GW1-2022-06256_Well Construction - GW1_20220628

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WELL CONSTRUCTION RECORD Fat frta:mdS3w LY:
This formcanbc uwd far singl€at multiple ncils PIN
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1.WL41 Coutmor information: a
Scott Hunt, Jr FnaaM (L1 DI`iGRIPItO1a
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Ne�FeliCammctorC:rtit�tieuNnrrbct IL.R M SINGI[ur¢n1)T�rRri1��I1si'llR•i�INER ifs 'i�t `
FROM 170 DIAMETER Tt ROMSS atATERiAL
SABDACCO Inc 0 (L L0 (L 1° Ia. SCE-40 PVC
Carr urvl�'arui. 18LIYIEFtC 1M.QI1>TUBINC"r( tieruiateli+aQduu"', a .;;
6R03t TO OMMIETER I THIM MESS I 3L{lERIAL
2.Well Coustraction Permit# > (L 11L
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l tur:7trtrtinrh7exsrl7Fei�rraas fcr.Caunn,Strce,tariars'�,flh�Jt�LPsc.7
3.Well Use(eltcck well use): 37.'SCRitI:N s
VHatar$uppfy Welts 6Tti)M TC1 ... II MIA\Ir,1FR ` St,OTSf7.F TH(L't Nim I 111ATFMT4t,
rlrlgticultural t5lvYtmicipaf E'ublis 10 R. 2b R, 1° io, O30 SCH-40 PVC
CMeetltcnrutl(HuttinpCooting Supply) OResidctltial Water Supply(single) fL <L is
lindusirRtllConinterCial 01kcsideatial Water Supply(stinted) 1ti CRO1iT..# a „f;
M?#Y TO 4.DLtTER[4f ENUM-ACLMENT MEi OD&hF1OU,%-r`
f]ltti lion (L � fL
Non-Water Supply Weft:
MMonitoring
NJe C]Rccotict$ f rL
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icliort Well: R'
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OA uifer Sutra^ �lani i
Rcco{ety 0611pi 'Battier a Tt1 nfa'rt Rtdt. CtMW Ar rrlFtr vttTnuu
� �' � 8 R. 20 fit. Sand #2
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Cllrxperimental Technology ❑5ttbsidcnC4 Con1tul
�ti=t)1I1i,l.iN tOG'(rtrich'sddltl®trill elieets`if`aeeessn: >�-. .,....; ,. _.
tlGtxsd=nal(Closed Loop) OTracr.'r FROM fro 1DFSCRCI7TION(o*r.hanlatin,wattsacR u[t.adt,I
ElGeoltemW(HeatmWCoolit>2Retutul OI]tltet(" laiumtiler02.1Reuxuks? fL: (L See Geologist's log
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#.Date Nell(&)Completed: 6/14/22 Well ID#,Tw-3
54.\VLA.Locatiaa; fL fit m:, . w s a k
Commercial Property (t ; fit, II I
Facilftp,Outcr Noma Faci1ily IMP(farpir able) J V
3400 N. Elm St., Lumberton, NC, 28358 fT rL ' +'a'r' -' + "-' �• RY
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6'lrrrsicat Astdrxs.C%_and Zip w2tt13ED
Robeson Temp well for ground water sample.
Caan$ t*3ief tdSstlit{ Uien Nt+:tPL++?} i
Sb.Latitude and Longitude in d neaaJmittutcsfsca7nds ordc mat degrees: 22.Ccrti(1caf.
(ifuell fwK om I.-tt4=4 is atffitl_sd)
« `(� 6/18/2022
SiotntumofCzt tcdSlrtlCon tar 2f. �, M_..._v_=
6.1s(atre)theweil(s): OPermanettt or 'ETemporal[S' Lha6gninblhir,erne.lirsrrbracrrtfxttrrrPrtunrt+irlrsrt (rxrntrnrrr7rttcter(nzsiaa (uare
Id. 15A XCAV,0 C,010)or 15A NCAC(12C.(7-M[Vdi Consimm on Swrsetarefsanef rhar a
7.Is tUs al repair to an otistltt veil. Effi:s or RINo rWy of ritit rewire!!ras hre:r trrolMINI rnr,}r:01 moler.
If 41ars!x rr npain fill Val A170Im wdf on4wrterkm firtikW rhgi nature g0fir
rc+:.crrurder 021 nmv:rks.sra parr or MI dr.&A,(if 1114 farm. 23.Site drs it im or additional bell detalbq:
You may use the back of dds page to provide additional well site details or well
S.Nuather of welts Constructed-i — _ --- _- ctttfsttuction Maik You long alw ailach additimial pans if necessary.
Ferr madadlrtc a�lre°Cdan it sat-nc+rrr sral+f4y wrlh ONLY'1401(7rr Wive e4rrtsowellorr.)wa Can T I i
x4vidtane fo+:.r.
9.Total well depth below land surfate; 20 (p.) 24a. ibr Alll Wells: Submit this futnt within IU days of complation of well
For roar 01t,rscth list tr(74kpd.!r rfdoi ranr(rr,?nt+lr-3020.9.,(Ind 2410w) Congntctipn t6 tht:follonin5:
10.Static water Iml below lop of cminW, ({1,) DVt®clan of`hater Restlnrces.Infnrmadon Prracessing Unit,
lf,vtrrvr h vAd is c7n+k+, silt :+sr^+ 61617%fail Service Caster.Raleigh,,XC 276994617
1 L Borehole diameter:2.25 2-4b.Forn V !s ONLY: In addi€oo to sending ilia Gant to the address in
24akove.allo subtait a copy of this font t:itlfin 30 days of completion of well
12.Well construction method:DPT conmr ciion t�r the fandwing
(i.e.auger retail'.cable.dice txssh ctc:1 Dis'isiou ff f Water Resources,Under2mund Injecilon Control Program,
FOR WATER SUPPLY WELLS ONLY: 11636%fail Serviim Center,Raleigh.,NC 276"-I636
13a.Yield(fipm) Method of text:. 24c.For Water Supply&to cctiou«vests:
Also submit fit;copy of this form %vithiu 30 daysofcantpletioftof
13b.Disinfiectian nype:_. Amount: WCH Caasinu.ion to the eaftnty;health dcpatiMMA of the County Wkrc
coustmetcd.
Fanu G%1-I NanitCartlina EXla nient of En+irownem and Na wal Rewuies-Dievion of 1Vader Re5uuaS Revised Atgust'-MA
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