GW1-2022-05242_Well Construction - GW1_20220531

WELL CONSTRUCTION RE-CORD Far titcrml U�sc.ONLY:
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Robert Miller FRONS TO DF-lettl ION
1YelOcor,46zlor N­,i a ff. ft. I
2675 fL M. I
NC.WcU Cdnlmclor Cen if=iion Nui&& 15.OUTER CASING OR_LINER1l1'i,! ficabk T
FRONT. I TO IDTAMET TC,;
SAEDACCO Inc 0 fL 731 (L 6- in. Sch40 Pvc
26.INNER CASING OR TUBING ftwodwrind clyed4loo'p)
FRONT -— To I i)w%tir.Tw. THICKNM NIATERLALL
Mxf rt.
116N.'ater.Supplyr Well: -FRONT' TO $1 MT S 17Y. THICKNIS91 ji MATERIAL
- ft� 931 ft, 6. • 0' .02 S6h40 Stainless
nAgdcultural [JNlu9ieJpaMWje- 'i2l I
Ol3mthemial(Heating/Cooiing Supply), 011esidantial N'Vatcr.Supply(single) R. I
01ndusWaXontutcrcial OResidential NViter.Supply,(slmmd) 18.GROUT
FRONI To MATERIAL I E%1PLACLXENTNWFH0D&A1N10UNT.
13 Idioption 0 ft;' 67 (L Portland trimi
NouWaver Supply Won:
Injection weUo- ft. tc.
0Aq*feri1cc*ge" Wdroundii-Wor Acindkifion 1%SAN&'(.PLtVrL-I1A(_'K(it aliplic;ONY
PROM it) r1lXrrldAG
-IM kc6avely M&Unity lJuder"
701 ft. 981 ft, Silica Sand 20/40
13slonmi-Itct Mitt nlgc.
IlAquoi. . I
1:Mxperimctltal Tcchnotpgy Ccowiwl
'20;
DRILLINGLOG(illach ad4lilional sheets if nec"staryl
Meo.flignual(Closed Loop) 'ElTracer YR031 I.Ter DFSCRIMU N(color.lhardiiut. K."grajif site.W.)
ElGeodienual ffleatingV�Coolfiig R2tuni) [30dier(explain.under 02 1 Rewaiks) ft. (L. 9;!--
it., ft.
r-1 V
4-'0a0'VeU(9)CbmpIetcd: 2/18/22 Wi11ID#EW-67
1L. (L
ft. MAY 3 1 2022
(t. fL Infoirrn.Vjain ProC;—=tng Unh
FicilitpUwNrNanto Fac My IM eJ17 aypjjcnbl'e)
1248 Bill Hall Rd, White Oak, NC, 28399 ft, ft.
PliySicmfA is.'Cjly sand Zip`
Cumberland Three feet bentonite Seal from 671to 701 Five
CoubLv 11amel No,'(PIN) fee
56. 'and Lou'j;iiudc in 6 Latifiede g=rWmjtutWictondi or dechni-il dciwevii 2L C w!vrtifi 4ozi:
N 2/17/2022
Dale
6.Is(arc)the-ivcll(s)- oPermanent or oTemporaty rebj By,signing khr fajw; Ire evefify q!w Wq i!,el4s)vs.wz c-cwvimeied itu areoT&wre
v�idf 15A XCAC 01C,,0104 or 15A NCAC 0C.0209 Well Cpirarrricdcvr§Mmards and Akli a
-7.U thbi a repaii-to;to,5,4ting ivc1h ove-S, , 'ZINo A.,record64y'K"al p,rol-f&.4 rq­,"ifbl uril(4ijeri
or
Ivell f.%Pfahl 111e,wrare qfrlle
_Pai"i;931 at L,w the brxi aldshfurar. 23.Site diaUvranior additional well dehols-
you way use back of this W.1
8.Numberofitefficonstructed: 1 construction'deiaL You also art ieli ad�liuoiial pages if it cessary.wiqls OjVLY wirli r1je sajrie To"j6"kdair,ytwi eon
SbRITtA L,WSTUCTIONS
9.1roial isell deptlube6w land surface. 98' j!I.iL Pat All.Wellsr
Sollfitit dds fbno uithin 36 days of'o6m Id.iod of v vff
Av i'disfisi a#4*6-ftdorefit(e,'Tampf�-3@2(Vaeid:2@My' 'Constnicti On'to(hd fo.110VO I figt p
in.Statie water kvel lk-low top of caminw. (ft.) Division of Water k6ou rcei isin
I r. 41inrormatibuProctg Unit,,
1617 Alan SLrvice Qtf&,kileigh,NC 2760-M 11
11.Borehole diameter,10 0-) 24b.For Tkila flah _NLjl_q ONLY:, In additionto sending file form to the addrm in
24ai6d►• 6b3 submit a Copy of I aLis',fann witbiti 30 days,of cotnplqtilol,of W01
12,'Well Construction method: Sonic ta 1110 k6wing:
isu''- i—NM%cA A i
FOR WATER SUPPLY'WELLS ONLY:` 1636 Man Service Center,RalcipikiNe:2*94634
13.i Yield(1,-pm) Method of 24r.-For Water Supply&Injeal on Welts:
,,
Also subihil ow. cop), of this fd"n4ithin. 10 ft�s o(C6111flietion of
136.Disinfection type:, Amount-, %vCIIComq1nlCt1;p; to the collnW kalili department ofibc•C0110'.whCru
con�Mictcdr
Fonn,G%14 Nooh C31011M W-Pamixflt orEndfujumm and Naniral Resources-Division ofWalerRmou Revised AqVA M 3