GW1-2022-07654_Well Construction - GW1_20220818

WELL CONSTRUC 110N RECORD � For Itttcrtol Use ONLY:
This form can be used for single or mnitipk%tells'
f.Well Ctmfractoranformation: �\
lA.-WA1ERZONES .
Rich Lemire FROM 'To I DFYCRIPTtOR
Well Cottriclot l`arty tt G•
tt. tt.
NC Well Contractor Certification Number i G E" E i`� 15:oUTFR CA tNG.((drotuftPft d nags UR LINER a" ikabk
6'ROR1 TO DIAiltETFR TRICKNESS MATE.RTAL.
SAEDACCO Inc 8 2022 0 ft. 5 ft. 12- 1.. SCE-40 PVC
AIIG
(.:amgiamyName N1?R'CASIIVG OR TUBING('iSbiberetat cI1JWddtsftp
Ursa FROM TO V AMeTER THICK\ESS MATERIAL
2.Well Construction Permit fi: ft"FifBii£7:1 �tuGtfl ft. TO
yt, _ _
last till aliplirable w-ell permiir si r.C iwmr v'..Skie. It.
3.Well Ilse(check:well use): 173C.REEN 777777
WatcrSupplyWell: FROM to PIAMFTrooL LOTSIM THIMMS 131ATPRIAL
OAgiiculttlral Omuoicipalli'tthlic. 5 G. 15 ft. 2^ in 010 SCH-40 PVC
DGeof cornal(Heattnp'Cooling Supply) pResidential Water Supph•(single) XR
f1• tt• in.
01ndustriatl'Conmicrc-ial OResidential Water Stlpjll)'(S141red) FROM GR O� TO AfATF,RIAL E11VfACFRIThT\1F TTIOD C ARIOIi\T
Dori ation 0 (1. 2 (1. PORTLAND POURED
Non•Water Supply Well:
h. 4.
eklonilorinG 0Rccovcty
injection Well:
0AquWr Recharge 064ouodwatcr Rcutcdlation 19.SAND/GRAVEL PACK lit ittiftlkitblij
FN-%I TO ,,*.IATF,Rt4t, "IPI.Af,37MEYT Nr:'I'11011
❑Aquifer Storage and Rccovcry ❑Salrnity Bonier 3 t1. 15 to. SAND #2
OAquifcrTest OStomnmaterDrimagc
QEylrnmcnmI 17cchnology ❑Stthsidcncc Control
30"I/R11,1.1NG<tsOG(attach"additional'ebetts if ecswiti
❑Ckothenual(Closed Loop) DTracet FROM I To DFSCRII'TtU1iiYlsr.NafHnccirAt'nirkn .^ 4rr.etea
DGeothenual(F{eatinklCooline Return) [3011ter(explain under#21 Remarks) 0 ft. 5 to. GRAY SILTY SAND
5 ft. 15 ft. REDISH SILTY SAND
4.Date Well(%)Completed: 7-28-22 Well iDNMW-10
ft. f4
5a.Well Llicatitm: ft. ft.
CIRCLE K #2723027 n. ft.
Faciln} h%wrNarix Facith ID9(if mpplwblc,)
2001 Skibo Rd., FAYETTEVILLE, NC, 28314
Plgsical Address.City,and Zip 2tsREMARKS`.,
7 777-
CXIMBERLAND Bentonite seal from 2-3'
(=onnN° Palvel Id-nairication'W"(PiN)
Sh.l htitudc and Longitude in degmcs/minutes/seconds or decimal degrevs: 22.Certil ication:
0twell field,91te IaL9on's is sirllltiertQ
N W 7/28/2022 6z a
...-�....s .....-� �.<..,,..v. .., ,.,:. ,.;,ram--_..�..,�, ._.ri<,=._.._
Sigrutur aif e'i _ddI Contactor Date
6.is(are)the svell(s): MPennanent or 07femporan
M signing this fdnry,1 hereby C'rrtitr film�rhr w-r/Its)t'vs f"rir)conkinwird lit wc,rd&nee
ifirlr 15A NCAC fi2,C,(i1W nr)S,t A'CAC 112C:t)20.9 Well CotrS7maim Stwu4tuds Rohl that it
7.Is this a repair tit an existing-well: E]Yes llr a I o reVy fi rhis rernnl hna'hrrn piorkled rn�tb.-rirll mtvier.
If ibis ie a lep ir,fill air loaikvr wrJl cortrrnirv7v+t firjorwuirtorr and r.c{tlani the none of dirt '
reltsir umdrrP2f rrrnariz srt7ir+n or ern for balk of shim forme. 23.Site dial;ram rtr additional well.details:
Y(no only Ilse live back;of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may alsoatlach additional pages if Imxes&ify
For me+hWe)'rr/errhm ai neat-miter sjfp;ni.wells 0jV1.1'with(he some romtrurtion,you can
.monfiruricfarm. SIJB jTTALiNCTLICTIONS
l I Total anduuiaee:well depth below 15 24a. for All Yells: Sttbntil this form within 30 days of completion of welt
(fit.)
fov,nultiptr wells list all(lrprk i dl,(terew terms pte•,;@249'tnul 20ltW) construction to(tic following:
lU.Static water level below trip of casing: a (ft.) Uivishtn of Water Resources,Information Pruccising Unit,
Ifavver level&above easing,use"+" 1617 Mail Service Center,Raleigh,!IC 27699-:1617
11.Borehole diameter.8.25° An. 2Jb.Ur itZjalj ;ONLY. lit addition to sending the form to tom addres in
24a above. also submit a copy, of this fon'n within 3(t days of completion of%vell
12.'*Yell construction method:AUGERS constmctiou to the following:
(i.e.miter.rotary.cable.dimri push ctc.)
Dfvislpn of Water Rcsourc'es Undet'p•onnd Injection Contln►Pmtr'am,
FOR WATER SUPPLY WELLS ONLY: 1636 Wail Service Center.Raleigh,INC 276"-1636
13a.Yield(Rpm) Mc.0ind of test: 24c For Water Supply bi injection Wells:
Also suhmil one cop), of th►s form %ifhin 30 days of completion of
13b.DitinfetKiun type „ _ Amount: well construction to the courtly lit department of the clnmh,.wherc
constructed,
Fonn old'-I North Carolina D.WnniLnt of En imiuixttt aitd Naniral Resources-Division of N'alci Resources Reused August 2(113