GW1-2022-06257_Well Construction - GW1_20220628

WELL CONSTRUCTION RECORD For lacrsrah4t_ ONLY;
'!Lis Conn ran be«scd far sine lc or u altipk wCils
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1.Welt Contractor Information:
sal q`4#1tR:' IfLS -77777 77777
Scott Hunt, Jr FRONT I to I Inicitit"ON,
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ft. fl.
4561-A
NC%Veileonfuctorcer(ificationwumber i�1[)VPE T 191jirsETFstil(Isi'OlTRICIM if " let{
FRONt. Ata(1ttEY8R TIIt4'[a'�IfSS NiAYEP(Al,
SAEDACCO Inc 0 (L ].0 f4 1" 1L SCE-40 PVC
Cgtwtxtrro :t6't111NFR 41NGOiti48IlYGT eriatc6ttfort
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FRONT for DMIETBQ. TUW&NFSS I MA ERMLL
2.Wish Construction Permit# RT it. en
Lfrrtrll ccplfrrnle irellpcnvi'a tie.Craunrs,SMT,t'arfrruM ll s in 4c.i
ft. !i ilr
3.Well Use(eht ck well use): s7:`Scat!sFN;;.
`Eater Supply We1L• FRONT I DrA'tiFTM srOTSM, I Ytil(7iN-5 _ NIATERM,
OftrRalltuml rllYin1ACiik9111rtblIC 10 ft. 20 ft. 1° in .010 SC$ 40 PVC
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C1Gs odsemml ttiaatitrgCootiug Supptyl OMidenrial Water Supply(Single! f4 i fr, to
IIXRo1,-f .._
OlodusitinUConuttercial Olkesidknttl Water Supply(shall d) FRoar MURAL 4 I HHPYACEMENT NIMOD&ANJOIT r
❑Irti"ttion it. I ft
Non-Water Supply Well: a. h
Mmonitgring C 1tecu xy
njeet n Well:
0Agotfcr Rccbargc C1Qm ndv a(cr Rcawdi,-rtiorr rv,;5►ttddlrt t EL PA'CArfir - icxftfe}
FRONT 101 NIATERtAt. N.A1mtat:t;'tttnR't MCTIM r+
Qrtquifr t Store and Rccotcty 13SAlinity Barrier 8 ft. 20 ft, Sand #2
❑ galfcrTeto 05tonnwatcr Dminap ft. iG
oExpctimcutal Ttxhnotol y ❑Sufisid=c GoMml
.;2isi'DTffClitiCs:lAGfsiitacttaddiuonaitrsteels`iC-i►ecc+ccan�`r -
13Geotitermal(ClastdLoup) Mrictr FRONT ucs�utfmovfwlor.banrrat�+:sblLrark t cerl
❑Gootltctmai Retuml t309W ex dttut(tier#3tftetnwks f� } ft See Geologist's log
fL fL a
4.DateWOO)Completed: 6/14/22 E1et�(1ID�TW-2 ft, I ft. ' =tY e�•
5a.Well Lucatinn: fL ft J U N � $ 2�2
Commercial Property R. t ft
Facility+` voct-Narm FacilitytDMOfapplicable) R
ems'! r3i�,
3400 N. Elm St., Lumberton, NC, 28358 A. ' p.
Physical Address City.and Zip ,.2 'REMA W,,..
Robeson Temp well for ground water sample.
Caunty pArroIdeloi ,ylionNo.(FIN.y
46.Latitude and t nngitude is or decimal degrees: r2.Caertifi oa:
(ir'ttuil rQW,oats laVloug is5uitic tt()
lL' C4' �Cag �unt 6/18/2022
5i;retasaofC�tigdRirSlCo . tor Dale
6.Is(area)the w°cU(s): oPenrmnent or ZTemporan, Hr aging this m..1 Prerebr serti6-rbrr flu trellis!P va(tsrre)curtsrrrt-W ire aa�'a•oma u`nte
rcaa l d u NCA' VIC MOO or 15A NCA,C 02C,(209 Well[ttreurraGr(nrt Srcrex frrats and*00
7.is this a repairto an eusuin»well: MVcs or MN(P s`.,rr ojti,it rfwa�rrllrrt Ltrn(a�t idff�t�tka'sfY1P tnaarcr.
Pf tlrf;sk rt rr)�Ir.,fiPl:xn tknwcrr arfdcrnsrfurrd:rr#lrtjotrrurritnr:a Fad cxpPtritr rdtr ruraarr gfnc� am or adtfltional w'eil details:
rrp�ir reseter�1 aerraLrLs srrrl�nr eta ells b,�ri;of tTds f°rnr. 23.Site d�
Yew Lnm�vuseile back of this page ro prodd€additional tali site details or(felt
S.Number of wells constructed- 1 eousttails. You ulay also aftactt additional pages if awessary-.
Fur wa l4fda jftfeerlteu or or�ua-sewer suppfp welds ONLY orith the sr meeforsrrarth r.cuff twos:�nadronefora. IT .
9.Totalnell depth,hetow land surface`. 20 00 24a. Far Alli Weilx: Subndl this form within 11,lints of compaction of well
For tat;alfiole ivells l ins a dtep;hr if tdffit'ra7ukya wlple=3021,R),gall 2 @ d(l ) consChiction t{D the fbumin;.
lth.Static water level Maw top-of casing: (fp,) b fi{+Wnn of Water Resources.Information Processing Unit.
If,tan'r let-el is afore cuolt.,rise^a" �160 Mail Service Center,Raleigh.YC 27699-1617
H.f3nrrhDtc diameter:2.25" 1m) 24b.Far fii Sffnn We11c ONLY: its addition to sending die foam to tlx:addim in
24a allow, as tr su ruit a copy of(iris fbmt within 30 days of completion of smell
12,Well construction method:DPT Constme-tion 1 the fotaowing:
di.:.augcr, '.cable.tfirct;pas►(c(c.} Division} f Water Resources,Underground Injection Control Pr'oarank,
FOR WATER SUPPLY WELD ONLY: 11636 Mali!Service Ceater.Ralelph,NC 276994636
13a,Yield(gpm) 5lcthod of(CM 2�For Watier Supply Injew"m Wells:
of(Also orin ividda 30 daysofcomplationof
submitsubmitqa..copy of f
13b.Disinfection Amannt: _ ._ . WC11 constru ion to tic count pa leolth deriment of(lie caum where
comsmictcd,
Form MY-r honh Catalina Wpanvw of Ea(tannxis otel V=PJ Rcsot e-Dnvisionof Water Rerourvs fteviscd AtQpuA-_'A 13
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