GW1-2022-05228_Well Construction - GW1_20220531

WELL CONSTRUCTIONRECGRD
This forth can be used r6r single or maltirik ONLY:
I 146ntrat to r Information:
14:WATER ZONIS
Robert Miller FROIN11- TO "PSCRIPTION,
W01 CorArddor ft- rt.
2675
rt. rt
NC Well Cdattactar Certification Nun-he'T 15.OUTER CASING(ra iLli I-aiwj ensli OR LINER 4 if a p
TO. 11TAIMETIEFt THICICNESS T,FROIT q1L1a,1 Nk11L-%L,
L
SAEDACCO Inc 0 ftt 601 6 ij 1 Sch40 Pvc
Ooqany�N;3tve tti.INNER C 4SINGOR TUBING4peodwrinal eNsed4000)
moTa D1.01IFTER, I TUTCKNM l 'iL
tt.
l
2,-Well Comtructloii Permit
fist ail r4lkabjr ser.if p ohuk*,(i.,e.Coj tn rin rrc; r1r.)
3.wckus�e(c4mic Well uso.
N.SCRI.kN
Water FROM TO I DFXMETF�R I ST.OTSIIX I TN1ChNFS-' 1`57ATRWAL
OAgriculitmal 60, ft: 801 ft. 6. , in. 0 .02 S6h40 Stainless
C36cotficrml(Helling1coojing Supply), bResidential Water Supply-(single) Jmi
C31ndusffialtConummial ORtsidential Wi(cr'Supply(shared) 18,GROUT
-TO N11%1TFRL%1 I E%1PLACENW_NT.NFM0D&A?401JNT
0 ft. 541 (L Portland trimi
NoriAVAtir Supply Well:
Injection well, rL
QAquifcr Rccliairge" NljiouMs�ttcr Remediation 19..qAND,'CFL%4EL PACK(if aplilicalAv)
:FROW, TO 1$1A!FPR(.%1. rttiPLACEMENT WIT11011
Q Ilinity Bifii.cf 571 ft. 8-51 A. Silica Sand 20/4o
ElAquikiTcit. bvt;16"
dExperimental ToAnoicgy pfiotasidcrtcc(on4rol
20.'DRJLLIING LOG(attach additional jlheejs if rwesinry)
dGeothennal(P.lased Loop) LITracer FR03T TO mcrupirloN upbr. Ate,dt.)
OGeotheniml(MaEfilor-ooli ngReturn). [101her(explain under#21 Retuad s)
4.'Daie Weli(S)ponipidted: 2/28/22
,Will 1D#EW-6 4
5a,NVOI Lacatin":
MAy 3
fL
FacHily IDP(i'f'nTPIW'b'Je) ft" ft.,
1248 Bill Hall Rd, White Oak, NC, 28399
PlkY5"Ad&cssL City.and i tp '21.REMARKS
Cumberland Three feet bentonite Seal from 541to 571
I-�kitiidc'atid lxim'Aitudc in dc,gmcs/ inuft�lse 22.Certification:
.m cnnds dr(levintal d
N 1,1712022
Dale
6.Is(am)the ivell(s)t 'mPernianciat or oTemporary. y#p4g Fjmyrfa ( m (wjft iLro b iy vs econywreied by.weviW=re
W&15A KCAC 02C,0100 or 15A KCAC 02 Ch200 Well ronitiziction SionWards and 4xia
7.Is this a repair to an mWing Nvell: 08'es% or 'ENo
a repali,fill twit JI'vi"Im
,e&ir Ca ';921.ivwr ,kw r'Ck%Me boel qrtylisform. 23.Site diag"m or additional well details:
You L114Y Use ili,.back of illils pale to ptovide additional well sim.,details or iiill
8.Nnniber of At&s constructed: 1 c6lis(tuction details: You may if necessary.
85, 2da. Far All Wells 'Sl bfidt this fdrm"thin 10 days of'onniplLti6u of iiell
por,mawple lve?Mfif kh1q.v&Y ffdWre)0(excivpfc-
10.Static%vaterlevel below top of rasing: 00 Divisian at Water Resources,Inforrantion Pruecsilng Unit,
1617 NlAil Service Center,Raleigh,NC 27699-1617
11.Borehole diameter-.10 (in.) 24b.For Loteellan NVe-IN ONLY. Tri addition to sending Use formi to the addrms in
246ab0e.als,o siibhiit imv of this fonn within 36 divs of-Completion of jail12.Well.constmetion method: Sonic Lonstiuctioll to tile
rusk etc:)
FOR WATER SUPPLYNVELLS ONLY: 1636 Afall Service Center,Raleigh,NC 27699-1636
H&Vidd(gpm) 24c.For Water'Supply&Injection n Wells:
Also subifift olke"Cdpy Of this f0ful,Within 30 days ofcomoletion of
13 Avell consthictidn'to the county health department of the countyWL-re
Aina"Uh.—
constructcd,
Nonli Catalina DeXonxnt of Emifujuirm and Nation]Rem=es-Divi;Ion of`Walcr Ro2s=CES kc0sed August 2013
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