GW1-2022-05224_Well Construction - GW1_20220531

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WELL CONSTRUCTION RECORD Fpr,IrLcrnnt Etss,Dl1I ti::
This farm s8n bc:used ftii,i6g,ie or multipk nvcft
1,tYell:CdDtr:[ctorIitforetration:
14.WATER ZONES
Robert Miller FRONT; 70 OPSCRtP'"ON
11't ECbsnsxiortKans0: R. trLI
2675 R.
NC.Wc11 Coritmclor Ccr ifuation Niurdiei 4S.OUTER CASfNG(for anilfl 49M nCO3)OR LINER fif a"llenbtel
FRO NT. TO - DrttifET6R TD1ct;;.�tE,C'4 rr.•17ERL4t;•.
SAEDACCO Inc 0 fL,1 45' ft. 6" in, Sch40 Pvc
ConlTtan}:NamC 16.:1NNFR CASING OR TUB1NG'I-mihcrroat ctnccd4oa
FRONT .TO DUME.TER THICKNESS hrAlERUL
2.WcJI Construction['ci ntit t;; R. ft; h4
1rr1 rdicjapirt'nbie vseiiine"r",tiir:r=�Cnunhr;S',hin;.Vnrimrcr.Ilrfetfl'Gb,rrc:J
rt., ft. iii.
3.Wol-lfsc(glIpc!:ivvll rise): t t:SCREEN
`�':ttcr Supply Well: FROM_ To 5tx%raTeR .sr,orsrry; TtuC mss MATKRrAL
bAgricui t al I.M6iclpalftIU ic: 45 i fi. 65' ft, 6" 'ins 0' .62 Sch40 ' Stainless
®Gcothernlal(Heating/Cooling Supply) CiResidential Water Supply-(single). ft. ft. n:
®hCdustriaUConmtcrcial. ®Residential�irater 5uppf){sllarrd) FRO ROTFT To, NTATaRtu., I EXP[,AM,MNT NWFHOD 5.04ouNT
❑Im atitin 0 fL: 39' f4 Portland trimi
Non-Waver Supply W H:
h.. rL
l7htonit�ring ®Rtt_m�er}'
InAectiotl Welt: ft.
f
0Aquiferl#ech:irge 6HGitsurrdtSuterRciatcdiabon 19.SANDICKA EL-PAC tirsr)l,c:d,tel'
42-
17Atpnf�rStorrgeais3Tecasri}' 17Silinin lictmcr 'FROM ft.. o' ft. Sil carSand z0/4o RNMACt�tr�TstFrtroti
❑AgnikiT- csf ❑Stomm:ltcrPrUn:lgc ft.• tt.
Mx,pcnimcntal U1 AnctQgy QJ itb5idcncc C620 T,01
20:DRILLING-LOG(mlach Addhiooal sheetsif ncccsmr4l
❑Geotltr n1tal.(Clgselt I ot)p) ❑Tracts FROhr; TO DFSCIUMON fmbv,hartU`.+: sA' t tr` ">i txtk,ttc l
❑Goo[ltennal(Hearin Goollue Re[unl) ❑Outer-( pl liutil►der24 Retuarl s) fL ►L I
. tL rL
4.'Date,NVeli(s)6illplctetl;_ 3/z/22 IV'e1lID#EW-57
ft" ft.
9 �YcllLfrertione It. (L s.^
t E1-iE2 ian r fL gzz.sti'^. Uni
rt.. fL 'Dt,ASI" MOG
Fao(litp0wcprNaxc Facility lim(tapplicaldc), R. rt.
1248 Bill Hall Rd, White Oak, NC, 28399
Phasienl.lildicss City,and Zip 21 REMMARKS.,
Cumberland Three feet bentonite Seal from 391to 42'
CcbtiLi' Pnmcl 1tl.rsiirvpjjiun No,(PIN)
Sb.I dltiti�dc aril I.cingtfailc in.dcgrcc�/minutcs?sci ands or tteeimul ctc�ccs: 22.Certification:
(iftsell( tiJ tva11aU`louy i;s�tl7iCicnt)
N ��' _ 2/17/2022
Sietnttirapf�: c;3r�i r;•_ 5s '�-= .Date
6.Is(arEj the wll(�): MPettnatten( or '❑Tetuporaty. Bj.rgnrng ihir.fmnrr;i hereby certify Mar Me meiffs� way f kirm)cuasrryered,br;aeconbmce
irilh'i5it NCAC•02&.010U3 or.15A NCAC•02C,424f1 lreli Goitsrrsictloir Staruiar� srrsri rianr a
7.h:thL%asrtpdir6rlt 6dt,tingNvei1 17'fIci lir MNo rapisafrfiirircvidlaiistnrnnrm';rkrroifrurflrnut�r.
1f rs'r(s It u riprtr,jiN cart 41r1�471 well e*eutnrtv(an tryramusiSin mod iup?bi rile w.rore of rise
-Par a"ji;iji. or ct2 the&A—r:frha form. 23.Site diAgrant or.additional!well'details:
You"luay use-IU'c,back of this page,to:j�"ro�ryde addi6onai tall site-details:or 1re11
S.IUtitthet'Qf ritills ioD+;tructed: 1 cciustnict#m1 datails: You:inag.ilso adach ldtlil3arral pages if necessary.
fur;midtdeYr dt{s�Yra�rtax rrrxi-iFarrer�cg�ty�•u�i7ls Ur�'LY utris rllr arrrea rorrsiavrrlag tir=trrrrn
si ane farm; • SUl3lt1l°rTAL WST T .TiONS.
9. l�iilivell depilt bct9i'ri:md sttrfke. 70' 2Ja Fat All 'Wills. Suhtirit This fuim ttiitlun 36 days rrf eonrptcdciri of welt
F�araroatauieicrtdr''ici�Pia*i as't�ri irrv7tcevru Pc:7 ;Dtr'triuiF Pf 9' CvnStnictignicytfi fo11Aviing;:,
Ia.-Static water level.ttclow top of easinw: (ft.) b#i 6idn of Water Romd Mis,Infarniafion 1?toccssing Unit,
if tcw;c'r tees i d�sbravc cvratrr tL "+" 1617 Mail Spice Center,Raleigh,NC 27699-I617
It.Burchotc d1aurctcr:10" (#n) 2415.ForFujalilill MkI1g qNL Lt. in addition to sendit thb foml to rile address•in
246a0i 'e.also S0111it a COPS='of this-fomt within 3b days"of contpiotidit,of well
12.Wcll.tro)tsfertctiou tnMhod: sonic construction to[Itt;foilomlig:
(Le.auger_rutafy.cab1R I irerl puslieta.) Diciclou of Water Resotirem Uiidergrbund Iiljectton.Coutrvil,Tropain,
FOR NVATBR SUPPLY WELLS ONLY- 463fi hfatl Scrrice Geutcr,Raleigh,XC276"4636
13:1 Yield(fipnr) ,1lcthod of.test: 74r.For Wafer Supply&inicetion'Wetls:
Also'61166iit dni;copy of this fuini►sithin.30 days of"cotllpletion of
13h ion•type:. ATa.Unt• «vetl consi-action'to the couniti;health department of the coitnh•.ithetc
eonstmctcd.
Form GW-1 Nonit Carolina DepoAmrnt of Endrorurrut ami Natursl Resources-:Division of Water Re;ou Rcc•iscd Augustlh013.