MLY ii1rh
SURN117TAL[,NSTLTMONS
9.1[66dwell depth below land sui6 C_ 681
;414. For All Wells 'Sabridt this ftirni within 10 days of;cornplclion of well
ForWrAthiple rdidepft lfdoere* 20 IAQ-Y con'5triiction'to,tk folto ink:ll,.
Water Resaurvek�IrIffirmatitinProcess ng Unit,
10.Static water level below top of casing:' (fL) Divisian of
l6b'Alait'Se"i ice&uier,,k-dcigh,SIC 2760417
It.Borehole diameter;10 40 24b.DrIalm.flanNeMSONLY: TR addition to sending the-foml to the'address,in
24a�a'6& .als'o Submit a copy of this fonu within 3O days %v�s'of completion,of zll
11'Well'coustructiou nietho,d: Sonic Lons(ruction[a the
(13'cl.mijcr.,M' tiwi .cabf&'dimct push etc.) 'it- Control P rograw,
'Division of Water Resiat rc&,l[rudirgmund Tojelon
FOR WATER SUPPLYMVELLS�ONZLY- 1636 Atoll Service Center,Raileiglij NC 27699-1636
13x VIM(gpip) 13ctivad Df test
Nc..For Water Supply 4 Injection Wells:
' *
Also Subfnit 0 ii with-in-30 ddy pfqottapletiofl of
13h.I)Ainfection type.. -well constructi cop}' of this foHon to the county Health department-of the county when;
Amount: conshumd,
Fann d%M-1 RevisM Aqust'201.3